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Figure.
Number of Emergency Department Visits Among Children Aged 3 to 4 Years for Ocular Chemical Burns by Mechanism of Injury, 2010-2015
Number of Emergency Department Visits Among Children Aged 3 to 4 Years for Ocular Chemical Burns by Mechanism of Injury, 2010-2015
Table.  
Characteristics of Preschool-Aged Children Presenting to the Emergency Department With Detergent Pod–Related Ocular Burns, 2010-2015 (n = 1201)
Characteristics of Preschool-Aged Children Presenting to the Emergency Department With Detergent Pod–Related Ocular Burns, 2010-2015 (n = 1201)
1.
Hall  AH. Epidemiology of ocular chemical burn injuries. In: Schrage  N, Burgher  F, Blomet  J,  et al, eds.  Chemical Ocular Burns: New Understanding and Treatments. Heidelberg, Germany: Springer Berlin Heidelberg; 2011:9-15.
2.
Haring  RS, Sheffield  ID, Channa  R, Canner  JK, Schneider  EB.  Epidemiologic trends of chemical ocular burns in the United States.  JAMA Ophthalmol. 2016;134(10):1119-1124.PubMedGoogle ScholarCrossref
3.
Karel  LI, Handzel  MC, Rosini  JM.  Laundry detergent pod ingestion in 2 pediatric patients.  J Emerg Nurs. 2015;41(1):80-82.PubMedGoogle ScholarCrossref
4.
US Consumer Product Safety Commission. National Electronic Injury Surveillance System. https://www.cpsc.gov/Research--Statistics/NEISS-Injury-Data. Accessed October 3, 2016.
5.
Florence  C, Haegerich  T, Simon  T, Zhou  C, Luo  F.  Estimated lifetime medical and work-loss costs of emergency department-treated nonfatal injuries: United States, 2013.  MMWR Morb Mortal Wkly Rep. 2015;64(38):1078-1082.PubMedGoogle ScholarCrossref
6.
Basso  F, Bouillé  J, Le Goff  K, Robert-Demontrond  P, Oullier  O.  Assessing the role of shape and label in the misleading packaging of food imitating products: from empirical evidence to policy recommendation.  Front Psychol. 2016;7:450.PubMedGoogle ScholarCrossref
Research Letter
March 2017

Detergent Pod–Related Eye Injuries Among Preschool-Aged Children

Author Affiliations
  • 1Johns Hopkins Center for Injury Research and Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  • 2Institute for Public Communication, University of Lugano, Lugano, Switzerland
  • 3Carver College of Medicine, University of Iowa, Iowa City
 

Copyright 2017 American Medical Association. All Rights Reserved.

JAMA Ophthalmol. 2017;135(3):283-284. doi:10.1001/jamaophthalmol.2016.5694

Chemical ocular burns are a significant cause of morbidity and vision loss in the United States and can lead to lifelong sequelae.1 Data suggest young children are at especially high risk of experiencing these injuries.2

The widespread adoption of laundry detergent pods, which are dissolvable pouches containing enough laundry detergent for a single use, has led to an increase in associated injuries among children. Reports of pod-related injuries, including poisoning, choking, and burns, have suggested that this pattern may be in part due to the products’ colorful packaging and candy-like appearance.3

In the context of the high incidence of chemical ocular burns among small children, we sought to characterize the burden of and circumstances surrounding chemical ocular burns due to laundry detergent pods.

Methods

The National Electronic Injury Surveillance System (NEISS), run by the US Consumer Product Safety Commission, is a validated probability sample of product-related injuries and can be scaled to the US population to provide national estimates of consumer product–related injuries presenting to US emergency departments.4 The NEISS includes patient-level and visit-level variables as well as a narrative summary of the injury event. The NEISS is a publicly available and deidentified data set and is exempt from institutional review board approval.

We queried the NEISS from January 1, 2010, to December 31, 2015, for eye injuries resulting in chemical burn or conjunctivitis among children aged 3 to 4 years (ie, preschool-aged children). We chose children aged 3 years as a cutoff for being generally strong enough to damage a detergent pod, and the NEISS only reports poisonings for children 4 years and younger.4 We searched the narrative summaries for references to laundry detergent pods and used standard descriptive statistical methods to compare differences by year, sex, race/ethnicity, setting, and discharge disposition. We also reviewed the circumstances leading to the injuries.

Results

Between January 1, 2010, and December 31, 2015, 1201 laundry detergent pod–related ocular burns occurred among children aged 3 to 4 years (Table). The number of chemical burns associated with laundry detergent pods increased from 12 instances in 2012 to 480 in 2015; the proportion of all chemical ocular injuries associated with these devices increased from 0.8% (95% CI, 0.2-3.2) of burns in 2012 to 26% (95% CI, 12.7-45.8) in 2015 (Figure).

Males (54.4%; 95% CI, 27.1-79.2) and females (45.6%; 95% CI, 20.8-72.9) presented with pod-related ocular burns in approximately equal proportions, and 1020 injuries (84.9%) occurred at home. All patients were treated and released from the emergency department. Patients were predominantly white (46.3%) and non-Hispanic (88.7%). These injuries most often occurred when children were handling the pods and the contents squirted into one or both of their eyes or when the pod contents leaked onto their hands and a burn resulted from subsequent hand-eye contact.

Discussion

Between 2012 and 2015, the proportion of injuries associated with these devices increased 32-fold, and in our study, pod-related injuries were associated with more than one-quarter of chemical ocular burns among children in this age group.

The NEISS does not allow for longitudinal follow-up of patients, and information on long-term outcomes is unavailable. Similarly, the NEISS only includes data on patients presenting to emergency departments, and visits to community physicians and urgent care facilities are not included. While the NEISS is not universal in scope, it is a validated sample of injuries commonly used to generate national estimates.5

Conclusions

These data suggest that the role of laundry detergent pods in eye injuries among preschool-aged children is growing. As with most injuries in this age group, these burns occurred almost exclusively in the home. In addition to proper storage and use of these devices, prevention strategies might include redesigning packaging to reduce the attractiveness of these products to young children and improving their strength and durability.6

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Article Information

Corresponding Author: R. Sterling Haring, DO, MPH, Johns Hopkins Center for Injury Research and Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Hampton House, Room 545, Baltimore, MD 21205 (sterling.haring@jhmi.edu).

Published Online: February 2, 2017. doi:10.1001/jamaophthalmol.2016.5694

Author Contributions: Dr Haring had full access to all the data in the study and takes full responsibility for the integrity of the data and accuracy of the data analysis.

Concept and design: Haring, Frattaroli.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Haring, Frattaroli.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Haring, Sheffield.

Administrative, technical, or material support: Sheffield.

Supervision: Frattaroli.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

References
1.
Hall  AH. Epidemiology of ocular chemical burn injuries. In: Schrage  N, Burgher  F, Blomet  J,  et al, eds.  Chemical Ocular Burns: New Understanding and Treatments. Heidelberg, Germany: Springer Berlin Heidelberg; 2011:9-15.
2.
Haring  RS, Sheffield  ID, Channa  R, Canner  JK, Schneider  EB.  Epidemiologic trends of chemical ocular burns in the United States.  JAMA Ophthalmol. 2016;134(10):1119-1124.PubMedGoogle ScholarCrossref
3.
Karel  LI, Handzel  MC, Rosini  JM.  Laundry detergent pod ingestion in 2 pediatric patients.  J Emerg Nurs. 2015;41(1):80-82.PubMedGoogle ScholarCrossref
4.
US Consumer Product Safety Commission. National Electronic Injury Surveillance System. https://www.cpsc.gov/Research--Statistics/NEISS-Injury-Data. Accessed October 3, 2016.
5.
Florence  C, Haegerich  T, Simon  T, Zhou  C, Luo  F.  Estimated lifetime medical and work-loss costs of emergency department-treated nonfatal injuries: United States, 2013.  MMWR Morb Mortal Wkly Rep. 2015;64(38):1078-1082.PubMedGoogle ScholarCrossref
6.
Basso  F, Bouillé  J, Le Goff  K, Robert-Demontrond  P, Oullier  O.  Assessing the role of shape and label in the misleading packaging of food imitating products: from empirical evidence to policy recommendation.  Front Psychol. 2016;7:450.PubMedGoogle ScholarCrossref
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