From Medscape Medical News:

The number of bouncy-house injuries has skyrocketed in the last 10 years, reaching the point where an American child is injured every 46 minutes, according to research published online November 26 in Pediatrics.

Meghan C. Thompson, BA, from the Center for Injury Research and Policy, Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, and colleagues analyzed injury records for almost 65,000 children, finding that the rate and number of bouncy-house-related injuries increased 15-fold from 1990 to 2010, more than doubling in the last 2 years alone.

“Bouncer-related injury patterns identified in this study were similar to those described for trampolines,” the authors write. For both trampolines and inflatable bouncers, with increasing age the frequency of upper-extremity injuries and fractures decreased and lower-extremity injuries increased.

Children aged 6 to 12 years were most often hurt compared with those aged 0 to 5 years and 13 to 17 years (54.0% vs 35.8% and 10.2%, respectively).

Boys were more likely to sustain injuries than girls (54.6% vs 45.4%), including concussions/closed head injuries and lacerations (relative risk [RR], 2.49 [95% confidence interval (CI), 1.46 – 4.25] and 2.41 [95% CI, 1.55 – 3.73], respectively), or injure their head/neck or face (RR, 1.37 [95% CI, 1.09 – 1.73] and 1.76 [95% CI, 1.35 – 2.30], respectively). In contrast, girls were more likely than boys to sustain lower-extremity injury (RR, 1.39; 95% CI, 1.17 – 1.64).

Of the 65.2% of cases for which a venue was reported, 43.7% of injuries occurred at a sports or recreational facility and 37.5% occurred at home.

The vast majority of children treated in the emergency were released or left against medical advice (96.6%); only 3.4% of injuries required hospitalization or 24-hour observation, primarily for fractures (81.7%).

“Policy makers must consider whether the similarities observed in bouncer-related injuries warrant a similar response” to the recommendations given for trampolines, the authors write, noting that although pediatric bouncer-related injury rates are currently lower than trampoline-related rates (5.28 vs 31.9 per 100,000 in 2009), they are rising rapidly. “[P]olicy makers should, at minimum, formulate recommendations for safer bouncer usage and design,” they emphasize.

65,000 Injuries Over the Course of 20 Years

For the study, researchers analyzed the National Electronic Injury Surveillance System records for an estimated 64,657 children younger than 18 years who had been treated in US emergency departments for inflatable bouncer-related injuries from 1990 to 2010.

Results revealed that the rate and number of bouncy-house related injuries increased 15-fold during the period from 1995 to 2010, from 1.01 per 100,000 children (95% confidence interval [CI], 0.70 – 1.32 injuries/100,000 children) in 1995 to 15.2 per 100,000 children (95% CI, 9.93 – 20.56 injuries/100,000 children) in 2010. There were 702 (95% CI, 284 – 1120) injuries in 1995 compared with 11,311 (95% CI, 7115 – 15,506) injuries in 2010. ( P < .001 for both). In 2010 the average number of injuries in the United States was 31 per day, corresponding to an injury report every 46 minutes.

Fractures were the most common type of injury (27.5%) and most frequently occurred in children aged 5 years and younger (relative risk [RR], 1.31; 95% CI, 1.12 – 1.54); strains and sprains were also common (27.3%) and were reported most frequently among teenagers aged 13 to 17 years (RR, 1.45; 95% CI, 1.12 – 1.88). Teenagers were also more likely to experience lower-extremity injuries (RR, 1.37; 95% CI, 1.13 – 1.66).

As with trampoline-related accidents, the majority of injuries occurred to the extremities (lower, 32.9%; upper, 29.7%). An additional 18.5% of injuries involved the head and neck, 9.3% affected the face, and 9.0% were trunk injuries.

Lacerations were 14.3 times (95% CI, 10.46 – 19.53 times) more likely to occur in the face than any other body region, and fractures were 3.31 times (95% CI, 2.58 – 4.24 times) more likely to occur in the upper extremity than any other body region, particularly among children aged 12 years and younger (RR, 1.89; 95% CI, 1.05 – 3.41).

Stunts and Collisions

As with trampoline-related accidents, falling was the major source of injury, accounting for 43.3% of cases. More children were injured falling in or on the bouncer than getting on or off (26.1% vs 17.2%), which may be a matter of design, the authors note.

Other sources of injury included other children (16.2%), with 9.9% of cases attributable to colliding with or being pushed/pulled by another person and 6.3% the result of another child’s fall.

“Stunts and collisions were common injury mechanisms in this study and in previous bouncer and trampoline studies,” the authors write, noting that as with trampolines, the presence of several children on a single bouncer is a risk factor for injury.

According to the authors, the similar nature and mechanism of trampoline- and bouncer-associated injuries suggests that prevention methods for one may be extrapolated to the other, but this concept has not been adequately explored.

As previously reported by Medscape Medical News, recommendations from the American Academy of Pediatrics in 2012 addressed trampolines and recommended their use only as part of a structured training program that includes appropriate safety measures. These recommendations made no mention of bouncy houses because they do not fall into the training category. Other organizations such as ASTM International and the US Consumer Product Safety Commission have attempted to address bouncer safety issues. In the end, the standards are set by individual manufacturers, the authors write.

“To date, the medical and public health community has not provided safety recommendations regarding pediatric use of inflatable bouncers,” the authors assert, noting that the recent increase in injuries also underscores the need for guidelines to improve bouncer use and design.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 26, 2012. Full text

From KOMO News of Chicago:

CHICAGO (AP) – They may be a big hit at kids’ birthday parties, but inflatable bounce houses can be dangerous, with the number of injuries soaring in recent years, a nationwide study found.

Kids often crowd into bounce houses, and jumping up and down can send other children flying into the air, too.

The numbers suggest 30 U.S. children a day are treated in emergency rooms for broken bones, sprains, cuts and concussions from bounce house accidents. Most involve children falling inside or out of the inflated playthings, and many children get hurt when they collide with other bouncing kids.

The number of children aged 17 and younger who got emergency-room treatment for bounce house injuries has climbed along with the popularity of bounce houses – from fewer than 1,000 in 1995 to nearly 11,000 in 2010. That’s a 15-fold increase, and a doubling just since 2008.

“I was surprised by the number, especially by the rapid increase in the number of injuries,” said lead author Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.

Amusement parks and fairs have bounce houses, and the playthings can also be rented or purchased for home use.

Smith and colleagues analyzed national surveillance data on ER treatment for nonfatal injuries linked with bounce houses, maintained by the U.S. Consumer Product Safety Commission. Their study was published online Monday in the journal Pediatrics.

Only about 3 percent of children were hospitalized, mostly for broken bones.

More than one-third of the injuries were in children aged 5 and younger. The safety commission recommends against letting children younger than 6 use full-size trampolines, and Smith said barring kids that young from even smaller, home-use bounce houses would make sense.

“There is no evidence that the size or location of an inflatable bouncer affects the injury risk,” he said.

Other recommendations, often listed in manufacturers’ instruction pamphlets, include not overloading bounce houses with too many kids and not allowing young children to bounce with much older, heavier kids or adults, said Laura Woodburn, a spokeswoman for the National Association of Amusement Ride Safety Officials.

The study didn’t include deaths, but some accidents are fatal. Separate data from the product safety commission show four bounce house deaths from 2003 to 2007, all involving children striking their heads on a hard surface.

Several nonfatal accidents occurred last year when bounce houses collapsed or were lifted by high winds.

A group that issues voluntary industry standards says bounce houses should be supervised by trained operators and recommends that bouncers be prohibited from doing flips and purposefully colliding with others, the study authors noted.

Bounce house injuries are similar to those linked with trampolines, and the American Academy of Pediatrics has recommended against using trampolines at home. Policymakers should consider whether bounce houses warrant similar precautions, the authors said.