Head, face, and neck injury patterns across the life course: a 20-year NEISS analysis of 2,345,287 emergency department visits in the U.S.

Abstract

Background: Head, face, and neck injuries impose a substantial burden for emergency departments (ED); the mechanisms driving them across the life course however remain poorly understood at the population level. Large-scale, integrated analysis spanning anatomical regions, injury mechanisms, age groups, settings, and associated products or environmental surfaces offers an opportunity to identify the patterns and vulnerable populations that smaller or shorter-term studies cannot resolve.

Methods: We queried National Electronic Injury Surveillance System (NEISS) records from 2006 to 2025 for injuries to the head, face, eyes, mouth, neck, or ears. Demographics, anatomical region, injury setting, associated products or environmental surfaces, and ED disposition were extracted, and a rule-based narrative classifier assigned 1 of 17 injury mechanisms from free-text descriptions. Non-routine ED disposition was defined as admission, transfer, observation, or fatality. Analyses were descriptive and based on unweighted NEISS case records.

Results: Among 2,345,287 ED presentations, representing 31.8% of all NEISS-coded visits, the head was most often injured (51.2%), followed by the face (28.2%). Annual volume rose 35.2% (105,727 in 2006 to 142,918 in 2025), driven mainly by head injuries (+ 83.4%). Median age was 14 years and 56.4% of patients were male, but among older adults (≥ 65 years), females predominated (60.6%). Falls were the leading mechanism (53.0% across subcategories). Most patients were treated and discharged (89.4%) and admission rate rose roughly 18-fold from toddlers (1.3%) to older adults (23.3%). Non-routine ED disposition increased with age, and syncope- or medical-related falls had the highest non-routine ED disposition rate (33.9%). The home was the most common injury setting (63.1%). Injury exposures varied by age group, with beds most common in infants, tables in toddlers, sports equipment in children and adolescents, and floors in older adults.

Conclusions: Head, face, and neck injuries represent a large and growing share of NEISS-coded ED presentations, with distinct patterns by age, sex, injury mechanism, setting, and clinical outcome. These findings may assist in the planning of targeted prevention strategies and future research on risk stratification for vulnerable age groups and injury mechanisms.