Ambulatory cell phone injuries in the United States: an emerging national concern.

BACKGROUND Over the past 15 years, the use of cell phones has increased 8-fold in the United States. Cell phone use has been shown to increase crash risks for drivers, but no systematic analyses have described injuries related to ambulatory cell phone use. OBJECTIVE The purpose of this study is to describe and quantitate injuries and deaths among persons using cell phones while walking. METHODS We searched the National Electronic Injury Surveillance System (NEISS) for emergency department (ED) reports of injuries related to phone use. The cases that returned were screened initially using words that would eliminate cases unlikely to be related to cell phone use and walking, possibly linked to distraction. The resulting cases were randomized and evaluated for consistency with predetermined case definitions by two authors blinded to the dates of the incidents. Cases that were disagreed upon were evaluated in a second screening by both authors for final case determination. National ED visit rates were estimated based on NEISS sampling methods. Annual variations were analyzed using linear regression with a restricted maximum likelihood approach. RESULTS Our screening process identified 5,754 possible cases that occurred between 2000 and 2011, and 310 were agreed on as cases of cell-phone-induced distraction. The majority of the patients were female (68%) and 40 years of age or younger (54%). The primary mechanism of injury was a fall (72%), and most patients were treated and released from the ED (85%). No patients died from their injuries while they were in the ED. Linear modeling by year revealed a statistically significant increase in distraction injury rates over the years of study (p<0.001 for trend). CONCLUSIONS The number of ED visits by ambulatory persons injured while being distracted by cell phone use has been increasing. More research is needed to determine the risks associated with walking and talking on a cell phone and to develop strategies for intervention. PRACTICAL APPLICATIONS Cell phone use continues to increase both at home and outdoor environments. The use of smart phones, with their more enticing features, increases the likelihood of distraction-induced injuries even more. Manufacturers should consider the addition of tools or applications on smart phones to remind users to remain alert to outside auditory stimuli that herald external hazards and to encourage them to not use these devices while engaged in other activities.