Circus And Aerial Arts Apparatus-related Injuries: Epidemiology And Patterns

PURPOSE: Circus and aerial arts activities are growing in the United States and present a risk of serious injury. This research identifies patient demographics and patterns of apparatus-related aerial arts injuries. METHODS: The National Electronic Injury Surveillance System (NEISS) database was queried to characterize patient demographics, injury type, and injury subsite associated with aerial/circus-related injuries between 2004 and 2023 in United States emergency departments. The narrative field was searched to find presentations containing Circus, Trapeze, Silk, Lyra, Contort, Acrobat, Cirque, or Aerial. The 590 results were screened to exclude non-relevant RESULTS: fireworks, mobility trapezes, playground, and tumbling/ground injuries. These were further specified by the type of apparatus (if specified), mechanism of injury (fall, contact, or strain), and location (home, class, facility). RESULTS: Among the 131 apparatus-related injuries, the average patient age was 17.8 (SD 14.7); 98 cases were female and 33 were male. Trapeze-related injuries were most common (88, 66.6%), followed by silks (15, 11.3%), and aerial yoga (5, 3.8%). Falls were the most prevalent injury mechanism (86, 65.6%), followed by apparatus or external contact (19, 14.5%), apparatus-related strains/sprains (12, 9.2%), and landing-related injuries (5, 3.8%). The most common injury was fracture (43), sprain/strain (21), contusion (17), internal injury (16), other (14), concussion (14), and laceration (8). One especially concerning injury was strangulation by silks. The most common locations of injury were head (29), lower arm (15), elbow (11), and shoulder (10). Fractures were associated with younger age (t = -2.974, p = .0038) and fall (χ2 = 4.909, p = .0267). Gender provided no statistical increase in fracture and was unrelated to the mechanism of injury. Concussions had no change in prevalence among age (p = .44). CONCLUSION: This is the first study to identify the prevalence of ED-presenting aerial arts-related injuries and to highlight the frequency of fall-related injuries. Precautions are key to safe training and avoiding fractures and serious injuries: safety lines, mats, spotting, and foam pits. Further research into aerial arts is warranted to improve safety.