US Pediatric Injuries Involving Amusement Rides, 1990-2010

Abstract

This study investigates pediatric injuries involving amusement rides treated in US emergency departments by retrospectively analyzing data from the National Electronic Injury Surveillance System. From 1990 to 2010, an estimated 92 885 children ≤17 years sought treatment in US hospital emergency departments for injuries involving amusement rides, yielding an annual average of 4423 injuries. The average annual injury rate was 6.24 injuries per 100 000 US children, and the mean patient age was 8.73 years. The head and neck was the most commonly injured body region (28.0%), and the most common type of injury was a soft tissue injury (29.4%). Falling in, on, off, or against the ride was the most frequent mechanism of injury (31.7%). Only 1.5% of injuries resulted in hospitalization. An improved national system for monitoring injuries involving amusement rides is needed. There are opportunities to improve the safety of amusement rides for children, especially to prevent injuries from falls.

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Clinical Pediatrics
52(5) 433 –440
© The Author(s) 2013
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DOI: 10.1177/0009922813476341
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Introduction
Although some case studies and literature reviews
describe injuries or fatalities associated with amuse-
ment rides,1-3 little is known about amusement ride–
related injuries from an epidemiological perspective.
The US Consumer Product Safety Commission
(CPSC) has published several reports detailing nonoc-
cupational amusement ride–related injuries using data
from the National Electronic Injury Surveillance
System (NEISS).4-13 Although the CPSC only has juris-
diction over mobile (eg, traveling carnivals or fairs),
and not fixed-site (eg, amusement parks) amusement
rides, the NEISS includes injury data for both mobility
types.12 In 2004, the CPSC estimated 2500 mobile and
3400 fixed-site ride–related injuries, for a total of 5900
ride-related injuries.12 Additionally, a report based on
an International Association of Amusement Parks and
Attractions (IAAPA) survey estimates that there were
1299 fixed-site ride–related injuries in 2010.14
Only one medical study provides national estimates
for injuries involving amusement rides.15 Using 2002-
2006 NEISS data, this study estimated that 46 000 children
≤18 years presented to US emergency departments
(EDs) for amusement ride–related injuries, amounting
to 9200 annual injuries. Males and females had similar
476341CPJXXX10.1177/00099228134763
41Clinical Pediatrics XX(X)Thompson et al
1Center for Injury Research and policy, The Research Institute at
Nationwide Children’s Hospital, Columbus, OH, USA
2The Ohio State University College of Medicine, Columbus, OH, USA
3Child Injury Prevention Alliance, Columbus, OH, USA
Corresponding Author:
Gary A. Smith, Center for Injury Research and Policy,
The Research Institute at Nationwide Children’s Hospital,
700 Children’s Drive, Columbus, OH 43205, USA.
Email: gary.smith@nationwidechildrens.org
US Pediatric Injuries Involving
Amusement Rides, 1990-2010
Meghan C. Thompson, BA1, Thiphalak Chounthirath, MS1,
Huiyun Xiang, MD, PhD, MPH1, 2, and Gary A. Smith, MD, DrPH1, 2, 3
Abstract
This study investigates pediatric injuries involving amusement rides treated in US emergency departments by
retrospectively analyzing data from the National Electronic Injury Surveillance System. From 1990 to 2010, an
estimated 92 885 children ≤17 years sought treatment in US hospital emergency departments for injuries involving
amusement rides, yielding an annual average of 4423 injuries. The average annual injury rate was 6.24 injuries per
100 000 US children, and the mean patient age was 8.73 years. The head and neck was the most commonly injured
body region (28.0%), and the most common type of injury was a soft tissue injury (29.4%). Falling in, on, off, or against
the ride was the most frequent mechanism of injury (31.7%). Only 1.5% of injuries resulted in hospitalization. An
improved national system for monitoring injuries involving amusement rides is needed. There are opportunities to
improve the safety of amusement rides for children, especially to prevent injuries from falls.
Keywords
amusement rides, children, pediatric, injury, trauma, emergency department
Abbreviations:
ASTM, American Society for Testing and Materials; CI, confidence interval; CPSC, US Consumer Product Safety
Commission; ED, emergency department; IAAPA, International Association of Amusement Parks and Attractions;
NEISS, National Electronic Injury Surveillance System; RR, relative risk; US, United States
Article
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434 Clinical Pediatrics 52(5)
injury frequencies, the mean age was 8.5 years, and
musculoskeletal injuries comprised 46% of injuries.15
However, no national study has described the type of
ride involved (eg, roller coaster), the mobility of the
ride, or the mechanism of injury.
This study is the first national study to calculate pop-
ulation injury rates, define and describe the type of ride
involved, and investigate mechanisms for pediatric
amusement ride–related injuries.
Methods
Data
The NEISS is a nationally representative, stratified
probability sample that collects data on patients with
injuries treated in approximately 100 hospital EDs in
the United States and its territories.16 The CPSC man-
ages the NEISS and has collected product-related injury
data since 1971.16 Data from ED records are entered
into the NEISS database daily at participating hospitals.
Reported data include a product code, patient demo-
graphic characteristics, diagnosis, body region injured,
ED disposition, location where the injury occurred, and
a brief narrative describing the injury episode.16
Sample Determination
Data were obtained from the CPSC for cases containing
NEISS product code 1293 (“amusement attractions—
including rides”) for children ≤17 years for 1990-
2010.17,18 Manual review of these 5626 cases yielded
2617 cases meeting the study inclusion criteria.
Cases were included if the narrative stated that the
patient rode a ride or rides or the injury occurred when
the patient fell against, was waiting in line for, or was
struck by a ride. Among included rides were roller
coasters, bumper cars, merry-go-rounds, log flumes,
alpine slides, mechanical bulls, coin-operated rides,
and mini-train rides. Previous research has described
the “passive” nature of rides,15 and most included rides
are “passive” activities, with the exceptions of bumper
cars and alpine slides because of the relatively high fre-
quency of injuries associated with these types of rides
in the data set. Cases were excluded if the narrative did
not specify ride involvement (eg, the person fell at an
amusement park, but no ride was mentioned) or did not
state that the patient had ridden a ride. Injuries related
to “attractions,” “games,” or “toys” were also excluded.
Inflatable amusements were excluded, along with slides
(except alpine slides), go-carts, bungee-related rides,
climbing equipment, ball pits, dunking booths, water-
related rides (except log flumes), and laser tag-related
injuries. In addition, cases involving seizures, heat
exhaustion, and dehydration were excluded. Inclusion
of cases that did not fit within these decision rules was
decided on a case-by-case basis.
Additionally, a hospital near an amusement park with
many fixed-site rides (which accounted for approxi-
mately 20% of total ride-related injuries from 1997-
2001) left NEISS in late 2000.9 This study excluded
cases from this hospital, and remaining cases were
reweighted accordingly, to facilitate consistency of esti-
mates over the study period.
Variables
NEISS variables. Age was grouped as (a) 0 to 5, (b) 6
to 12, and (c) 13 to 17 years. Injured body region cate-
gories were (a) upper extremity (NEISS categories of
shoulder, upper arm, lower arm, wrist, hand, and fin-
ger); (b) lower extremity (upper leg, knee, lower leg,
ankle, foot, and toe); (c) head and neck; (d) face (eye-
ball, mouth, ear, and face); (e) trunk (upper trunk, lower
trunk, and pubic region); and (f) other site (25% to 50%
of body, all of body, and internal). Type of injury categories
were (a) soft tissue injuries (contusions/abrasions and
hematomas), (b) strains and sprains, (c) lacerations (lac-
erations and punctures), (d) fractures, (e) concussions or
closed head injuries (concussions and internal organ
injuries to the head region), and (f) other injuries
(ingested foreign object, aspirated foreign object, burn,
amputation, crush injury, dislocation, foreign body, dental
injury, anoxia, hemorrhage, electric shock, poisoning,
avulsion, dermatitis/conjunctivitis, internal organ injuries
to regions other than the head, and other). Narratives or
diagnoses specifying a “not stated” diagnosis were treated
as missing injury types.
Emergency department disposition categories were
(a) treated and released or examined and released with-
out treatment; (b) hospitalized (treated and transferred to
another hospital, treated and admitted for hospitalization
within the same facility, or held for <24 hours for obser-
vation); and (c) left against medical advice. Location
where injury occurred was grouped as (a) places of
sports or recreation, (b) other public property, and
(c) other (home, farm, street/highway, manufactured/
mobile home, and school). Places of recreation or sports
include amusement parks and parks.17 Public properties
relevant to this study include malls, stores, restaurants,
and arcades.17
Variables created from case narratives. Categories for
type of ride included (a) roller coaster, (b) bumper car,
(c) merry-go-round or carousel, and (d) other or
unknown ride type. When the narrative mentioned a
specific ride name, Internet searches determined the
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Thompson et al 435
ride type when possible. A variable modeled after the
CPSC’s ride classification methodology was created to
indicate whether the ride was a (a) fixed-site ride; (b) mobile
ride; (c) ride at a mall, store, restaurant or arcade; or
had an (d) uncertain or unknown ride status.12 For
fixed-site rides, the CPSC’s criteria that “the case nar-
rative stated the name of an amusement park or that the
incident occurred at a park” was used.12 In this study,
roller coasters, log flumes, and alpine slides were also
assumed to be fixed-site unless stated otherwise. The
CPSC’s definition that the injury “occurred at a carni-
val, fair, or festival” was used for mobile rides.12 An
additional category of store, mall, restaurant, or arcade
rides (including coin-operated rides) was created,
which is sometimes abbreviated as “mall rides” in this
study. The CPSC classifies coin-operated rides as “not
a ride” in its estimates.12
Primary mechanism of injury was categorized as fol-
lows: the patient (a) fell in, on, off, or against the ride;
(b) hit a body part on the ride or hit something in the
surrounding environment while riding; (c) was injured
getting on or off of the ride; (d) caught part of his or her
body or clothing in the ride, was caught and dragged by
the ride, or smashed a body part between parts of the
ride; (e) was struck by part of a moving or stationary
ride; and (f) other or unknown mechanism. Injury
mechanism categories were formed after review of
NEISS narratives, but patterns identified by the CPSC12
and saferparks.org19 were useful in initially identifying
mechanisms. Mechanisms involving combinations of
these categories were determined according to rules:
getting caught superseded all other mechanisms, get-
ting on and off superseded falls and hitting a body part
on the ride, and falls superseded hitting part of one’s
body on the ride. Another variable was created to indi-
cate whether the narrative cited an important ride
malfunction.
Data Analysis
Data analyses used IBM SPSS 19.0 (SPSS, An IBM
Company Inc, Armonk, NY), EpiInfo 6 (USD, Stone
Mountain, GA), SAS 9.2 (SAS Institute, Cary, NC),
and SUDAAN 10.0 (Research Triangle Institute,
Research Triangle Park, NC). National estimates were
based on CPSC sample weights that account for sam-
pling changes.16 For this study, the CPSC excluded the
hospital that left the NEISS in 2000 from the sample
weight calculations. US Census Bureau July 1 popula-
tion estimates were used to compute annual national
injury rates per 100 000 US children ≤17 years.20,21
Relative risk (RR) and χ2 analyses tested for associa-
tions. A significance level of α = .05 was used. All
results are based on weighted data and are accompanied
by 95% confidence intervals (95% CIs). To avoid insta-
bilities from small samples, subgroups with <20 actual
cases were excluded from analyses. This study received
institutional review board approval at The Research
Institute at Nationwide Children’s Hospital.
Results
National Estimates and Injury Rates
From 1990 to 2010, an estimated 92 885 (95% CI = 79
379-106 399) children ≤17 years old sought treatment
in hospital EDs for injuries involving amusement rides,
for an annual average of 4423 (95% CI = 3780-5067)
injuries. The average age of an injured child was 8.72
years (95% CI = 8.45-9.01), and more females (55.5%)
were injured than males (44.5%, Table 1, Figure 1).
Injury frequency varied by season, with 70.1% of inju-
ries occurring from May to September (Figure 2).
The injury rate per 100 000 children ≤17 years for
injuries involving amusement rides ranged from 4.41
(95% CI = 2.71-6.11) in 2003 to 8.79 (95% CI = 6.08-
11.50) in 1991, for an average rate of 6.24 injuries (95%
CI = 5.35-7.13) per 100 000 from 1990 to 2010. Overall,
the average injury rate per 100 000 children for females
(7.09, 1990-2010, 95% CI = 6.00-8.18) was greater than
that of males (5.46, 1991-2010, 95% CI = 4.62-6.29).
Description of Injuries and Risk Analyses
Body region injured, type of injury, location where injury
occurred, and disposition from ED. The head and neck
region (28.0%) was the most frequently injured
region, followed by the upper extremity (23.9%), face
(18.3%) and lower extremity (16.9%; Table 1). The
youngest patients (0-5 years) were 2.47 times (95%
CI = 2.00-3.04) more likely to injure their face than
6- to 17-year-olds.
Soft tissue injuries (29.4%) were the most common
injury type, followed by strains and sprains (21.4%),
lacerations (19.8%), fractures (10.2%) and concussions
or closed head injuries (7.3%; Table 1). Fractures were
more likely to be to the upper extremity (RR = 4.18,
95% CI = 3.63-4.81) and lacerations were more likely to
be to the face (RR = 4.26, 95% CI = 3.42-5.30) than any
other body region. Like body region injured, type of
injury varied by age. The youngest patients (0-5 years)
were more likely to incur lacerations (RR = 2.03, 95%
CI = 1.64-2.51) or concussions/closed head injuries (RR
= 1.65, 95% CI = 1.18-2.30) than patients 6 to 17 years
old, whereas the 6- to 17-year-olds were more likely to
sustain a sprain or strain (RR = 3.26, 95% CI = 2.38-4.45)
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436 Clinical Pediatrics 52(5)
than 0- to 5-year-olds. Female patients had a higher risk
of soft tissue injuries (RR = 1.35, 95% CI = 1.14-1.60)
than males, and male patients had higher risk of lacera-
tions (RR = 1.8, 95% CI = 1.45-2.25).
Of events with a known location (91.5%), 64.9%
occurred at a sports or recreation place, 31.2% at another
public property, and 3.9% at another location. Most
patients were treated and released, or examined and
released without treatment (97.8%; Table 1).
Description of rides involved. Fixed-site rides were
involved in 33.5% of cases, mobile rides in 29.1% of
cases, and in 11.7% of cases the ride involved was at a
mall, store, restaurant, or arcade. An estimated 25.7% of
narratives did not have sufficient information for cate-
gorization as a fixed-site, mobile, or mall ride. The type
of ride included roller coasters (10.1%), bumper cars
(3.9%), merry-go-rounds or carousels (20.9%), and
unknown or other ride types (65.2%; Table 2).
Rides at malls, stores, restaurants, or arcades demon-
strated injury pattern differences by age, body region
injured, and type of injury when compared with fixed-
site and mobile rides. Consistent with the expected
smaller physical size of the rides, 0- to 5-year-olds were
more likely to have injuries involving mall rides than
6- to 17-year-olds (RR = 7.34, 95% CI = 4.35-10.90).
Additionally, injuries associated with rides at malls were
Table 1. Description of Pediatric Injuries Involving Amusement Rides in the United States, 1990-2010.
Characteristic
Number, National Estimate
(95% CI)
Percentage of Total
National Estimate
Gender
Male 41 290 (35 029-47 551) 44.5
Female 51 486 (43 457-59 515) 55.5
Age (years)
0-5 28 252 (23 508-32 996) 30.4
6-12 40 679 (34 188-47 170) 43.8
13-17 23 954 (19 547-28 361) 25.8
Type of injury
Soft tissue 27 128 (22 679-31 577) 29.4
Strain or sprain 19 767 (16 236-23 298) 21.4
Laceration 18 325 (14 645-22 005) 19.8
Other injuries 11 015 (8530-13 500) 11.9
Fracture 9423 (7511-11 335) 10.2
Concussion or closed head injury 6734 (5139-8329) 7.3
Body region injured
Head and neck 25 822 (21 188-30 455) 28.0
Upper extremity 22 106 (18 421-25 791) 23.9
Face 16 887 (13 964-19 810) 18.3
Lower extremity 15 656 (12 753-18 558) 16.9
Trunk 10 069 (7874-12 263) 10.9
Other site 1846 (1032-2659) 2.0
Disposition from emergency department
Treated and released or examined and
released without treatment
90 829 (77 643-104 014) 97.8
Hospitalized, transferred to another hospital,
or held <24 hours for observation
1403 (797-2009) 1.5
Left against medical advice —a0.7
Location of injury
Place of sports or recreation (including
amusement parks and parks)
55 210 (45 744-64 675) 64.9
Other public property (including malls,
stores, and restaurants)
26 509 (21 511-31 507) 31.2
Other location (home, farm, street/highway,
manufactured/mobile home, or school)
3312 (2071-4553) 3.9
aEstimate not provided because of <20 actual cases and potentially unstable estimate.
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Thompson et al 437
more likely to be head and neck injuries (RR = 1.33,
95% CI = 1.08-1.63) or facial injuries (RR = 1.57, 95%
CI = 1.18-2.10) than those associated with fixed-site or
mobile rides. Rides at a mall were 2.13 (95% CI = 1.35-
3.33) times more likely to result in concussions or closed
head injuries and 1.76 (95% CI = 1.31-2.39) times more
likely to result in lacerations than fixed-site or mobile
rides.
Mechanism. Falling on, in, off, or against a ride was
the most frequent mechanism (31.7% of all cases), fol-
lowed by hitting part of one’s body on the ride or being
hit by something while riding (17.7%; Table 2). More
than half (51.7%) of cases involving falls were among
0- to 5-year-olds. Of injuries involving rides at malls,
72.6% were attributable to falling in, on, off, or against
the ride. Of all case narratives, 3.5% mentioned a ride
malfunction that appeared to contribute to the injury
event (Table 2).
Discussion
The amusement ride industry includes many ride types
in several settings.15 Given that the US amusement
parks and arcades industries brought in an estimated
13.4 billion dollars in revenue in 2009,22 and attendance
at establishments with US fixed-site rides was estimated
to be 290.1 million in 2010 alone,14 amusement ride–
related injuries have received remarkably little attention
in the medical and public health literature.
An estimated 92 885 children ≤17 years old were
treated in US EDs for amusement ride–related injuries
from 1990 to 2010, which translates into an annual aver-
age of 4423 injuries. This figure is lower than the previ-
ous estimate of 9200 injuries per year15; however,
differences in inclusion criteria (eg, this study excludes
some ride types, such as inflatable amusements) likely
explain this gap. The manual review of each individual
case in this study, coupled with the well-documented
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
JanFeb MarchApr MayJuneJulyAug Sept OctNov Dec
Esmated Number of Injuries
Month
Figure 2. Estimated number of amusement ride–related
injuries, by month, among US children ≤17 years seen in US
hospital emergency departments, 1990-2010.
Figure 1. Estimated number of injuries associated with amusement rides among children ≤17 years seeking care at US hospital
emergency departments, by age and gender, 1990-2010.a
a Estimates for 0 years are not provided because of <20 actual cases and potentially unstable estimates.
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438 Clinical Pediatrics 52(5)
and detailed definition of what constitutes an amuse-
ment ride–related injury, represents an improvement on
the only other published study on this topic15 by adding
specificity to estimates.
This study is the first to calculate national injury rates
for pediatric injuries involving amusement rides. The
average rate of 6.24 (95% CI = 5.35-7.13) injuries per
100 000 children demonstrates that ride-related injuries
do occur; however, the low percentage of patients hospi-
talized or held for observation (1.5%) suggests that inju-
ries serious enough to require hospitalization are rare.
Unexpectedly, more females were injured than males
(55.5% vs 44.5%), and the average injury rate per 100 000
children for females (7.09, 1990-2010) was greater than
that of males (5.46 injuries, 1991-2010). These gender
differences are unexpected, because males generally
exhibit higher overall injury rates than females.23
The CPSC has legal authority to regulate mobile, but
not fixed-site, amusement rides.12 Regulation of fixed-
site rides, such as those found at amusement parks, is
left to state or local governments, with large variations
by state.24 Fixed-site ride–related injuries occurred
more frequently than mobile– or mall ride–related inju-
ries in this study, highlighting the importance of injury
prevention on all ride types, regardless of regulatory
status. Of particular concern, authors have previously
asserted that these regulatory variations lead to a “frag-
mented system” of surveillance and safety oversight.2
The ASTM International Technical Committee F24
on Amusement Rides and Devices includes 9 subcom-
mittees that have developed 16 standards that include
parameters for ride design, maintenance, and opera-
tion.25 Standard F2291-11 “Standard Practice for Design
of Amusement Rides and Devices” provides detailed
design guidelines for manufacturers of amusement
rides.26 Despite the existence of ASTM standards such
as F2291, neither the CPSC nor any other single govern-
ment agency has legal authority to regulate and audit
fixed-site rides, leaving room for manufacturer and
operator discretion that could feasibly contribute to
inconsistent and variable adherence to ASTM’s
standards.
The finding that 31.7% of cases involved falling in,
on, off, or against a ride suggests that addressing
factors, such as ride restraints27 and operator and rider
conduct,8,28 could potentially decrease fall-related
injuries. Falls account for approximately three fourths
of playground equipment-related injuries29; therefore,
Table 2. Description of Type of Ride Involved and Mechanism of Injury for Pediatric Amusement Ride–Related Injuries in the
United States, 1990-2010.
Characteristic
Number, National Estimate
(95% CI)
Percentagea of Total
National Estimate
Fixed, mobile, or other ride
Fixed 31 129 (24 358-37 901) 33.5
Mobile 27 065 (21 781-32 349) 29.1
Unknown or uncertain 23 826 (19 447-28 205) 25.7
Mall, store, restaurant, or arcade 10 864 (7871-13 857) 11.7
Type of ride
Other or unknown 60 538 (51 163-69 913) 65.2
Merry-go-round or carousel 19 396 (15 554-23 238) 20.9
Roller coaster 9374 (6716-12 033) 10.1
Bumper cars 3576 (2548-4604) 3.9
Mechanism of injury
Other or unknown mechanism 32 031 (26 451-37 612) 34.5
Fell in, off, on, or against ride 29 420 (24 554-34 286) 31.7
Hit part of body on ride or was hit by something in the
environment of ride while riding ride
16 459 (13 367-19 551) 17.7
Caught body part or clothing in ride, caught and dragged
by ride, part of body was smashed between parts of ride
6654 (5022-8286) 7.2
Injured while getting on or off the ride 5894 (4353-7434) 6.3
Struck by a moving or stationary ride 2427 (1616-3238) 2.6
Ride malfunction
No significant ride malfunction stated in case narrative 89 675 (76 581-102 768) 96.5
Significant ride malfunction stated in case narrative 3210 (1985-4435) 3.5
aPercentages may not add to 100.0% because of rounding error.
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Thompson et al 439
strategies used to prevent fall-related injuries associated
with playground equipment may help inform interven-
tions to prevent fall-related injuries in and around
amusement rides.
Although ASTM provides some design and manufac-
turing guidelines for coin-operated rides,30 rides located
at malls are often overshadowed by larger amusement
park rides in the legal and public health discourse.
Nearly 11 000 pediatric injuries from 1990 to 2010
involved rides found at a mall, store, restaurant, or
arcade. Rides at malls were more than 7 times more
likely to be associated with injuries among the youngest
children (age 0-5 years) than older children. Additionally,
rides at malls were associated with increased risks of
head/neck or facial injuries and increased risks of lac-
erations and concussions/closed head injuries when
compared with fixed-site or mobile rides. Rides at malls
may be placed over hard surfaces that do not reduce
energy transfer in the case of a fall and may not be
equipped with child restraints. Injury prevention on
these rides merits increased attention and a place in the
public health discussion alongside rides at amusement
parks and fairs.
This study has limitations that underscore the need
for better national data collection for injuries involving
amusement rides. The NEISS product code for “amuse-
ment attractions, including rides” contains a heteroge-
neous assortment of rides and attractions, and case
narratives contain varying levels of detail.17 As in previous
reports and studies,4-13,15 this study uses product code
1293 only. However, some ride types included in this
study, such as merry-go-rounds and zip lines, are also
found under additional product codes.17 Another limita-
tion is that this study relied on decision rules when
detailed information in the narrative was missing; for
example, roller coasters were classified as fixed-site
rides unless stated otherwise. Because some roller coasters
for children are mobile, this study may have misclassi-
fied some of these cases. NEISS estimates also exclude
injured children seeking care in non-ED settings. In
addition, given the wide variety of rides covered in this
article, it is a challenge to make specific recommenda-
tions regarding injury prevention interventions for the
many ride types.
The NEISS sampling design may introduce biases
when examining amusement ride–related injuries.
Estimates including fixed-site rides found at amuse-
ment parks are affected by the proximity of parks to
hospitals participating in the NEISS, and NEISS sam-
pling is not based on the geographic distribution of
amusement parks.31 Additionally, a 2003 article found
that NEISS sampling changes in 1997 resulted in a net
increase of 8 hospitals “within 20 miles” of “top 50”
attendance amusement parks, leading to an estimated
29 922 751 extra park attendees near NEISS hospitals
from 1997 onward.31 Therefore, our study does not
emphasize trends over time. As previously noted, this
study excludes a hospital that left NEISS in 2000 and
previously contributed the greatest share of fixed-site
ride–related injuries.9 Although previous CPSC reports
advise against exclusion of this hospital from estimates
because estimates would likely be biased downward,7,8
this study excludes this hospital to improve compara-
bility across study years. In addition, sample weights
were adjusted by the CPSC for our study data set to
mitigate bias associated with the exclusion of this hos-
pital. Finally, the injury rates presented in this article
are based on population data because exposure data,
such as ridership numbers or amusement park atten-
dance figures, were unavailable.
Despite its limitations, the methodology of this
study is an important advance over the single previ-
ously published national study on this topic. This
study establishes injury rate estimates for pediatric
injuries involving many types of amusement rides and
provides the first overview of the characteristics of
rides involved and mechanisms of injury. There are
opportunities to improve the safety of amusement
rides, especially to prevent injuries from falls. Injuries
to young children associated with rides located at
malls, stores, restaurants, or arcades merit further
study and preventive action.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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