Pumpkin carving drives over half of Halloween ED injuries

Pumpkin carving is responsible for more than half of Halloween-related emergency department (ED) visits in the United States, and orthopaedic surgeons are urging families to take precautions before carving and trick-or-treating this month.¹ The American Academy of Orthopaedic Surgeons (AAOS) released guidance on October 9 addressing hand lacerations, falls, and pedestrian safety ahead of the holiday.¹

"A pumpkin-carving cut can be more serious than it looks. Even a small wound can damage the tendons, nerves, or blood vessels beneath the skin and affect movement or sensation in the hand," said Erica D. Taylor, MD, MBA, FAAOS, an orthopaedic hand surgeon at Duke Health.¹ "If a cut causes numbness, tingling or difficulty moving a finger, it should be evaluated promptly."¹

Halloween injury burden in children and adolescents

The US Consumer Product Safety Commission (CPSC) estimates an annual average of 3,200 Halloween-related injuries treated in US EDs over a recent 3-year period.² Of those, 55% were related to pumpkin carving; 25% were falls from putting up decorations, tripping on costumes, or walking while trick-or-treating; and 20% involved lacerations, ingestions, allergic reactions, and other costume- or decoration-related injuries.² Patients younger than 18 years accounted for 46% of injuries, and approximately 10% occurred in children aged 6 years or younger.²

Pumpkin carving hand injury patterns in pediatric patients

A National Electronic Injury Surveillance System (NEISS) analysis estimated 20,579 (95% CI, 17,738-23,420) pumpkin-related knife injuries treated in US EDs from 2012 to 2021, with no meaningful change in incidence over the decade.³ Hand injuries made up 87.6% of cases, most often involving the thumb (33.5%) and index finger (25.0%).³ Patients aged 10 to 19 years were the most frequently injured age group (31.5%), followed by children younger than 10 years (19.5%); girls and young women aged 10 to 19 years were the single most commonly injured subgroup.³ Injuries clustered tightly in time: 83.5% occurred in October, 45.6% in the final week of the month, and incidence peaked on October 30.³

That seasonal predictability gives pediatricians a narrow, well-defined window for anticipatory guidance. Clinically, Taylor's warning reflects a practical concern: a small puncture or laceration on the volar finger can appear minor while concealing tendon or digital nerve injury, making a focused assessment of sensation and isolated flexion important after any carving wound.

AAOS recommends that adults handle all carving, while young children draw designs or decorate pumpkins with paint and markers.¹ Carving should take place in a clean, dry, well-lit area using tools designed for pumpkins, and glow sticks or artificial lights should replace candles inside jack-o'-lanterns.¹ For first aid, the organization advises applying pressure with a clean cloth, elevating the injured area above the heart, and seeking care if a wound is deep or bleeding persists beyond 10 to 15 minutes.¹

Trick-or-treating pedestrian risk and costume safety for children

AAOS also advises well-fitting, hemmed costumes; avoiding top-heavy designs, masks, and hats that limit balance or vision; slip-resistant footwear; and bright colors or reflective tape with flashlights after dark.¹ Children younger than 12 years should be accompanied by an adult, and older children should travel in groups on a planned route.¹

Visibility guidance carries particular weight for younger children. An analysis of 42 years of Fatality Analysis Reporting System data found the risk of pedestrian death was 43% higher on Halloween evening than on control evenings (OR, 1.43; 95% CI, 1.29-1.59), translating to about 4 additional deaths each year.⁴ Children aged 4 to 8 years faced a 10-fold increase in risk (OR, 10.00; 95% CI, 5.23-19.11), with fatalities peaking around 6 PM, though the absolute risk was small and declined over the study period.⁴

References

1. American Academy of Orthopaedic Surgeons. Halloween scares should be spooky, not painful. News release. Newswise. October 9, 2026. Accessed October 12, 2026. https://www.newswise.com/articles/halloween-scares-should-be-spooky-not-painful

2. US Consumer Product Safety Commission. CPSC offers safety tips to keep hazards from haunting your Halloween. News release. October 18, 2022. Accessed October 12, 2026. https://www.cpsc.gov/Newsroom/News-Releases/2023/CPSC-Offers-Safety-Tips-to-Keep-Hazards-from-Haunting-Your-Halloween

3. Johnson CA, LaRochelle L, Newton WN, Daly CA. Pumpkin carving knife injuries: national incidence and trends of hand injury. Am J Emerg Med. 2022;60:83-87. doi:10.1016/j.ajem.2022.07.052

4. Staples JA, Yip C, Redelmeier DA. Pedestrian fatalities associated with Halloween in the United States. JAMA Pediatr. 2019;173(1):101-103. doi:10.1001/jamapediatrics.2018.4052