Evaluating the e-Cigarette Epidemic in US Emergency Departments


  • Neil Vallabh Pediatric Ophthalmology, Cincinnati Children’s Hospital Medical Center
  • Andrew F. Zheng Family Medicine, Cleveland Clinic Akron General
  • Hersh Varma Pediatric Ophthalmology, Cincinnati Children’s Hospital Medical Center
  • Ryan Reber Emergency Medicine, Cleveland Clinic Akron General
  • W. Walker Motley Pediatric Ophthalmology, Cincinnati Children’s Hospital Medical Center; Ophthalmology, University of Cincinnati




e-Cigarette, Vape, Liquid nicotine, Injury surveillance, Epidemiology


Background: Electronic cigarettes (e-cigarettes) are often thought to be a healthier option to cigarette smoking. e-Cigarettes have been found to overheat and explode. e-Cigarette explosions have caused severe trauma and rendered patients in critical conditions. Inadvertent exposures to liquid nicotine products have caused systemic poisoning injuries. We sought to characterize e-cigarette injuries presenting to emergency departments (ED) in 2018.
Methods: We analyzed one year of data from the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS). Patients presenting with injuries associated with e-cigarette products were manually identified for inclusion. We performed descriptive analyses on demographic factors, affected bodily regions, dispositions, locations of occurrence, and mechanisms of injury. By applying sample weights, nationally representative estimates were calculated.
Results: A total of 361 667 injury cases were reported in NEISS (2018). We identified 50 e-cigarette injury cases, generating a national estimate of 1739 (95% CI [1333-2148]) patients presenting to US EDs with e-cigarette injuries in 2018. Approximately 1000 pediatric patients (age ≤17 years) and 700 adult patients (age ≥18 years) were included. The median age when presenting to the ED was 4 years (interquartile range [IQR], 1-25). Over 85% of injuries occurred at home. Ingestion (55.0%) was the most common mechanism of injury, followed by explosion (35.8%).
Conclusion: Children and adults are susceptible to injury from e-cigarette products. Changes in manufacturing standards may prevent injuries from these products.






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