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Correspondence to Dr Matthew E Rossheim, Department of Global and Community Health, George Mason University, Fairfax VA 22030, USA; [email protected]
Introduction
Electronic cigarettes (e-cigarettes) are devices that use an electric heater to aerosolise a liquid often containing propylene glycol, vegetable glycerin, nicotine and chemical flavorants for user inhalation.1 E-cigarettes are commonly powered via a lithium-ion battery contained in the device.2 3 Since 2009, studies and media reports have documented instances of e-cigarettes overheating, igniting, and/or exploding.4 5 These events appear to result from lithium-ion battery failures in which the battery overheats to the point of catching fire or exploding, a phenomenon referred to as ‘thermal runaway’.2 3 6 Thermal runaway is thought to be a function of the materials, design, quality of manufacturing and handling.2 3 6 One way this is thought to occur is by e-cigarette batteries short circuiting when they are in contact with metal objects, for example, keys or coins.7
E-cigarette-caused fires and explosions have resulted in severe injuries including: loss of body parts (eg, eye, tongue, teeth), hole blown through the roof of mouth and third degree burns to the face, legs and hands.5 In May 2018, an e-cigarette explosion wound to the head was determined by a medical examiner’s office as the cause of death for a male in his 30s.8 Although e-cigarette explosion and burn injuries are considered ‘rare’,3 5 7–9 they have not been well monitored. The US Food and Drug Administration (FDA) Center for Tobacco Products (CTP) has used media sources, information from federal agency reports and incidents recorded in the peer-reviewed research literature to attempt to estimate injuries caused by e-cigarettes.4 Using these methods, CTP noted 92 explosions/fires that injured 47 people between 2009 and September of 2015.4 A report by the US Fire Administration that included media reports through 2016 identified 195 separate explosion/fire incidents involving e-cigarettes, 133 of which resulted in acute injuries and one-half of which occurred in the year 2016 alone.5 This rapid increase in incidents and injuries in a single year suggests that e-cigarette fire and explosion injuries have become more common in recent years.
However, because many e-cigarette injuries may not be described in a published case report,...