Head, face, and neck injury patterns across the life course: a 20-year NEISS analysis of 2,345,287 emergency department visits in the U.S.
13 affiliations
- 1Department of Plastic Surgery and Hand Surgery, Technical University of Munich, Munich, Germany. [email protected].
- 2Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. [email protected].
- 3Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- 4Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Munich, Germany.
- 5Department of Plastic Surgery and Hand Surgery, Technical University of Munich, Munich, Germany.
- 6Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- 7Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- 8Department of Preventive and Community Dentistry, Faculty of Dental Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil.
- 9Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
- 10Department of Plastic and Reconstructive Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- 11Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA.
- 12Cleft and Craniofacial Clinic, Mass General Hospital for Children and Shriners Hospital for Children, Boston, MA, USA.
- 13Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
Abstract
Background
Head, face, and neck injuries impose a substantial burden for emergency departments (ED); the mechanisms driving them across the life course however remain poorly understood at the population level. Large-scale, integrated analysis spanning anatomical regions, injury mechanisms, age groups, settings, and associated products or environmental surfaces offers an opportunity to identify the patterns and vulnerable populations that smaller or shorter-term studies cannot resolve.Methods
We queried National Electronic Injury Surveillance System (NEISS) records from 2006 to 2025 for injuries to the head, face, eyes, mouth, neck, or ears. Demographics, anatomical region, injury setting, associated products or environmental surfaces, and ED disposition were extracted, and a rule-based narrative classifier assigned 1 of 17 injury mechanisms from free-text descriptions. Non-routine ED disposition was defined as admission, transfer, observation, or fatality. Analyses were descriptive and based on unweighted NEISS case records.Results
Among 2,345,287 ED presentations, representing 31.8% of all NEISS-coded visits, the head was most often injured (51.2%), followed by the face (28.2%). Annual volume rose 35.2% (105,727 in 2006 to 142,918 in 2025), driven mainly by head injuries (+ 83.4%). Median age was 14 years and 56.4% of patients were male, but among older adults (≥ 65 years), females predominated (60.6%). Falls were the leading mechanism (53.0% across subcategories). Most patients were treated and discharged (89.4%) and admission rate rose roughly 18-fold from toddlers (1.3%) to older adults (23.3%). Non-routine ED disposition increased with age, and syncope- or medical-related falls had the highest non-routine ED disposition rate (33.9%). The home was the most common injury setting (63.1%). Injury exposures varied by age group, with beds most common in infants, tables in toddlers, sports equipment in children and adolescents, and floors in older adults.Conclusions
Head, face, and neck injuries represent a large and growing share of NEISS-coded ED presentations, with distinct patterns by age, sex, injury mechanism, setting, and clinical outcome. These findings may assist in the planning of targeted prevention strategies and future research on risk stratification for vulnerable age groups and injury mechanisms.
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BibTeX
@article{alfertshofer2026head,
title = {{Head, face, and neck injury patterns across the life course: a 20-year NEISS analysis of 2,345,287 emergency department visits in the U.S.}},
author = {Michael Alfertshofer and Cosima C Hoch and Dirk Nolte and Hans-Günther Machens and Leonard Knoedler and Shady Abu-Sirhan and Siti Rahmayanti and Deise Caldas Kühlman and Jeffrey E Janis and Zachary S Peacock and Steffen Koerdt and Sarina Bucher and Max Heiland and Nicholas Moellhoff and Samuel Knoedler},
journal = {BMC emergency medicine},
year = {2026},
month = oct,
doi = {10.1186/s12873-026-01821-3},
url = {https://europepmc.org/article/MED/42902187},
note = {CC BY},
}
RIS
TY - JOUR
TI - Head, face, and neck injury patterns across the life course: a 20-year NEISS analysis of 2,345,287 emergency department visits in the U.S.
AU - Michael Alfertshofer
AU - Cosima C Hoch
AU - Dirk Nolte
AU - Hans-Günther Machens
AU - Leonard Knoedler
AU - Shady Abu-Sirhan
AU - Siti Rahmayanti
AU - Deise Caldas Kühlman
AU - Jeffrey E Janis
AU - Zachary S Peacock
AU - Steffen Koerdt
AU - Sarina Bucher
AU - Max Heiland
AU - Nicholas Moellhoff
AU - Samuel Knoedler
PY - 2026
DA - 2026/10/20
JO - BMC emergency medicine
DO - 10.1186/s12873-026-01821-3
UR - https://europepmc.org/article/MED/42902187
AB - Background Head, face, and neck injuries impose a substantial burden for emergency departments (ED); the mechanisms driving them across the life course however remain poorly understood at the population level. Large-scale, integrated analysis spanning anatomical regions, injury mechanisms, age groups, settings, and associated products or environmental surfaces offers an opportunity to identify the patterns and vulnerable populations that smaller or shorter-term studies cannot resolve.Methods We queried National Electronic Injury Surveillance System (NEISS) records from 2006 to 2025 for injuries to the head, face, eyes, mouth, neck, or ears. Demographics, anatomical region, injury setting, associated products or environmental surfaces, and ED disposition were extracted, and a rule-based narrative classifier assigned 1 of 17 injury mechanisms from free-text descriptions. Non-routine ED disposition was defined as admission, transfer, observation, or fatality. Analyses were descriptive and based on unweighted NEISS case records.Results Among 2,345,287 ED presentations, representing 31.8% of all NEISS-coded visits, the head was most often injured (51.2%), followed by the face (28.2%). Annual volume rose 35.2% (105,727 in 2006 to 142,918 in 2025), driven mainly by head injuries (+ 83.4%). Median age was 14 years and 56.4% of patients were male, but among older adults (≥ 65 years), females predominated (60.6%). Falls were the leading mechanism (53.0% across subcategories). Most patients were treated and discharged (89.4%) and admission rate rose roughly 18-fold from toddlers (1.3%) to older adults (23.3%). Non-routine ED disposition increased with age, and syncope- or medical-related falls had the highest non-routine ED disposition rate (33.9%). The home was the most common injury setting (63.1%). Injury exposures varied by age group, with beds most common in infants, tables in toddlers, sports equipment in children and adolescents, and floors in older adults.Conclusions Head, face, and neck injuries represent a large and growing share of NEISS-coded ED presentations, with distinct patterns by age, sex, injury mechanism, setting, and clinical outcome. These findings may assist in the planning of targeted prevention strategies and future research on risk stratification for vulnerable age groups and injury mechanisms.
SN - 1471-227X
ER -