Injury Prevention 1996; 2: 61-66

METHODOLOGIC ISSUES

Limitations of child injury data from the CPSC'sNational Electronic Injury Surveillance System:the case of baby walker related data

Harold B Weiss

AbstractObjectives-The US Consumer ProductSafety Commission's National ElectronicInjury Surveillance System (NEISS) is aprimary source for children's consumerproduct injury surveillance data in theUS. Differing interpretations of theemergency department basedNEISS babywalker data by various parties promptedthis detailed examination, reclassification,and analysis of the NEISS data to explainthese discrepancies.Methods-Case selection was performedby searching the NEISS 1982-91 databasefor the baby walker product code andvarious text strings for children less than24 months old. False negative and falsepositive cases were identified and re-classified. Adjusted population rates werecomputed and the types and locations ofhospitals contributing to the sample wereexamined.

Results-One per cent false positive and4% false negative misclassification rateswere observed. In 1991, two children'shospitals reported 14% ofthe baby walkerrelated injuries, though these hospitalsmade up just 2% of the sample frame.Through random allocation, one statecurrently contains four acute care hos-pitals and the only two children's hos-pitals reporting to the NEISS system.These six hospitals contributed 18% ofthewalker cases whereas the state representsonly 3% of the US infant population.

Department ofEmergency Medicine,Center for InjuryResearch and Control,University ofPittsburgh, USA

Correspondence and reprintsrequests to:Harold (Hank) Weiss,Research Assistant Professor,Center for Injury Researchand Control, 230 McKeePlace, Suite 400, Pittsburgh,PA 15213, USA.

Conclusions-Misclassification in NEISSbaby walker reports is minimal, withfalse negatives outweighing falsepositives. For trend analysis of productrelated injuries at the frequency ofoccur-rence observed for baby walkers, NEISSsuffers from low sensitivity due to sampl-ing error. For children's injuries, NEISS'estimates have been affected by children'shospitals coming in and out ofthe sampleand currently reflects a random geog-raphic imbalance because one state cont-ributes both of the reporting children'shospitals. To overcome these problemsimproved multiple product coding, a uni-que baby walker code, and stratificationof children's hospitals in an enlargedNEISS sample is recommended.(Injury Prevention 1996; 2: 61-66)

Keywords: consumer product safety, emergencydepartment, population surveillance, baby walkers.

Since 1972, the US Consumer Product SafetyCommission (CPSC) National ElectronicInjury Surveillance System (NEISS) has beena primary source for consumer product injurysurveillance data.1 NEISS statistics are oftenquoted, used for scientific publications,2-4receive widespread media coverage, and areused to initiate and develop CPSC regulatoryactions, especially for child related products.While about 40% of all NEISS reports concemchildren ages 0-14, in a recent one monthperiod 77% (10 of 13) of CPSC press releasespertained to children and risks to children.5 Ofall 1994 proposed CPSC regulations, 73% (14of 19) were targeted toward products of partic-ular relevance to children.6Baby walkers are one of these child related

products that have received a great deal ofattention by CPSC over the years. CPSC'sinvolvement and the NEISS data itself haveoften been associated with widely contrastingepidemiologic interpretations of the babywalker data by proponents and opponents.These differing claims prompted this detailedexamination of the data for possible explana-tions. The aim was to determine the usefulnessand limitations of the NEISS data for babywalkers and by analogy, perhaps other childproduct related injuries.

Baby walker related injuriesA baby walker is a juvenile furniture devicewith a seat and leg openings usually mounted toa plastic deck attached to a base with wheels.Walkers are used to keep babies occupied andhappy, though some parents mistakenly believewalkers assist a child in learning to walk.7 Theirownership and use in the US have become anicon of pretoddler activity. The annual USproduction of baby walkers is estimated atalmost two million units per year by industrysources (unpublished data, Juvenile ProductsManufacturers Association, personal com-munication, 1992) and in the publishedliterature.89 An estimated 70-90%/ of 6 to 12months old children use a walker at sometime.'01'

Concomitant with the high use is anassociated injury risk. Much of what is knownabout walker related injuries is based on theNEISS data, CPSC case reports, and a few

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small hospital based studies. In 1980, theNEISS reported about 10 000 walker relatedinjuries. By 1991, the NEISS estimates in-creased to 27 800.12 In one hospital case seriesof clinic, emergency department, or hos-pitalized head injuries, walker related injuriesrepresented the third most common

mechanism of head injuries in children lessthan 2 years old.'3Most serious walker related trauma seen in

the emergency department results from stairfalls.'2 In a survey of fall injuries at a Canadianchildren's hospital emergency department,only one baby walker injury was reported notrelated to stairs among 124 events.8 In additionto stair falls, the increased mobility and access

provided by a walker are a factor in burnscaused by pulling down hot liquids and in toxicexposures. 14

Concern about the safety of baby walkers hasbeen expressed for many years. This concern

reached a high point in August 1992 with thesubmission of a petition to the CPSC by theConsumer Federation of America, AmericanAcademy of Pediatrics, National SAFE KIDScampaign, and the Consumers Union seekingtheir ban. Along with this petition came a seriesof claims and counter claims regarding theincidence and trends of baby walker relatedinjuries using NEISS data. For example, in1992 the Consumer Federation of Americawrote: 'Each year as many as 28 900 childrenare admitted in hospital emergency rooms withwalker associated injuries'. A baby walkermanufacturer claimed, however, that: '... 23"'0of the NEISS [walker] numbers may representdoorway jumper incidents'.'5 In another in-stance, a medical group reported: 'infantinjuries from such walkers increased almost 45per cent from 19 997 in 1986 to 28 913 in1991 .16 In contrast, CPSC staff reported:'There was no significant change in the rate ofinjury over the period 1984 to 1991 involvingwalkers'.'6 These contrasting claims promptedus to examine reasons for these discrepancies.We sought to clarify the surveillance method-ology used by NEISS in order to determine theusefulness and limitations of the NEISS babywalker data.

MethodsTHE NEISS SYSTEMThe NEISS collects a standardized data setfrom a national sample of emergency depart-ment patients treated for product relatedinjuries. The data fields collected include dateof treatment, age and sex of patient, injurydiagnosis/body part, disposition, two productcodes, third product (uncoded) or child resis-tant closure involvement, accident locale, fireor motor vehicle involvement, and two 71character text comment fields. Patient data isobtained from emergency department recordsby a designated and trained NEISS coderthrough emergency department log andmedical record review. Attempts are made byCPSC trainers to orient as many emergency

department staff as possible to the need fordocumenting product involvement. After

identification, reports are locally coded andelectronically forwarded to a central location.NEISS cases are drawn from all (qualified) firstvisits that involve product related injuries seenin the sampled emergency departments. Bylegislative mandate the NEISS excludesinjuries from most motor vehicles, drugs andcosmetics, alcohol, tobacco, and firearms.The sample is designed to be statistically

representative of all hospitals with emergencydepartments located within the US and itsterritories. As of January 1995, 91 hospitalscontribute to NEISS'7; however, the numbersand types of reporting hospitals have variedover the years. Estimates of national frequen-cies are achieved by applying a weighting factorspecific to each observation in the sampletaking into account the stratified (by number ofvisits) sampling frame and hospital specificcircumstances. Cases from children's hospitalsemergency departments are weighted nodifferently than cases from other hospitals.Through this system more than 200 000 annualreports are processed representing projectedestimates of more than nine million productrelated injuries per year, categorized by about800 different generic product codes.

PRELIMINARY CASE SELECTIONCase selection was aimed at obtaining a rec-lassified data set that included all NEISSreports involving a baby walker but excludingnon-walker case reports. A freedom of inform-ation request was made to CPSC for apreliminary data set for the 10 year period1982-91. The request asked for every reportfor children less than 24 months of age thatincluded the NEISS product code '1508'(defined by NEISS as 'baby walkers orjumpers, also consider baby exercisers'"8) ineither of the two product code fields (n = 3829,unweighted) plus all non-'1508' coded casesthat contained the text string 'WALKER' inthe 'comments' text field (n = 178, unweigh-ted). The text string inclusion criteria allowedfor finding and including non-'1508' codedreports that were baby walker related (falsenegatives). Excluding reports of cases 24months of age or older eliminated concern formisclassified geriatric 'walker' related injuries.

False positive reports were identified fromthe subset of 3829 unweighted reports ofinjuries to children less than 24 months of agewith product code '1508' by excluding injuriesrelated to 'baby jumpers', 'exercisers', andother non-walker products. Jumper andstroller cases were removed by computerassisted searches for the text strings 'JUMP' or'STROL' in the event narrative and subse-quent manual review. In addition, all reportswith a '1508' product code that did not have thetext string 'WALK' in the comments field weremanually reviewed (n = 45, unweighted) formisspellings or mention of an alternative (non-walker) juvenile product.

False negative reports were identified bymanually reviewing the narratives of the 178reports (less than 24 months of age) that had thetext string 'WALKER' in the comment field

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Limitations of NEISS child injury data

but were not coded as '1508' in either productfield. A schematic of the case selection proce-

dures is shown in fig 1. This search strategy

fails to identify those presumably few falsenegatives that misspelled the word'WALKER' in non- '1508' coded cases (basedon the low rate of misspelling observed withinthe '1508' coded cases).

CHILDREN'S HOSPITALSIt was obvious that the number of child injuriesfrom a certain size sample hospital serving onlychildren must be considerably higher than a

similar size non-children's hospital. Yet, CPSChas not performed any special accounting in theNEISS sample for children's hospitals, eitherby sample stratification or weight adjustment.Because the number of children's hospitals inNEISS could have an important impact on

sample estimates, the reclassified and adjustedbaby walker reports were analyzed taking intoaccount the number of children's hospitals

Case selection procedures

Baby walker related reports (unweighted)

ICPSC NEISS data, 1982-91J

in=37 n=134

Figure 1 Schematic overview of baby walker case selection and reclassification proce-dures and results.

40 000

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Figure 2 Corrected weighted estimates of baby walker related injuries by age and

cumulative incidence reported to CPSC, NEISS, 1982-91.

contributing to the data system over differentperiods. Facility codes for children's hospitalscontributing to NEISS were identified frompublished system descriptions and computermatched to each reported case.

DATA ANALYSISBecause changes in the sampling framebetween the initial NEISS sample design andsubsequent growth of hospital emergency

department patient loads used in an updatedsample design, CPSC suggests applying an

upward adjustment to all weighted estimatesfor the period 1984 to 1989 by 12%." Thisadjustment was made only for the trendanalyses and rates described in the results.Rates were calculated using US live births from1982 to 1991 as a proxy of exposure. Thisapproximation of the population at risk isappropriate, as most baby walker relatedinjuries occur for a one year period between 4and 16 months of age (see fig 2).

Sampling errors are measures of the varia-tion in estimates occurring by chance because a

sample rather than all emergency departmentswere surveyed. Generalized NEISS standarderrors corresponding to a coefficient of varia-tion of 0- 13 and 95% confidence intervals wereapplied to the reclassified and rate adjusteddata. This coefficient of variation was obtainedfrom CPSC.'0 It represents the interpolatedcoefficient of variation for estimates in therange of 10 000 to 25 000 cases. CPSC com-

puted this coefficient by averaging thegeneralized sampling errors for annualestimates for the period 1982-92.

ResultsAmong the 3829 '1508' coded reports, 29 were

removed because they mentioned jumpers or

strollers or had ambiguous narratives.' Twoexamples of deleted reports were: 'babysjumper fell hitting pt in head. DX: scalplaceration' and 'Pt fell while walking stroller onto floor fractured clavicle'. Among the 45reports with '1508' product codes that did nothave the text string 'WALK' in the 'comments'field, 26 of these were obvious misspellings andtypographical errors of the word 'WALKER'(for example 'WAKER, WLAKER, etc'), 12narratives did not mention a juvenile product(for example, 'child fell down stairs'), one

report involved a 'BABYCREEPER' stair fall,and these were retained. Six of the 45 reportswithout the text 'WALK' contained names of(presumed) other types of juvenile products(for example, 'CHAIR, CARRIAGE, CAR-RIER, CRAWLER') and were excluded, leav-ing a total of 3794 (unweighted) coded cases.

Among the 178 non-'1508' coded cases withthe text string 'WALKER', 41 records con-

tained the text 'NEW WALKER' referringin all likelihood from the context of the accom-panying narratives to a baby just starting to

walk, not to the age of a product, and were

excluded. Of the remaining 137 reports, 134consisted of baby walker related cases typifiedby baby walker related falls, tips, and trips and

'1508' coded cases <24 months Non-'1508' coded cases <24 monthsin product fields: with 'WALKER' in narrative:

n = 3829 n = 178

Identification and removal ofnon-baby walker products

(jumpers, strollers, chairs, carriers)-35

Identification and removal of casesnot baby walker related

(new walkers and other events)-44

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to a lesser extent, baby walker related poison-ings, liquid burns, contact bums, and hit byobjects. Most ofthese cases involved more thantwo products and were coded in NEISS as stairrelated, stair/rug related, or stair/floor relatedwithout a second product code listed. Twotypical examples of identified non-'1508' codedcases were (emphasis added): 'Pt fell down a

flight of carpeted stairs while in walker landedon carpeted floor head trauma' and 'in a walkerpulled on telephone cord which tipped over a

crock pot:hot water scalded chest arms wristshands'. Multiple product involvement wastypical of the false negative cases. About 20%of this subgroup represented instances whereNEISS coders did not use the second productcode field.The case selection results are summarized in

fig 1. This reclassified (corrected) data setresulted in a projected 10 year population(weighted) total of 195 588 estimated cases.

This represents an increase of 5158 estimatedcases from the unedited '1508' coded cases.

Figure 2 shows the age distribution by monthof the reclassified data. Fifty nine per cent ofthe cases were male. A May-June peak inmonthly estimates was observed over theperiod. Four per cent of the cases were hos-pitalized.

Figure 3 shows the projected rates by year forthe adjusted estimates. The adjustmentschange the trend data only slightly. The datashow an increase in reported baby walkerrelated injury rate over the 10 year period from4 6/1000 in 1982 to 6 9/1000 in 1991. However,as can be seen from the graph, with the large950% confidence intervals the changes inreported rates never achieve significance.

mined from CPSC records that as of April1995, five children's hospitals of different sizeshad randomly been a part of the NEISS sampleat different times (bee table).'7 In 1991 the babywalker related injury rates at the two children'shospitals in the NEISS sample were 11 9 and10.9/10 000 hospital emergency departmentvisits. The overall NEISS baby walker relatedrate was 2.9/10 000 emergency departmentvisits. The two children's hospitals, one largeand one very large hospital, reported 14% of allthe NEISS baby walker related injuries thoughthey encompassed 2% of the patients amongNEISS sampled hospitals. In some years, theone very large children's hospital in the samplecontributed as much as 17% of all weightedwalker related injury estimates. The new largechildren's hospital added in 1991 accounteditself for 9% of the walker related injuryestimates for that year; enough to account forover a third (36%) of the variation from theyear before. The drop in rate from 1989 to 1990was observed to be about the same as the dropin the percentage ofweighted cases contributedby the two children's hospitals that exited theNEISS at the end of 1989.From a geographic perspective it was noted

that both children's hospitals in the 1991NEISS sample were located in one state andthat state (Pennsylvania) had four other hos-pitals contributing to NEISS. Together, thesix Pennsylvania hospitals contributed more

than 18% of all 1991 national walker relatedinjury weighted estimates, though Pennsyl-vania contains only 3% of the US infantpopulation.

Regarding children's hospitals, it was deter- DiscussionThe preceding analyses clarify baby walkerinjury misclassification and suggest reasons for

9.0 the discrepancies in reported estimates of thenumber of baby walker injuries and the

8-0 significance of attributed incidence trends.Some misclassification was apparent, with false

7-0 negatives outnumbering false positives. Thenet effect of the reclassification was a relatively

6-0 - minor upward correction. No basis for a

5-0 _ /( \9t/ t significant impact of 'jumper' related cases inthe '1508' coded data was found. The narrative

4.0 text string contained in each record was crucialto determining the magnitude and direction of

3-0 - misclassification.Adjustments for birth rates over the study

2 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 period resulted in relatively minor downwardYear

corrections in rates for most recent years as

births generally increased over the study,ure 3 Trends in corrected and adjusted baby walker related injury rates/100 live period. The largest uncertainties in the trendths, projected estimates for US 1982-91; 9500 confidence intervals using a 013 estimates stem not from misclassification or

eralized coefficient of variation are shown. (Source of data: US CPSC, NEISS.) rate adjustments but from the relatively smallNEISS sample size resulting in large standarderrors and from hospital type and geographic

ildren's hospitals contributing to NEISS, US 1982- 91 imbalance in the actual random sampling selec-

Emergency department tion process. On sample variation groundsy State load stratum* First month Last month alone, about a 70% increase in observed rates

tsburgh PA Large 1/91 Current from 4-6 to 7 9 would be necessary to achieveladelphia PA Very large 12/80 Currentami FL Large 5/81 12/89 significance at the x = 0 05 level from oneasno CA Large 10/78 12/89 period to another. There is a trend toward an

troit MI Large 12/80 9/84 increase in rates, but it is not significant at theirge = 25 896-42 298 visits, very large = 42 299+. Source: US CPSC. a = 0-05 level.

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Limitations of NEISS child injury data

The drop in calculated rates from 1989 to1990 and the large increase in the reported ratefrom 1990 to 1991 (and likely to be carriedthrough for estimates to the present) can beattributed, in part, to the changes in the under-lying NEISS sample selection process as child-ren's hospitals went out of and into the sample.While the contributions of the children's hos-pitals do not explain all the variation, they arean important factor in year to year changes.The impact on trends described due to hospitaltype probably holds for other children's prod-uct related injuries reported to NEISS. Thiseffect will be even greater for products that areused more in north eastern climates such as iceskates, snow skis, and sleds because both child-ren's hospitals now reporting to NEISS hap-pen to be located in colder climates (both are inPennsylvania). Conversely, child productrelated injuries that involve more temperateactivities (outdoor sports and in-line skating forexample) may be underestimated.

In early 1995, the CPSC began an effort tocollect reports from nine additional children'shospitals to enhance the reporting of childproduct related injuries. Those data will beused for case finding purposes the first year, butCPSC plans to include those children's hos-pitals in producing national estimates in thefuture (Arthur McDonald, CPSC, personalcommunication, 20 November 1995). It wasrecognized that a probability sample of child-ren's hospitals cannot be used to create nationalestimates for children's injuries seen in allemergency departments.Other forms ofbias that can occur in a sample

surveillance system such as NEISS were notexamined in this study. Most of the inform-ation in NEISS represents third party repor-ting subject to varying biases. If the emergencydepartment documentation is in error (byomission or commission) or the walkerrelatedness of the patient's injury wasundocumented in the medical record, thenadjusted estimates will be affected accordingly.Another factor potentially affecting estimateswas exposure to the risk. Denominators usedfor risk calculations should reflect the com-bined exposure to and use of the product.However, information on the rate of babywalker ownership and the length and frequencyof use was not available.The effect of changes in multistory housing

on exposure risk over time is not known.According to the CPSC, 'multistory housinghas risen dramatically, from about 39 percent ofall new single family housing in 1980 to about52 percent in 1989'.16 The regional pattern ofthis increase is obscure since NEISS babywalker injury reports are not geographicallyrandomly distributed and the proportion of allhousing that is multistory over time (a largeincrease in a small factor will show little effect)is unknown. Any effect of increased multistoryhousing may be muted by the large proportionof baby walker stair falls that occur downbasement stairs, not second story to first storyfalls. The issue of consistently proportionalrepresentation of trauma centers in the NEISSsample was not looked at either, but this could

theoretically impact on the stability ofestimated hospitalization rates for various pro-ducts over time.

Conclusions and recommendationsBy clarifying appropriate case selection criteriausing specific product codes and narrative textstrings, through rate adjustments and calcula-tions ofsample variances, and by examining thetypes and locations of hospitals contributing tothe product specific sample over time, impor-tant NEISS limitations have been portrayed.

Misclassification in NEISS baby walkerreports is minimal with false negativesoutweighing false positives. A 1%/ false positiverate was countered by a 400 false negative rate.The short narrative text string proved to be avaluable adjunct to the coded data. For trendanalysis of product related injuries at the levelofoccurrence studied for baby walkers, NEISSsuffers from poor sensitivity due to relativelylarge sampling error. Year to year, walkerrelated injury trend data can be affected bychildren's hospitals coming in and out of thesample. For all children's injuries, NEISS'hospital type sampling scheme reflects a ran-dom geographic imbalance from 1991 to 1994because one north eastern state contributesboth of the reporting children's hospitals.To overcome these problems, it is recom-

mended that NEISS promotes consistentsecond product coding and improve documen-tation and coder training to ensure completionofall product fields in multiple products relatedinjury events. Although few jumper injurieswere included in the '1508' coded cases, itwould be prudent to add a new separate code toallow differential (unique) coding for babywalkers and jumpers. The CPSC should ensurethe stability and representation of children'shospitals in the NEISS sample by stratifyingchildren's hospitals in the sample design. Mostimportantly, the CPSC should enlarge thehospital sample size to reduce sample variation,though this will require additional cost. With-out these changes, uncertainty will continue toaccompany the use of NEISS data for interp-reting incidence and trend patterns for babywalker related injuries in particular, and pos-sibly for other product related child injuries.

Parts of this paper were presented at the Annual Meeting of theAmerican Public Health Association, in San Francisco, October1993.The author wishes to thank the helpful and thorough reviews

of this manuscript by Dr Jeffrey Coben, Dr Herbert Garrison,Dr Samuel Forjuoh, Mr Steve Dearwater, and Mr ArthurMcDonald. I would also like to thank the Allegheny CountyHealth Department and Dr Mary Jones for assistance inprocuring the NEISS data and CPSC and NEISS hospitals forsupplying the data upon which this work was based.

1 US Consumer Product Safety Commission. NEISS datahighlights. Vol 10. Washington, DC: US CPSC, Jan-Dec1986.

2 Schieber R, Branche-Dorsey C, Ryan G. Comparison ofin-line skating injuries with rollerskating and skateboar-ding injuries. JAMA 1994; 271: 1856-8.

3 Reilly J, Walter M. Consumer product aspiration andingestion in children: analysis of emergency room reportsto the national electronic injury surveillance system. AnnOtol Rhinol Laryngol 1992; 101: 739-41.

4 Senturia Y, Binns H, Christoffel K, Tanz R. Exposurecorrected risk estimates for childhood product relatedinjuries. Accid Anal Prev 1993; 25: 473-7.

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5 US Consumer Product Safety Commission. News fromCPSC-1995, March [Online]. Available Gopher:gopher://cpsc.gov:70/11/Pre_Rel/Pre_Rel/95 Pre (18April 1995).

6 US Consumer Product Safety Commission. Proposed rules.[Online]. Available Gopher: gopher://cpsc.gov:70/11/Fed_Reg/94_FedReg/Prop Rules (18 April 1995).

7 Reider M, Schwartz C, Newman J. Pattems of walker useand walker injury. Pediatrics 1986; 78: 488-93.

8 Coury D, Kasten E, Shepherd L, and the Columbus PROBEGroup. Infant walker use in private practice populations.Am J Dis Child 1992; 146: A507.

9 Eskind A. Bringing up baby. Wall Street Journal, 13 April1993.

10 Marcella S, McDonald B. The infant walker: an unapp-reciated household hazard. Conn Med 1990; 54: 127-9.

11 American Medical Association Board of Trustees. Use ofinfant walkers. Am J Dis Child 1991; 145: 933-4.

12 US Consumer Product Safety Commission. Stair steps andbaby walkers don't mix. Consumer Product SAFETYALERT(No 009207) Washington, DC: US CPSC, 1992.

13 Partington M, Swanson J, Meyer F. Head injury and the useof baby walkers: A continuing problem. Ann Emerg Med1991; 20: 52-4.

14 Gaudreault P, McCormick M, Lacouture P, Lovejoy F.

Poisoning exposures and use ofsyrup ofipecac in childrenless than 1 year old. Ann Emerg Med 1986; 15: 808-10.15 GRACO Children's Products. Comments opposing the peti-tion of the Consumer Federation of America et al, to banbaby walkers. (Address to the commission.) (Writtentestimony submitted to the Consumer Product SafetyCommission). Washington, DC: US CPSC, 4 December1992.

16 US Consumer Product Safety Commission. Baby walkerpetition, HP 92-2. (Briefing package) Washington, DC:US CPSC, Released March, 1993.

17 US Consumer Product Safety Commission, National InjuryInformation Clearinghouse. List of NEISS hospitals.Washington, DC: US CPSC, April 1995.

18 US Consumer Product Safety Commission. NEISS codingmanual. Washington, DC: US CPSC, 1987.19 US Consumer Product Safety Commission. Memo fromLeonard Schachter to Terrance R Karels regarding petition

requesting a ban of baby walkers (HP 92-2). Washington,DC: US CPSC, 10 December 1992: 4,5. (Part of babywalker petition briefing package HP 92-2.)20 US Consumer Product Safety Commission. The NEISS

sample (design and implementation). Washington, DC:CPSC Division of Hazard and Injury Data Systems,February, 1994.

Canadian daredevil seeks tightrope record

From Reuters, Hong Kong: 'a man who dubs himself Canada's "prince of the air" willattempt the longest and highest tightrope walk in history tomorrow above the torrents ofChina's awesome Three Gorges on the Yangtze River. With no margin for error, JayCochrane admits to fear.Only a balancing pole and determination will keep him on the wire. On either side ofabout

600 metres of wire stretched across the narrowest point of the gorge is a sheer rock facedropping 400 metres. "Of course I'm afraid," he said yesterday. Speaking by telephonefrom China, Cochrane said: "I have a healthy respect and fear of what I'm about toattempt".The 54 year old Cochrane ... has performed death defying stunts for 40 years. He holds

the Guinness Book of Records title for living on a wire for 21 days and nights. And, ifsuccessful tomorrow, Cochrane will shatter the current 500-metre tightrope walking record."I'm not a stuntman", he said "I'm taking a calculated risk".' (Editor's note: but are suchcalculated risks good examples for children?)

Along the same lines: in-line skating role models?

A contributor to CCSN's BBS writes: 'As an in-line instructor, one of the toughest parts ofmy job is trying to get skaters, be they adults or children, to wear protective gear. While onvacation in BC I had an opportunity to meet Ani, a professional in-line skater who hasappeared in aggressive movies and magazines. When Ani skates he wears only a knee brace.He toldme that he comes to in-line through skateboarding and skateboarders generally skatewithout gear.Ani does have cat-like grace even when he falls; after watching him skate I can attest to

that. However, in my opinion, this is what is wrong with my sport. The pro skaters eitherdon't realize or forget that once they grace the pages ofa magazine or appear in a movie theybecome more than a skater- they become role models. Ani is an adult and realizes the riskshe takes. What worries me are the kids who buy the magazines, who live for the movies, butwho are neither lucky nor born with Ani's skills.

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