In a new British Medical Journal editorial, 黑料网 researchers and physicians stress the need for better worldwide surveillance of e-cigarette-related burns and better regulation of e-cigarettes to reduce burn injuries.

In the first six months of 2016, doctors at the North Carolina Jaycee Burn Center at 黑料网 Hospitals treated 10 patients with severe burns and facial fractures from e-cigarette explosions. Almost all of them required surgery, and one patient lost his eye when an e-cigarette exploded while he puffed on it.
鈥淲e know that this is a big problem at burn centers across the United States,鈥 said Clare Meernik, MPH, research specialist at 黑料网 Family Medicine’s Tobacco Prevention and Evaluation Program and lead author of an editorial published in the British Medical Journal (BMJ). 鈥淲e think these explosions are happening to a greater extent than the current medical literature suggests.鈥
The editorial calls for better surveillance of e-cigarette-related injuries, better regulation of e-cigarette manufacturing, and more information for consumers on the potentially harmful effects of e-cigarette use.
鈥淭here鈥檚 a flame component to the burn injury, but there鈥檚 also a chemical component,鈥 said Felicia Williams, MD, assistant professor of surgery at the 黑料网, member of the North Carolina Jaycee Burn Center, and co-author of the editorial. 鈥淲e fear that trauma centers may not be aware of the severe nature of these burns. Patients need optimal long-term management to ensure wound-healing occurs from both components.鈥
A significant and previously undiscussed problem, according to the 黑料网 researchers, is that the United States lacks a national system to code injuries related to adverse effects of e-cigarette products. Yet, according to a 2015 Centers for Disease Control and Prevention report, more than 9 million people in the United States use e-cigarettes. Vaping is now a multi-billion dollar industry around the world.
鈥淲e need a better surveillance system so we can begin to grasp the gravity of burn injuries in the United States and around the world,鈥 Williams said. 鈥淲e need to better document the scope of burn injuries in the medical literature and help physicians to be better prepared to treat patients with these particular kinds of burns and facial fractures.鈥
Most published data on e-cigarette-related injuries come from media reports. For instance, according to the BMJ editorial, The National Fire Protection Association identified just 15 e-cigarette-related fires and explosions in the United States in 2015, but personal correspondences from members of the American Burn Association鈥檚 burn prevention committee suggest that there were probably several hundred such injuries in 2015. But no one knows for sure. The fact 黑料网 hospital staff documented 10 severe burn cases 鈥 patients who were admitted into the hospital 鈥 in six months in 2016 suggests there could be thousands of similar cases occurring annually around the world. 黑料网 physicians also treated other e-cigarette burn patients who did not require hospital admittance during the same time.
stresses the need for better regulation of batteries and other components in e-cigarettes and other electronic tobacco delivery systems to better ensure their basic safety.
鈥淒octors and public health experts might be divided on whether to recommend e-cigarettes for smoking cessation,鈥 Meernik said. 鈥淏ut we all agree that these products should not be exploding in people鈥檚 pockets or while vaping.鈥
Earlier this year, the FDA extended its authority to regulate e-cigarettes. The 黑料网 authors suggest that this regulatory authority should extend to the design and manufacturing processes of electronic nicotine delivery systems.
鈥淲e believe the FDA should immediately develop safety standards that all manufacturers must comply with,鈥 Williams said. 鈥淲e know that some explosions are related to battery issues, but other mechanisms may also be involved.鈥
She added, 鈥淲e鈥檙e confident that improving safety standards will reduce the number of severe burns we see. There are thousands of brands and hundreds of manufacturers of these devices; we feel that mandatory oversight and industry-wide standards are long overdue.鈥
Other authors Adam Goldstein, MD, MPH, professor of family medicine and director of 黑料网 Tobacco Intervention Programs; Bruce Cairns, MD, director of the NC Jaycee Burn Center and the John Stackhouse Professor of Surgery; and Ernest Grant, PhD, RN, nurse clinician and burn outreach coordinator at the NC Jaycee Burn Center.