Nonfatal upper extremity firework injuries in pediatric U.S. emergency department patients (ages <18) from 2015–2024, using NEISS data to describe injury rates, demographics, anatomical patterns, and age-related vulnerability.
434 NEISS cases representing a national estimate of 16,872 injuries were identified. Thermal burns accounted for 74.0% of diagnoses; hands (48.8%) and fingers (32.7%) were most often injured. Adolescent males (ages 12–17, 77.9% male) were most affected. Amputations made up 9.0% of cases. Most patients (78.8%) were treated and released; 13.8% required hospitalization.
Retrospective descriptive design limits causal inference. NEISS captures only ED-treated injuries, likely undercounting cases managed outside the ED or not seeking care. Long-term functional outcomes and follow-up data are not available.
Clinicians should anticipate thermal burns and traumatic amputations to the hand and fingers—especially in adolescent males—around holiday periods, and counsel families on firework hazards during routine and urgent care visits. Strengthened consumer-level regulations and targeted prevention campaigns are supported by these data.
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