Injuries related to lawn mowers affect young children in rural areas most severely

October 25, 2019

NEW ORLEANS - Each year, more than 9,000 children in the United States are treated in emergency departments for lawn mower-related injuries. New research being presented at the American Academy of Pediatrics (AAP) 2019 National Conference & Exhibition in New Orleans found that these injuries are more frequent and severe in rural areas, affecting younger children than in urban regions.

The research abstract, "Urban versus Rural Lawnmower Injuries in Children: A National 13-Year Study," will be presented on Sunday, Oct. 27, at the Hilton New Orleans Riverside.

"Despite efforts within the health community to highlight how easily children can be injured by lawn mowers, we still see thousands of children in emergency departments each year for lawn-mower-related injuries," said the abstract's presenting author, Ronit Shah, a medical student at the University of Toledo. "Our research shows young children in rural areas are more likely to be severely hurt."

The research team analyzed data from the Pediatric Health Information System for patients ages 1-18 years old from 2005 to 2017 who came to any of the 49 participating hospitals for a lawn mower injury.

The data showed that rural settings had significantly higher incidence of injuries, a younger median age of the patient, and higher rates of amputations, surgical complications, and infections.

Among the findings:

Rural areas had a nearly five-fold higher rate of in injuries, (7.26 injuries per 100,000 cases), compared with urban areas (1.47 injuries per 100,000 cases).

By geographic region, the highest rate of injuries was in the South (2.70 injuries per 100,000 cases), followed by the Midwest (2.16 injuries per 100,000 cases) and the Northeast (1.34 injuries per 100,000 cases). The Western United States had the lowest injury rate, 0.56 injuries per 100,000 cases.

Lawnmower injuries in rural areas required longer hospital stays, had higher rates of surgical complications (5.5% vs 2.6%), and occurred in younger patients.

Rural areas had an overall amputation rate of 15.5% compared to 9.6% in urban areas, with rural patients being 1.7 times more likely to undergo an amputation.

Children younger than 10 years old in rural areas had a higher rate of more severe injuries, had longer hospital stays, and incurred greater healthcare costs than children older than 10.

The American Academy of Orthopaedic Surgeons established updated lawnmower safety guidelines in 2014, and the Pediatric Orthopaedic Society of North America is collaborating with the AAP regarding lawnmower injury prevention awareness.

Shah said further public education efforts are needed, focused on geographic disparities pediatric lawnmower injuries.

"Future injury prevention and safety efforts should be specifically targeted for rural communities, especially in the Southern and Midwestern United States," Shah said.

Dr. Shah will present the research abstract, available below, on Sunday, Oct. 27, at 4:45 p.m. in the Jefferson Ballroom at the Hilton New Orleans Riverside. To request an interview with the abstract author, journalists may contact AAP media relations, e-mail the author at or Children's Hospital of Philadelphia public information officer Natalie Solimeo at

More information about lawn mower safety is available from the AAP.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at

Abstract Title: Urban versus Rural Lawnmower Injuries in Children: A National 13-Year Study

Ronit Shah, presenting author

Purpose: Although the AAOS established updated lawnmower safety guidelines in 2014 and POSNA is currently collaborating with the AAP regarding lawnmower injury prevention awareness, a significant number of injuries continue to occur. We sought to elaborate upon the epidemiology of lawnmower injuries in the pediatric age group as well as compare urban vs. rural injuries. Methods: The PHIS (Pediatric Health Information System) database was queried for patients of 1-18 years of age from 2005-2017 who presented to any of the 49 participating hospitals for a lawnmower injury. The patient cohort was identified using a search for lawnmower injury codes E920 and W28. Data was grouped according to urban and rural status; results were computed using bivariate tests as well as mixed effects multinomial regression. Results: There were a total of 1,302 lawnmower injuries identified (mean age 7.7 ± 5.1 years, range 1-18 years; 78.9% males). Incidence rates by region, adjusted for regional case volume, were 2.16 injuries per 100,000 cases in the South, 2.70 injuries per 100,000 cases in the Midwest, 1.34 injuries per 100,000 cases in the Northeast, and 0.56 injuries per 100,000 cases in the Western United States (Figure 1). After stratifying and adjusting for total case volume by locale (urban/rural), it was found that urban areas had an incidence rate of 1.47 injuries per 100,000 cases, while rural areas had a rate of 7.26 injuries per 100,000 cases. The injuries grouped by body region were: lower extremities (64.7%), upper extremities (22.0%), head/neck (2.2%), face (1.5%), and trunk (2.6%). Amputations represented 30.9%, fractures/dislocations/bony avulsions represented 24.2%, and open wounds/punctures/lacerations represented 28.8% of all injuries. Further, 7.6% needed no active intervention, 7.5% underwent open reduction, 1.6% underwent closed reduction, 19.8% underwent debridement, 11.2% underwent amputation, 11.3% underwent skin/tendon/muscle graft/repair, and 6.1% had other treatments. Rural areas had higher rates of infection and higher percentages of patients requiring inpatient stay. Surgical complication rate in rural areas was 5.5% as compared to 2.6% in urban areas (Table 1). Based on urban/rural status, a significant difference was observed with age group, length of stay, income, surgical complication, and presence of infection at the bi-variate level with (p<0.05). Rural areas had an overall amputation rate of 15.5% compared to 9.6% in urban areas, with rural patients being 1.7 times more likely to undergo an amputation (p<0.05). Conclusion: The findings of this study show that significant variation in pediatric lawnmower injuries exists between urban and rural settings, with rural settings having a higher incidence of injuries, a younger median age, and higher rates of amputations, surgical complications, and infections. Significance: Numerous geographic/locale disparities exist in pediatric lawnmower injuries which reveal the need for improved safety awareness, especially in at-risk rural populations.

AAP media contacts: Lisa Black, 630-626-6084,

Laura Alessio, 630-626-6276,

American Academy of Pediatrics

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