ED Visits for Body Piercing Complications in Youths

Source: Cirks BT, Maranich A, Nylund CM, et al. Emergency department visits after body piercings. Pediatr Emerg Care. 2024;40(12):882-888; doi: 10.1097/PEC.0000000000003284.Investigators from multiple institutions conducted a retrospective study to characterize body piercing injuries (BPI) in youths and young adults presenting to an emergency department (ED). For the study, they reviewed data in the National Electronic Injury Surveillance System (NEISS) from 2011 to 2020. NEISS includes injury visits from >100 US hospital EDs, including 7 children’s hospital EDs. Participating sites report injuries in a standardized manner. NEISS includes demographic information on patients, product codes for involved objects, affected body regions, diagnoses, and disposition. Reports include a free-text narrative section. Data from NEISS can be weighted to provide nationally representative estimates. Study participants were patients ≤24 years old with an injury associated with the product code for jewelry and narrative description indicating that the injury was related to piercing. The age and sex of study patients was recorded along with disposition (discharged from ED or hospitalized or transferred to another facility). Location of the injury was categorized as ear, mouth, head, face, upper trunk, lower trunk, and pubic. Upper trunk BPI commonly involved the nipple, and lower trunk BPI usually involved the navel. NEISS records of study participants were reviewed to identify BPI complicated by infection. Using ear BPI as the reference, the odds ratios (OR) for infection and hospitalization/transfer for BPI in other body areas were calculated.A total of 10,912 BPI in youths and young adults were identified in the NEISS database, yielding a national estimate of ED visits in this population during the 10-year study period of 338,972 (95% confidence interval [CI], 271,100, 403,843). The median age of study participants was 13.7 years old, with 55% occurring in those 13–24 years of age. Overall, 85% of visits for BPI were by female patients. The ear was the most common site of BPI (70.8%), followed by mouth (9.7%), face (8.0%), lower trunk (4.6%), upper trunk (4.3%) and pubic (0.5%). Among all ED visits for BPI, 1,398 (12.8%) were complicated by infection; 51.3% of infections with BPI involved the ear. However, compared to the ear, the risk of infection was significantly higher with BPI in the lower trunk (OR, 8.2; 95% CI, 6.3, 10.7), upper trunk (OR, 8.0; 95% CI, 6.4, 10.0), and mouth (OR, 2.4; 95% CI, 1.9, 3.1). Hospitalization/transfer was required for 81 (0.8%) cases of BPI. Compared to ear BPI, hospitalization/transfer was significantly more likely with BPI involving the pubic area (OR, 16.8; 95% CI, 4.6, 61.8), upper trunk (OR, 6.2; 95% CI, 2.1, 18.4) and face (OR, 5.0; 95% CI, 1.1, 21.7).The authors conclude that ED visits for BPI in youths and young adults are common.Dr Bechtel has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Body piercings are a rite of passage for children and adolescents. However, such rituals can come with risks, such as injury and infection, for which pediatricians should become familiar.1 (See AAP Grand Rounds. 2004;11[5]:53-54.)2 Complications vary depending on the body piercing site, materials used for the piercing, the practitioner’s experience, and hygiene regimens during and after the procedure.3 The results of the current study delineate this risk in the pediatric population. While age-specific prevalence rates of injury and infection were not determined, the authors demonstrated that these are not uncommon ED presentations, especially for female adolescents. Higher risk sites of piercing, such as the lower body and the mouth, had higher infection rates and need for hospitalization.There are, however, multiple limitations with the current study. First, the NEISS database is based on a sample of hospitals, which limits the ability to generate regional or state-specific results. Second, the standardized data collection limits the capture of detailed injury-specific variables, such as the exact location on the ear or face, the timing of piercing to ED presentation, where the piercing was done (commercial, medical, or home), and prior treatments. Third, the database likely underestimates the overall rates of BPI. It only includes data from EDs, excluding cases managed in urgent care facilities, primary care offices, or at home. Fourth, some demographic data, such as race, were not captured, limiting the generalizability of the findings. Finally, NEISS does not capture detailed clinical data on the reasons for hospitalization or the level of care required, such as inpatient ward vs critical care unit or specific interventions like surgery.BPIs are commonly treated in EDs. Further study is needed to determine the overall risk of injury and infection after a body piercing and ways to prevent its occurrence.Despite the enumerated limitations, the current study calls pediatricians’ attention to the increasingly popular practice of body piercing. It should be noted, however, that in addition to infection, piercing jewelry poses risks of contact dermatitis, scarring, and, in young children, insertion into inappropriate body orifices.4 The education of youths regarding the care and complications of body piercing need not await future, more comprehensive study.