PC2162: Body Piercings Resulting in Emergency Department Visits: Addressing a Hole in the Literature

Background: Piercings are a popular form of body modification amongst children, adolescents, and adults. Ears are the most frequent piercing location; the head, nipples, naval, dermal and pubic regions are also pierced. While the American Academy of Pediatrics (AAP) recommends postponing body piercing until the child can provide appropriate self-care, their 2017 clinical report covering piercings highlights the lack of reliable data describing piercing-related complications, including infections. We seek to close this knowledge gap by characterizing piercing-related injuries in pediatric patients evaluated in United States Emergency Departments (ED) from 2011-2020.

Methods: We queried the National Electronic Injury Surveillance System (NEISS) database using a jewelry product code to establish cases among patients up to 24 years old from 2011-2020. Case narratives were reviewed to identify piercing related injuries. We grouped encounters based on age, sex, and body part affected. We further described care patterns to include identification of infections and need for escalation of care (EOC). Reported values are population national estimates with 95% confidence intervals (CI) generated from actual piercing-related injury encounters at NEISS sampled emergency rooms using the NEISS-supplied weights and variance variables. Analysis included Rao-Scott Chi-square for all categorical comparisons.

Results: From 2011 to 2020, 10,912 piercing injuries were captured with resultant national estimates of 338,972 (CI 271,100-403,843) injuries with 59,485 (CI 44,688-74,282) infections and 2,538 (CI 1,673-3,404) EOC (Table 1). Patients were predominantly female (85.0%) and 13-24 years old (55.79%). Infections or EOC occurred in 17.55% and 0.75% of injuries, respectively. Both infections and EOC were significantly associated with age, P< 0.01. Of the body parts affected by piercing injuries, ears were the most involved (70.75%) and the most frequently infected (51.28%).

Conclusion: This is the first nationwide estimate of body piercing related injuries presenting to an ED. Unsurprisingly, our study found the highest frequency of injuries and infections in adolescents, females, and ear piercings. However, the low frequency of infection and EOC in children less than 6 appears to imply serious complications might be less common than previously thought. This information could assist pediatricians and other healthcare team members provide anticipatory guidance to families and patients by identifying characteristics associated with body piercing injuries resulting in an ED visit. Furthermore, it may inform future policy recommendations to prevent serious events related to piercings.