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Older adults who have difficulty moving around are commonly advised to adopt mobility-assistive devices to prevent injuries. However, limited evidence exists on the safety of these devices. Existing data sources such as the National Electronic Injury Surveillance System tend to focus on injury description rather than the underlying context, thus providing little to no actionable information regarding the safety of these devices. Although online reviews are often used by consumers to assess the safety of products, prior studies have not explored consumer-reported injuries and safety concerns within online reviews of mobility-assistive devices.
This study aimed to investigate injury types and contexts stemming from the use of mobility-assistive devices, as reported by older adults or their caregivers in online reviews. It not only identified injury severities and mobility-assistive device failure pathways but also shed light on the development of safety information and protocols for these products.
Reviews concerning assistive devices were extracted from the “assistive aid” categories, which are typically intended for older adult use, on Amazon’s US website. The extracted reviews were filtered so that only those pertaining to mobility-assistive devices (canes, gait or transfer belts, ramps, walkers or rollators, and wheelchairs or transport chairs) were retained. We conducted large-scale content analysis of these 48,886 retained reviews by coding them according to injury type (no injury, potential future injury, minor injury, and major injury) and injury pathway (device critical component breakage or decoupling; unintended movement; instability; poor, uneven surface handling; and trip hazards). Coding efforts were carried out across 2 separate phases in which the team manually verified all instances coded as minor injury, major injury, or potential future injury and established interrater reliability to validate coding efforts.
The content analysis provided a better understanding of the contexts and conditions leading to user injury, as well as the severity of injuries associated with these mobility-assistive devices. Injury pathways—device critical component failures; unintended device movement; poor, uneven surface handling; instability; and trip hazards—were identified for 5 product types (canes, gait and transfer belts, ramps, walkers and rollators, and wheelchairs and transport chairs). Outcomes were normalized per 10,000 posting counts (online reviews) mentioning minor injury, major injury, or potential future injury by product category. Overall, per 10,000 reviews, 240 (2.4%) described mobility-assistive equipment–related user injuries, whereas 2318 (23.18%) revealed potential future injuries.
This study highlights mobility-assistive device injury contexts and severities, suggesting that consumers who posted online reviews attribute most serious injuries to a defective item, rather than user misuse. It implies that many mobility-assistive device injuries may be preventable through patient and caregiver education on how to evaluate new and existing equipment for risk of potential future injury.
The Consumer Product Safety Commission (CPSC) has reported that from 2016 to 2020 there were approximately 14.6 million emergency department (ED) cases associated with older adults using consumer products [
The adoption of these devices is relatively common, with approximately 10% of community-living adults aged ≥65 years adopting them each year to help with their mobility limitations [
Regulatory agency injury prevention efforts often rely on customers and businesses to report unsafe products because it is logistically impossible to inspect every product in the market. It should be noted that safety hazards are generally reported after consumer harm, failing to prevent injury; for example, between 2014 and 2021, the CPSC issued recalls for hundreds of thousands of units of 4 bed handle brands but only after multiple deaths were attributed to these products [
Although medical device stores, specialized pharmacies, and physiotherapists may provide warnings or recommendations on specific devices, access to these may not be straightforward for every older adult. Location or health concerns may prevent access, leading to an older adult demographic that relies on online retailers for purchase of these devices. In this regard, online reviews are often used by consumers and regulators to assess the safety of products. Studies show that 0.2% to 4% of online reviews contain evidence of a product safety concern [
The aims of this study were to investigate older adult injuries stemming from the use of mobility-assistive devices, as reported by older adults or their caregivers. We not only identify injury severities and mobility-assistive device failure pathways but also shed light on the development of safety information and protocols for these devices. To do so, we developed and used an expansive, manually curated data set of mobility-assistive device safety concerns from consumer reviews on Amazon’s US website. On the basis of the findings from our prior studies, we expect that the curated data set of online reviews for mobility-assistive devices will provide valuable insight into the types of injuries that are associated with the use of mobility-assistive devices and the pathways by which mobility-assistive device use precipitates injuries.
Initial data were extracted from Amazon’s US website through the use of an automated script [
Large-scale data coding (labeling) efforts were undertaken as volunteers became available, resulting in 2 separate exploratory coding phases (I and II), described later in this section, and visualized in Figure S1 and Table S1 in
Major injury occurred: someone was seriously hurt by the product, as described in the following review, and required a physician or hospital visit (medical professional intervention) or died:
Very unstable as wheelbase is way too short...product [went] from under me walking down a ramp at least 6 times...broke my thumb.
Minor injury occurred: someone was actually hurt by the product, but it was a minor, self-treatable incident, and no physician visit or hospital visit was explicitly mentioned:
Seems to be not very stable, my mother fell with it and she really scraped her leg badly...she doesn’t want to use it.
Potential future injury: injury could possibly occur; thus, the review writer is cautious about using the product:
Not even 3 months old and already the wheels are falling off! my husband is handicapped and would not be good if the walker collapsed when he tried to sit because the wheel came off!
No injury occurred: there is no indication of an actual or potential future injury as a result of product use:
Sturdy cane. The stands by itself feature, very nice.
Phase I, described in Restrepo et al [
Before phase II coding, the 8 retained categories were further narrowed down to 5 (63%):
The 44,119 retained reviews were coded by 190 undergraduate student volunteers (junior raters) from a triple crown–accredited university in Thailand and an R1 public land-grant university in the United States, which resulted in 3300 (7.48%) shortlisted online reviews that mentioned potential safety concerns. Volunteer work was validated by methods described in phase I [
A mobility-assistive device safety concern data set comprising 2888 reviews was created by consolidating the validated concerns of both phase II (n=2203, 76.28%) and phase I (n=685, 23.72%).
Phases I and II volunteer-coded mobility-assistive device review pool distribution.
Category (Amazon’s US website) and focal product type | Unique products (n=487), n (%) | Phase I reviews (n=4767), n (%) | Phase II reviews (n=44,119), n (%) | Total reviews (n=48,886), n (%) | |
|
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Canes | 179 (36.8) | 2037 (42.7) | 15,664 (35.5) | 17,701 (36.2) |
|
Gait and transfer belts | 31 (6.4) | 106 (2.2) | 1524 (3.5) | 1630 (3.3) |
|
Ramps | 47 (9.7) | 160 (3.4) | 2091 (4.7) | 2251 (4.6) |
|
|||||
|
Walkers and rollators | 119 (24.4) | 1301 (27.3) | 14,987 (34) | 16,288 (33.3) |
|
Wheelchairs and transport chairs | 111 (22.8) | 1163 (24.4) | 9853 (22.3) | 11,016 (22.5) |
The manual validation efforts of phases I and II led to the discovery of 7 device failure mechanisms (injury pathways), resulting in additional coding (of the 2888 reviews) by the authors. Coding disagreements were discussed by the authors to refine the 7 identified injury pathways, leaving 6 (86%) discrete categories (pathways):
Critical component breakage or decoupling: defined as the device or a part or parts of it breaking, falling off, frequently requiring adjusting or retightening (with the exception of brakes), or collapsing; also used when the device was described as being cheaply made, “unsturdy,” or flimsy
Unintended movement: defined as the device or a part or parts of it moving without the user intending it to, although the part itself is not generating instability or at risk of decoupling; also used when the device’s brakes were said to require frequent adjusting or retightening
Instability: defined as the device or a part or parts of it causing instability or unsteadiness while being used; also used when the device was described as wobbly, tippy, off-balance, insecure, or unable to provide adequate support
Poor, uneven surface handling: defined as the device or a part or parts of it frequently getting caught or stuck in small cracks or seams, tangled in grass or gravel, or unable to cross small bumps or thresholds; also used when the device was explicitly described as unsafe when used outside
Trip hazards: defined as the device or a part or parts of it being prone to tripping the user; also used when the device was described as frequently catching the user’s feet
Design failure: defined as the device or a part or parts of it failing to safely assist the user because of a clearly identifiable design flaw not described by the previous 5 pathways (eg, poor ergonomic design, brake accessibility, or absence of brakes [by design]).
Of the 2888 reviews, 32 (1.11%) were deemed to provide insufficient context surrounding the injury to be accurately classified, and 128 (4.43%) had concerns related to shipping and inspection quality (missing parts, broken upon arrival, etc) rather than true safety concerns. Thus, of the 2888 reviews, 160 (5.54%) were removed, leaving 2728 (94.46%).
No hypotheses were specified a priori; therefore, no statistical tests were performed. The values presented in the following tables represent the normalized count per 10,000 reviews of the relevant product categories.
Our research collected and analyzed secondary data from publicly available reviews on Amazon’s US website. The reviewers’ names were not included in the analysis. Reviews are posted on a public forum, where reviewers do not have an expectation of privacy. This type of research was therefore classified as exempt regarding institutional review board considerations. Our research did not involve direct personal interaction with any human participants.
Mobility-assistive device injury–type distributions and totals as well as sample cases are presented in
Mobility-assistive device by injury type per 10,000 reviews.
Mobility-assistive device | Major injury, n (%) | Minor injury, n (%) | Potential future injury, n (%) |
Cane (n=672) | 2 (0.3) | 56 (8.3) | 614 (91.4) |
Gait or transfer belt (n=393) | 6 (1.5) | 43 (10.9) | 344 (87.5) |
Ramp (n=484) | 0 (0) | 22 (4.5) | 462 (95.5) |
Walker or rollator (n=479) | 10 (2.1) | 44 (9.2) | 425 (88.7) |
Wheelchair or transport chair (n=530) | 0 (0) | 57 (10.8) | 473 (89.2) |
Mobility-assistive device–specific sample review snippets for each injury type.
Mobility-assistive device | Major injury | Minor injury | Potential future injury |
Cane |
“[I]t offers no stability. my father’s dr. said stop using immediately. but unfortunately it was after he had a terrible fall, splitting open his head.” “[I] removed the plastic bag and the next thing i knew i was laying on my back hollering, i’ve fallen and i can’t get up! i walked away with a broken rib or two.” |
“[W]hen walking out of a restaurant the cane in my left hand snapped in half...i ended up with bruised rib, bruised stomach and head and scratched fingers. i don’t want this to happen to anyone else...very scary for anyone relying on these.” “[W]hen my father sat on it, the plastic clamp like thing that keeps the chair folder [sic] out just gave in!! it’s a miracle that my dad didn’t break something. he landed on his left arm, his fingers were swollen for 4 days.” |
“[C]ollapsed due to a broken plastic ring the first time my husband (who weighs less than the advertised maximum for the item) my husband [sic] sat in it and left him sprawled on the floor. fortunately he was not injured.” “[T]he bottom rubber stopper came off while i was walking leaving the metal exposed. i almost fell as it slipped out from under me! do not buy this product!” |
Gait or transfer belt |
“[T]wice the belts come undone and our family member has been seriously injured!! It’s a horrible feeling when they slip away n fall getting seriously injured w concussion and sprangs [sic] n bruises.” |
“When lifting my husband...the transfer gate slide up to his chest. no matter how tight you pull the transfer gate will not stay put. actually hurt my husband. who is a paraplegic.” “[O]nce worn and pulled by the helper it leaves a mark on the waist and the patients complain of pain around the waist.” |
“[O]ne of the handles threads snapped within a few minutes of its first use. my father almost fell. this product is dangerously, cheaply made.” “Crappy and unreliable. material is too thin to the point that buckle does not hold adjustment in place. i cannot trust this to secure and hold the elderly person it was bought for.” |
Ramp | —a |
“[T]here are two smooth lines that are very dangerously slippery. knowing that they are there, I’ve slipped many times.” “[T]he ramps are heavy and clumsily to handle. since i am the person who uses the scooter and having to use this has been a big mistake, it has caused my back to hurt.” |
“[V]ery little support in the center section so while you are midway with a wheel chair or just walking on it, the ramp bounces and shifts on the step. i don’t feel secure enough to use it with my dad’s wheel chair.” “[I] tried to use this with a lightweight wheelchair and i felt like it was going to buckle/break underneath me...this ramp is suppose [sic] to have a 600lb weight capacity.” |
Walker or rollator |
“[F]ront right wheel fell off causing my wife to hit her head on a piece of furniture. i had to take her to the emergency room.” “[T]his walker broke apart while my wife was using it. the metal just broke and the walker collapsed. she broke her wrist and hit her head.” |
“[T]he legs gave out and my grandma who was sitting on the walker fell back and hit her head on the concrete.” “[T]he back rest connects to the walker via these thick plastic sockets. while my wife was sitting on it both sockets cracked/broke and she fell off the back of the seat hitting her head on a wall. avoid this walker unless you like head injuries.” |
“[H]ad a cheap front flat bracket that has a weakness on its bent corner. so if your [sic] sitting on the walker and slide to the right or left there is a chance the bracket crumbling dumping you to the floor...i for one can’t be falling, i am hurt enough and i wouldn’t want my loved ones falling either.” “[Y]esterday my husband was using it and the leg broke in half. thankfully he was not hurt but could have been. it broke completely in two at the weld in the leg. this is a safety issue.” |
Wheelchair or transport chair | — |
“[B]ack wheels should be farther back. i fell over backwards and was unable to get up by myself. even a little pressure on the handles will cause the chair to tip backward.” “[T]he handles broke off as we were going down a stair step. almost got badly hurt. the pusher fell on top of the patient and the patient’s head hit the last step. very dangerous.” |
“[U]nfortunately, when my mom sits down in it, it rocks backward. She’s afraid to use it for fear of flipping over backward. sending it back as it’s unusable if it’s unsteady.” “[T]he brakes shouldn’t be relied on. if you plan to use it in a hilly area, don’t count on them to make much of a difference...they wouldn’t work on a hill or on a long slope.” |
aNot available.
Injury pathway by mobility-assistive device–type distributions and totals are displayed in
From the 6 identified pathways,
Injury pathway by mobility-assistive device type per 10,000 reviews.
Injury pathway | Cane, n (%) | Gait or transfer belt, n (%) | Ramp, n (%) | Walker or rollator, n (%) | Wheelchair or transport chair, n (%) |
Critical component breakage or decoupling (n=855) | 240 (28.1) | 123 (14.4) | 129 (15.1) | 141 (16.5) | 222 (26) |
Unintended movement (n=434) | 30 (6.9) | 184 (42.4) | 31 (7.1) | 101 (23.3) | 88 (20.3) |
Instability (n=457) | 180 (39.4) | 0 (0) | 129 (28.2) | 99 (21.7) | 49 (10.7) |
Poor, uneven surface handling (n=75) | 3 (4) | 0 (0) | 0 (0) | 26 (34.7) | 46 (61.3) |
Trip hazards (n=41) | 15 (36.6) | 0 (0) | 9 (22) | 15 (36.6) | 2 (4.9) |
Design failure (n=699) | 205 (29.3) | 86 (12.3) | 187 (26.8) | 98 (14) | 123 (17.6) |
“[T]he handle broke off with the brake assembly causing her to fall. she is now in a recovery/rehabilitation center.” (Product type: walker or rollator; injury type: major injury)
“[O]ne of the spring loaded buttons that holds the legs in position did not hold and the leg collapsed and i fell breaking a couple of ribs. thank god i didn’t break anything else.” (Product type: walker or rollator; injury type: major injury)
“[W]e were going down some stairs and when I leaned the chair back the handles snapped dropping both of us down the stairs.” (Product type: wheelchair or transport chair; injury type: minor injury)
“[S]eat broke attempting to use it the first time the plastic ring supporting the seat broke on the first attempted use and the seat failed. i fell on the floor bruising my tail bone.” (Product type: cane [with seat]; injury type: minor injury)
“[T]hree months into use, when it broke, nearly sending me to the pavement! one of the metal pegs...sheared off.” (Product type: cane; injury type: potential future injury)
“[T]he plastic wheels went sliding away from me yet again. just home from the emergency room with a broken left arm above the elbow...two fingers broken badly bruised hips...i would like to go to sleep until i am healed from this horrendous prices [sic] tragedy.” (Product type: walker or rollator; injury type: major injury)
“[M]y elderly aunt and it is cheap and slipped out from under her. she fell and broke her hip...she was in the hospital for almost a month.” (Product type: walker or rollator; injury type: major injury)
“[S]uddenly the wheelchair became crazy, drove out by itself and ran into a person before i stopped it...it was scary...think about if i run into kids or right into traffic.” (Product type: wheelchair or transport chair; injury type: minor injury)
“[I] put it a bit lose [sic] and it rose up to her breast and between me and my sister couldn’t move my mom. after, i made it so tight that she yelped when i buckled it, it still rose up and went under her breast and once again hurt her.” (Product type: gait or transfer belt; injury type: minor injury)
“[H]owever, i wish it had a rubberized pad to keep from slipping on it. the aluminum tends to get slippery, so watch yourself!” (Product type: ramp; injury type: potential future injury)
“[I] bought this small walker for my 89 year old 115 pound mother...the walker tipped over and she fell and broke her hip. this product is not strong, stable or well balanced and is very dangerous.” (Product type: walker or rollator; injury type: major injury)
“not safe...can cause falls-doesn’t feel stable...my dad and a good friend i bought this for stepped on the legs...my dad didn’t fall, but my friend did and cracked her head open on the corner of a wall and has 16 staples.” (Product type: cane; injury type: major injury)
“[I]t’s a very dangerous equipment...i used it for about two weeks, i tumbled from it twice, because it’s extremely unstable, as you slightly lean forward, it will flips [sic] over.” (Product type: wheelchair or transport chair; injury type: minor injury)
“[I] walked on a hill and fell 3x. it tips over easily if all 4 legs are not on a flat surface. this cane is a disaster for me.” (Product type: cane; injury type: minor injury)
“[I]t didn’t lay right as a ramp. when you stood at the top of the ramp the bottom part lifts off the ground.” (Product type: ramp; injury type: potential future injury)
“[W]heel of this walker got caught on a transition from carpet to tile and flipped my grandma over and she hit her head and had to go to the er.” (Product type: walker or rollator; injury type: major injury)
“[1st] day wheels hung up on threshold of door, mom flew over the top and broke her shoulder! wheels are too small!!” (Product type: walker or rollator; injury type: major injury)
“[I]f you are planning on using this wheelchair outside or if you are a person with both legs amputated, i would not consider buying this wheelchair, if you come across a crack in the sidewalk this wheelchair will tip on you. i learned the hard way.” (Product type: wheelchair or transport chair; injury type: minor injury)
“[T]hese tires vibrated the chair significantly over exposed aggregate walkways...this vibration was painful for her. i would not recommend this wheelchair for a recovery where vibration is painful to the surgical site.” (Product type: wheelchair or transport chair; injury type: minor injury)
“[T]he cane just doesn’t provide the proper support. when on uneven surfaces, the bottom simply doesn’t provide the support of a normal cane. i am severely injured with a spinal cord injury...for me, placing it flat on the ground isn’t as easy as i expected on uneven surfaces.” (Product type: cane; injury type: potential future injury)
“This walker is dangerous i have tripped over the wheel several times last week i tripped on the wheel and fell i have a bad fracture on my toe and foot.” (Product type: walker or rollator; injury type: major injury)
“[T]he cane is worthless i tripped on it and broke my right ankle.” (Product type: cane; injury type: major injury)
“[W]alkers rear wheels are so large they protrude so far back, user can trip very easily. ’ve caught my foot, tripped and fallen at least 5 times already. hard to get used to.” (Product type: walker or rollator; injury type: minor injury)
“[I] had the hurrycane less then [sic] 10 mins before i tripped over the base causing the cane to collapse on it’s self [sic] and causing me to hit the ground.” (Product type: cane; injury type: minor injury)
“[T]he hinges on the ramp that allow it to fold up do not recess into the seam once the ramp is opened. the hinges stick up and become trip hazards. i bought the ramp for my elderly father who has trouble navigating steps. he would have tripped on those hinges if he tried to walk up the ramp.” (Product type: ramp; injury type: potential future injury)
“[G]randmother…recently fell in the hallway and fractured her pelvis using it. she accidentally pressed one or both of the triggers causing it to fold while using it.” (Product type: walker or rollator; injury type: major injury)
“[T]he grip has a hard rubber bump that hit right in the center of my palm and transferred the full force of the cane hitting the ground directly through my palm into my wrist. there was none of the shock absorption...it became so painful that i have thrown these away, something i almost never do.” (Product type: cane; injury type: minor injury)
“[Two] months later it will not stand by itself without my doing a lot of adjusting. it falls over, i have to pick it up and when i bend to pick it up, i frequently fall.” (Product type: cane; injury type: minor injury)
“[I] assumed the buckle would be located in the middle. it is not. no matter how we tried to adjust it the buckle ends up under my breast making lifting painful.” (Product type: gait or transfer belt; injury type: minor injury)
“[H]eavy duty, but it’s difficult to undo, would be a big problem in an emergency.” (Product type: gait or transfer belt; injury type: potential future injury)
We created a novel data set of safety concerns from reviews of mobility-assistive devices on Amazon’s US website. The data set provided a better understanding of (1) the contexts and conditions leading to user injury and (2) the severity of injuries associated with these mobility-assistive devices. Prior studies of older adult injuries while using mobility-assistive devices reported incidence rates of ED visits and types of injuries associated with mobility-assistive device use [
Our findings suggest that many mobility-assistive device injuries may be preventable through patient and caregiver education about how to evaluate new and existing equipment for potential future injuries.
We found gait or transfer belts to have an unusually high rate of injuries linked to
Beyond weak braking systems, reviews of walkers or rollators also revealed that some were alarmingly susceptible to
Wheelchairs or transport chairs and walkers or rollators also lead
With regard to walker or rollator and cane
Regarding this, we found the bases of quad and tripod canes to be highly susceptible to instability, comprising more than two-thirds of identified
Aside from instability, users frequently reported these 2 product categories (canes and ramps) as having design-related issues (
In support of injury prevention efforts for this population classified as susceptible, our findings may inform educational interventions to inform older adults and their caregivers about safety issues associated with mobility-assistive equipment. Educational interventions would include information about how to select safe mobility-assistive products, how to fit the mobility-assistive device to the user, how to safely use the newly adopted mobility-assistive devices, and how to assess the safety of the product over time. Moreover, beyond our available data, which provide actionable consumer safety information, future use of the presented injury pathway categories may aid businesses and legislators seeking to monitor device safety because these may allow for more specific search parameters and more effective monitoring of frequent device failure mechanisms.
This study includes several limitations. Although the source data span >600,000 reviews and dozens of categories, we focused only on a subset of 1 category (mobility-assistive devices). We analyzed only injury incidents and concerns actively self-reported by older adults and caregivers within online mobility-assistive device reviews on a single major marketplace (Amazon’s US website); products listed by other retailers may yield different findings. As the sample is subject to self-selection bias, results should be taken as
We selected Amazon over other retailers because it is one of the largest and most popular online retailers in the United States, containing dedicated assistive device categories offering hundreds of different brands and products. Selecting a smaller retailer would have likely yielded fewer data, with diminished brand and product diversity. However, because we restricted our sample to reviews on Amazon’s US website, the study does not include experiences concerning devices acquired through medical device stores or specialized pharmacies, which may offer device-fitting services and have trained staff to assist in the selection and purchase of the correct device. As Amazon does not provide any of these services, consumers must conduct their own research at the time of purchase, which may result in certain negative experiences owing to poor equipment selection and fit rather than actual equipment malfunction.
Regardless, there may be skew in who is reporting issues via product reviews and thus some underreporting bias; however, our goal was to surface issues that regulators and manufacturers previously were not aware of to focus remediation efforts, rather than the conventional epidemiological concern of quantifying the incidence and distribution of incidents. The manageable volume of substantial issues surfaced by our method means that regulators and manufacturers can manually investigate the veracity of each report, as well as prioritize and plan remediation efforts.
In addition, within the curated data set, less frequently adopted devices, namely, gait or transfer belts and ramps, have considerably smaller sample sizes than categories such as canes and walkers or rollators. Beyond increased bias, this affects study results in that both normalized (
Finally, although the large-scale coding efforts resulted in 100,000 coded reviews, because of limited volunteer labor resources, only instances coded initially as “major injury,” “minor injury,” or “potential future injury” (n=6400, 6.4%) by the volunteers were verified by the authors and doctoral student. Future work could explore the possibility of training machine learning classifiers on the data set to use the models to rapidly annotate hundreds of thousands of reviews, which could then be filtered by desired injury and product type and manually analyzed.
We introduced a novel online review data set containing safety concerns for mobility-assistive devices typically used by older adults. Our findings highlight device-specific contexts within which these devices are harming older adults and indicate that older adults and their caregivers tend to attribute serious injuries to defective items, rather than misuse.
Supplementary material in the form of 1 figure and 9 tables designed to provide further insight into the coding process and data set.
Consumer Product Safety Commission
emergency department
Manufacturer and User Facility Device Experience
National Electronic Injury Surveillance System
This study was supported by the Virginia Tech Data & Decision Sciences destination area and the Virginia Tech Institute for Society, Culture, and Environment. The funders did not influence the content of the manuscript or its review and approval for publication.
We have made the data set available at Mendeley [
None declared.