Presenter Profile
Maneesha Agarwal, MD
Presentations
Differences in Consumer Products Resulting in Injuries in Children with Autism Spectrum Disorder and Children without Autism Spectrum Disorder
Maneesha Agarwal, MD
Elena Petkovska, MD
Dylan P. Hurley, MPH, MAB, HEC-C
Yin Zhang, MS
Wendy J. Pomerantz, MD, MS
Injuries are the leading cause of morbidity and mortality in children. A child presents to a U.S. emergency department for a consumer product–related injury (PRI) approximately every six seconds. Evidence shows that children with autism spectrum disorder (ASD) experience higher rates of injury-related healthcare visits compared to neurotypical peers. Despite this increased risk, differences in PRIs between children with ASD and those without documented ASD remain poorly understood. The primary objective of this study was to compare PRIs in children with ASD to peers without documented ASD.
This retrospective cohort study used data from the US Consumer Product Safety Commission National Electronic Injury Surveillance System (NEISS). Data were extracted for patients aged 0–21 years from 2005-2024. Variables included demographics, injured body part, diagnosis, disposition, product involved, and narrative text. Cases were classified as ASD if the narrative included terms such as autism, autistic, autism spectrum disorder, ASD, Asperger, pervasive developmental disorder, or PDD. Weighted injury rates per 100,000 children were calculated using ASD prevalence estimates from the CDC and national pediatric population data. Descriptive statistics characterized the populations. Using NEISS, total PRIs with 95% confidence intervals and injury rates were estimated for children with and without documented ASD, including product-specific differences. Comparative analyses were performed.
Over the 20-year study period, 2,174 PRIs were identified in children with ASD, corresponding to an estimated 60, 260 injuries (95% CI 42,908-77,613), compared to 3,597,027 cases in children without documented ASD, representing an estimated 109,850,428 injuries (95% CI 87,019,914-132,680,941) (Table 1). Children with ASD were more likely to be male and injured at home. Children without documented ASD were more likely to be treated and released and injured at a place of recreation or sports. Injury mechanisms differed, with more foreign body related injuries and poisonings in children with ASD. During the study period, PRI rates increased in children with ASD from 23 to 246 cases per 100,000 children with ASD (slope = 7.4, 95% CI 5.7-9.1) while decreasing in children without documented ASD from 192,303 to 165,606 cases per 100,000 children (slope = -2844.4, 95% CI -3777.6 - -1911.1). The most commonly implicated products also differed (Table 2). Elements of the built environment were more frequently associated with injuries in children with ASD whereas sports activities were more common among children without documented ASD.
Children with ASD experience distinct patterns of consumer product-related injuries compared to peers without documented ASD. These findings highlight the need for targeted injury prevention strategies and messaging for children with ASD and their caregivers.
1. Describe differences in the epidemiology of consumer product–related injuries between children with ASD and children without documented ASD.
2. Identify differences in injury mechanisms, injury locations, and consumer products associated with injuries among children with ASD compared with their peers.
3. Consider implications of these differences for developing targeted injury prevention strategies for children with ASD and their caregivers.
Characteristics of Self-Injury–Related Product Injuries in Children with Autism Spectrum Disorder and Comparison With Non–Self-Injury Cases
Maneesha Agarwal, MD
Elena Petkovska, MD
Dylan P. Hurley, MPH, MAB, HEC-C
Yin Zhang, MS
Wendy J. Pomerantz, MD, MS
Children with autism spectrum disorder (ASD) experience higher rates of injury-related healthcare encounters than their neurotypical peers. Self-injurious behavior (SIB), defined as behaviors directed toward oneself that may result in tissue damage, is common among children with ASD and may contribute to distinct injury patterns. However, little is known about how product-related injuries (PRIs) resulting from SIB differs from other PRIs among children with ASD. This study aimed to characterize SIB–related PRIs among children with ASD and compare them with non–self-injury PRIs.
This retrospective cohort study utilized data from the U.S. Consumer Product Safety Commission National Electronic Injury Surveillance System (NEISS) from 2005–2024. Children aged 0–21 years with documented ASD were identified through narrative review. Cases were categorized as self-injury or non–self-injury based on injury narratives and coding. Demographic characteristics, injury location, diagnosis, body part injured, and disposition were analyzed. National estimates and weighted rates per 100,000 children with ASD were calculated.
Among 2,174 PRIs identified in children with ASD, 513 cases (23.6%) were related to SIB, corresponding to an estimated 14,731 injuries (95% CI: 10,582–18,880), while 1,661 represented an estimated 45,529 non–self-injury injuries (95% CI: 32,400–58,659). Children with SIB–related injuries were older than those with non–self-injury PRIs (mean age 12.7 vs 9.0 years), with nearly half occurring in adolescents aged 15–21 years (49.0% vs 19.0%). Males accounted for the majority of injuries in both groups. Compared with non–self-injury cases, injuries from SIB occurred more frequently at school (19.6% vs 12.6%) and less frequently at home (42.4% vs 54.7%). Injury characteristics also differed. SIB-related cases were more commonly associated with internal organ injuries (34.4% vs 11.6%), contusions or hematomas (25.9% vs 10.8%), and lacerations or punctures (28.3% vs 19.2%). Head and face injuries predominated among SIB-related PRIs (65.2% vs 38.0%); these cases also demonstrated slightly higher rates of hospitalization (6.2% vs 4.7%) or transfer (5.9% vs 2.8%).
SIB–related PRIs among children with ASD demonstrate distinct demographic and injury patterns compared with non–self-injury PRIs. These injuries were more common among older children and adolescents and more frequently involved head and face injuries and potentially more severe injury types. These findings may help inform targeted injury prevention strategies and environmental modifications for children with ASD who engage in SIB.
1. Characterize self-injury–related product injury patterns among children and adolescents with ASD.
2. Compare demographic and clinical injury features between self-injury–related and non–self-injury product-related injuries in children with ASD.
3. Consider how patterns of self-injury–related product injuries can inform targeted prevention strategies and environmental modifications for children with ASD.
Product Related Injuries in Children & Adolescents with Autism Spectrum Disorder
Dylan P. Hurley, MPH, MAB, HEC-C
Elena Petkovska, MD
Wendy Pomerantz, MD, MS
Yin Zhang, MS
Maneesha Agarwal, MD
Approximately 40% of all nonfatal injuries are associated with consumer products. Autism spectrum disorder (ASD) affects 1 in 36 children, with prevalence continuing to rise. Children with ASD are at an increased risk of injury, but little is known about consumer product injuries in these children. The objective of this study is to better characterize consumer product–related injuries (PRIs) in children with ASD.
We extracted data from the US Consumer Product Safety Commission National Electronic Injury Surveillance System for all patients aged 0–21 years from 2005-2024. Case narratives were reviewed to identify whether the injured patient had documented ASD. Cases were classified as ASD if the narrative specifically mentioned: autism, autistic, autism spectrum disorder, ASD, Asperger, pervasive developmental disorder, PDD. Weighted rate per 100,000 children with ASD was calculated using prevalence data from the CDC and pediatric population. National estimates of injuries with 95% confidence intervals were calculated for overall injuries, demographics, and injury characteristics. Descriptive statistics were used to characterize the population. Top product categories implicated in PRIs in children with ASD as well as changes in PRIs in children with ASD over time were determined.
During the 20-year study period, 2,174 PRIs were identified in children with ASD, representing an estimated 60, 260 injuries nationwide (95% CI 42,908-77,613) (Table 1). The median age was 10.1 years (SD 0.27); more than one-third of children were aged 5-9 years, and approximately 80% were male. Most injuries occurred in the home, and 88% of children were treated and released. Laceration/puncture (20.5%) was the most common diagnosis, followed by internal organ injury (16.7%), and avulsion/crush/contusion/hematoma (13.2%) The most commonly injured body regions were head and face (44.8%), upper extremity (18.6%), and lower extremity 10.8%. During the study period, there was a statistically significant increase in weighted PRI rates in children with ASD from 23 to 246 cases per 100,000 children with ASD (slope = 7.4, 95% CI 5.7-9.1, p< 0.0001). The most commonly implicated products included bathroom stall walls (12.0%), floors (6.1%), and storm windows (6.0%) (Table 2).
Structural products such as walls, floors, and windows are the most common consumer products implicated in injury in the ASD population. These injuries often occurred in the home highlighting a need to explore prevention within the built environment for this vulnerable population.
1. Describe the epidemiology and injury characteristics of consumer product–related injuries among children and adolescents with autism spectrum disorder (ASD).
2. Identify the consumer products and environmental features most frequently implicated in injuries among children and adolescents with ASD.
3. Consider opportunities for injury prevention within the home and built environment based on patterns of product-related injuries in children and adolescents with ASD.