American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Featured Commentary

The online formats of SRGS include access to What You Should Know (WYSK): commentaries on articles published recently in top medical journals. These commentaries, written by practicing surgeons and other medical experts, focus on the strengths and weaknesses of the research, as well as on the articles' contributions in advancing the field of surgery.

Below is a sample of one of the commentaries published in the current edition of WYSK.

Onders B, Kim EH, Chounthirath T, Hodges NL, Smith GA. Pediatric Injuries Related to Window Blinds, Shades, and Cords. Pediatrics. 2018 Jan;141(1).

Commentary by: Max Langham, MD, FACS

Onders and colleagues have conducted a methodologically sound epidemiology study of injuries from window blinds, shades, and cords in children less than six years of age. They concluded that voluntary safety standards for window blinds should be replaced with a mandatory safety standard, eliminating the risk of hanging injuries in these young children. I agree with their recommendation.

The study used the Consumer Product Safety Commission's National Electronic Injury Surveillance System and In-Depth Investigations databases. It is retrospective and observational by design. While retrospective observational studies may be subject to bias, an underreporting of the actual risk is the only potential issue with the current study. Data presented by the authors clearly show no reduction in the annual reported number of injuries since the adoption of the voluntary safety standards intended to reduce these injuries. Because of its design, the study cannot assign causation to this failure. Why would mandatory standards make a difference?

Product safety standards are designed to reduce preventable injury by using design changes to remove opportunities for such injuries from products. There is a long track record of their success. Small children are a vulnerable population, and they are most commonly injured in the home. Injuries to these children have resulted in death or lifelong disability with devastating human and financial costs. Home injuries have decreased after changes in alkaline household cleaners, washing machine, and cooking stove design, in addition to similar changes. Cordless window coverings would reduce asphyxia and hanging, which are the leading causes of death from window coverings. Abrasions and head injuries from falling blinds might decrease as well, since these may be caused by infants and toddlers pulling themselves up by cords attached to improperly installed blinds.

Typical arguments against mandatory standards involve cost and excess government regulation. Costs associated with redesign and manufacturing of cordless shades would be minimal. Few would advocate for return to previous designs of home cleaners that caused fatal esophageal injuries, stoves that burned hands or tipped over, and washing machines that crushed arms. These products and the injuries related to them have faded from many textbooks, and few younger physicians have cared for children affected by these obsolete products. Small batteries and window cords remain products most often associated with injury presenting to today's emergency department. This reviewer hopes that changes in mandatory design standards for these products will be adopted. Our society has a collective interest in the welfare of children, and products that improve our lives, while seeking to prevent injuries occurring in children incapable of protecting themselves, will increase everyone's wellbeing.