Knife-Related Injuries Treated in United States Emergency Departments, 1990–2008

  • Gary A. Smith
    Reprint Address: Gary A. Smith, md, drph, Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
    Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, and Child Injury Prevention Alliance, Columbus, Ohio
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      Knives cause more disabling injuries than any other type of hand tool.

      Study Objectives

      This study investigates knife-related injuries requiring Emergency Department (ED) treatment among children and adults in the United States (US) from 1990 through 2008.


      A retrospective analysis of data from the National Electronic Injury Surveillance System of the Consumer Product Safety Commission was conducted.


      An estimated 8,250,914 (95% confidence interval [CI] 7,149,074–9,352,755) knife-related injuries were treated in US EDs from 1990 to 2008, averaging 434,259 (95% CI 427,198–441,322) injuries annually, or 1190 per day. The injury rate was 1.56 injuries per 1000 US resident population per year. Fingers/thumbs (66%; 5,447,467 of 8,249,410) were injured most often, and lacerations (94%; 7,793,487 of 8,249,553) were the most common type of injury. Pocket/utility knives were associated with injury most often (47%; 1,169,960 of 2,481,994), followed by cooking/kitchen knives (36%; 900,812 of 2,481,994). Children were more likely than adults to be injured while playing with a knife or during horseplay (p < 0.01; odds ratio 9.57; 95% CI 8.10–11.30). One percent of patients were admitted to the hospital, and altercation-related stabbings to the trunk accounted for 52% of these admissions.


      Knives represent an important source of morbidity and mortality to people of all ages. Manufacturers should develop safer knife designs that incorporate features, such as improved opening and closing mechanisms on pocket knives, to prevent these injuries. Other potential safety efforts include targeted educational interventions and changes in voluntary product safety standards and public policy.


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      1. Webster Dictionary. Knife definition. Available at: Accessed June 24, 2011.

      2. Toolbox Talks. Topic: Knife safety. Available at: Accessed June 24, 2011.

        • Freed H.A.
        • Milzman D.P.
        • Holt R.W.
        • et al.
        Age 14 starts a child’s increased risk of major knife or gun injury in Washington, DC.
        J Natl Med Assoc. 2004; 96: 169-174
        • Goniewicz M.
        • Peryga P.
        • Piejak T.
        The stabbed wounds as a cause of injuries of different parts of the body.
        Ann Univ Mariae Curie Sklodowska Med. 2004; 59: 193-199
        • Macpherson A.K.
        • Schull M.J.
        Penetrating trauma in Ontario emergency departments: a population-based study.
        CJEM. 2007; 9: 16-20
        • Maxwell R.
        • Trotter C.
        • Verne J.
        • et al.
        Trends in admissions to hospital involving an assault using a knife or other sharp instrument, England, 1997–2005.
        J Public Health. 2007; 29: 186-190
        • Leyland A.H.
        Homicides involving knives and other sharp objects in Scotland, 1981–2003.
        J Public Health. 2006; 28: 145-147
        • Huiras C.M.
        • Cogbill T.H.
        • Strutt P.J.
        Hunting-related injuries.
        Wis Med J. 1990; 89: 573-576
        • Reishus A.D.
        Injuries and illnesses of big game hunters in western Colorado: a 9-year analysis.
        Wilderness Environ Med. 2007; 18: 20-25
        • Meer M.
        • Siddiqi A.
        • Morkel J.A.
        • et al.
        Knife inflicted penetrating injuries of the maxillofacial region: a descriptive, record-based study.
        Injury. 2010; 41: 77-81
        • Dogan S.
        • Kocaeli H.
        • Taskapilioglu M.O.
        • et al.
        Stab injury of the thoracic spinal cord: case report.
        Turk Neurosurg. 2008; 18: 298-301
        • Frangos S.G.
        • Ben-Arie E.
        • Bernstein M.P.
        • Miglietta M.A.
        Thoracic stab wound with impaled knife.
        J Trauma. 2006; 60: 1379
        • Kessler E.
        • Schroeder T.
        The NEISS sample (design and implementation).
        U.S. Consumer Product Safety Commission, Washington, DC1999
        • Middleton K.
        • Hing E.
        National Hospital Ambulatory Medical Care Survey: 2003 outpatient department summary.
        Adv Data. 2005; 366: 1-36
      3. U.S. Bureau of the Census. United States resident population by age and sex. Available at: Accessed June 24, 2011.

      4. Health and Safety Executive (HSE). HSE information sheet. How to reduce your hand knife injuries. Plastics Processing Sheet No 12. May 2000. Available at: Accessed June 24, 2011.

        • Saour S.
        • Leong S.C.L.
        Frozen-food-related hand injuries.
        Ann Plast Surg. 2006; 57: 18-19
        • Jigjinni V.S.
        • Stevenson J.
        • Flemming A.F.S.
        The beefburger injury: a retrospective survey.
        BMJ. 1997; 315: 580
        • Geiderman J.M.
        Pumpkin carver’s palm.
        N Engl J Med. 1978; 298: 348
        • Marcus A.M.
        • Green J.K.
        • Werner F.W.
        The safety of pumpkin carving tools.
        Prev Med. 2004; 38: 799-803
        • Hankin F.M.
        • Noellert R.C.
        • Wilson M.R.
        Hazards of pumpkin carving.
        Am Fam Physician. 1988; 38: 221-222
        • Winternitz W.W.
        • Kleven L.H.
        • McElfresh E.C.
        • et al.
        “Pumpkin carvers” tendon injuries: repair of children’s flexor tendon lacerations caused by a sharp knife.
        Minn Med. 1988; 71: 622-624
        • Hainsworth S.V.
        • Delaney R.J.
        • Rutty G.N.
        How sharp is sharp? Towards quantification of the sharpness and penetration ability of kitchen knives used in stabbings.
        Int J Legal Med. 2008; 122: 281-291
      5. Brattain DH. Knife safety. Indiana FACS Best Practices. 2007. Available at: Accessed June 24, 2011.

      6. Knife safety. 2001. Available at: Accessed June 24, 2011.

      7. Joint Commission on Accreditation of Healthcare Organizations. Scalpel safety. Staying safe while working on the cutting edge. Environment of Care® News 2009;12:6–11.