The aim of the study was to investigate the epidemiology of firework-related injuries, identifying common injury patterns, and pinpointing key risk factors.

Notably, 80% of patients who sustained injuries were male, with the mean age of 24 years. This is in line with previous reports in the literature, which identified male gender as significant risk factor for firework-related injuries [6, 11, 12, 14, 21,22,23,24] and demonstrated a correlation between younger age and a higher risk [11, 14]. Injuries to the hand were by far the most frequent with about half of the patients sustaining injuries to multiple body regions, a pattern consistent with findings from previous studies [15]. The hand injury pattern found in the present study is in line with a multicenter study conducted over a seven-year period in five major German hospitals [14]. In addition to our findings, studies focused on ophthalmology and otolaryngology patients have demonstrated that eyes and ears are more frequently affected [6, 12, 15, 22, 24].

The predominant cause underlying these injuries was self-inflicted, specifically igniting the firework and throwing it away prematurely. This observation is consistent with the results of previous studies on the topic [21, 24]. Strikingly, our data study shows that nearly half of the patients sustained injuries as bystanders, a finding that is corroborated by previous research as well [1, 6, 12, 21,22,23,24].

Previous studies investigating the timing of firework-related injuries support our findings: a multicenter study reported, more than one-third (38.7%) of the patients sustained their injuries within the two hours after midnight on January 1st, with the remaining injuries taking place later in the afternoon on New Year’s Day. In a study conducted by Demmer et al., the median time of injury for adults was at 01:50 am on New Year’s Eve [14].

Crucially, our data highlights the following significant risk factors for surgical intervention: bone injuries, male sex, and injuries to multiple body regions. While the necessity for surgical intervention is clearly linked to multiple injuries and bone fractures the association with male sex is less well understood. However, it is known from other behavioral studies, that males are more prone to risk-taking behaviors [25]. Interestingly, a significant negative correlation was identified between the likelihood of burn injuries and meteorological conditions involving precipitation. According to existing literature, no comparable analysis or data are available.

Previous studies have demonstrated a correlation between substance use (e.g., alcohol and drugs) and elevated risk of firework-related injuries, particularly among younger individuals and during celebratory occasions such as New Year’s [1, 6, 7, 11, 22, 24, 26]. Surprisingly, our data provided unsuccessful information demonstrating whether alcohol and drugs have a significant influence on the frequency of injuries sustained around New Year’s Eve. Given that in a worldwide comparison the European Union has the highest per capita alcohol consumption, as compared to other regions of the world, and Germany ranks top 3 among the EU countries [27, 28], the potential relevance of this behavioral aspect and socioeconomical status associated with potential injuries would be an intriguing question to incorporate into future studies.

There are some limitations to our study. First, only pediatric and adult patients who were seen by the surgeon on-call in the pediatric and adult surgical emergency departments of the University Hospital Leipzig were included, excluding patients from departments such as otorhinolaryngology and ophthalmology. In addition, outpatient cases, as well as patients not directly injured by fireworks (e.g. patients who “stumbled over a rocket”), were also excluded, possibly underestimating the total number of New Year’s Eve-related injuries and the higher associated emergency department workload.

Additionally, anamnesis data varied considerably due to the involvement of multiple on-call physicians contributing to the SAP documentation system, leading to inconsistencies and incomplete records. The assessment of firework related injuries is not standardized in the authors’ institution. Consequently, we were compelled to rely on descriptions such as “rockets” or “firecrackers” documented in the patient’s history to identify and categorise the fireworks in question in accordance with German legislation (firework categories F1-F4).

As a result, the study’s limitations include its retrospective design and the existence of missing or incomplete data. The inability to follow-up patients’ cases and their outcome when they are transferred to other treating physicians and practices further limits the data.

The clinical relevance of our topic is undeniable: firework-related injuries are entirely preventable, and their prevention could significantly reduce the workload on emergency departments. Future studies should explore the extent of the increased workload during the festive period surrounding New Year’s Eve and assess whether stricter regulations on the private purchase and use of fireworks could help to reduce health care costs demand.

Evidence from successful prevention campaigns, such as in Denmark [29], or restrictive firework legislation (e.g. the sales ban during the COVID-19 pandemic), have shown a significant reduction in the number of firework related injuries [12, 14]. Figure 4 pinpoints our observation of a reduction in the number of patients with firework-related injuries around New Year’s, which lends support to the hypothesis that legal restrictions and sales bans (e.g. during the COVID-19 pandemic) result in a decline in such injuries. Launching additional prevention campaigns, led by organizations such as DGUV (Deutsche Gesetzliche Unfallversicherung – German Social Accidental Insurance) could raise the overall awareness of existing campaigns [30] with the aim of reducing firework-related injuries and their consequences. This raises the question which types of campaigns (e.g. visual media, social media, schools) are most effective in targeting the high-risk group of young males.

Another interesting field for future research is the psychological and emotional impacts of severe firework injuries, especially on children and adolescents. The results may help to assess the potential for additional legislative measures and guide future political action, such as restricting and reducing public sales of private fireworks and pyrotechnics in Germany, to decrease the prevalence of firework-related injuries and fatalities among patients and bystanders, as well as associated hospitalizations, healthcare costs, and psychological trauma.

Distribution of patients across New Year transitions