Retrospective Cohort Comparison of Fall Height in Children in the Greater Los Angeles Area: Targeting Populations for Injury Prevention
Abstract
The purpose of this study was to determine whether falls from significant height occur more frequently in young children. We conducted a 10-year (2004–2014), comparative study using a retrospective cohort of 4713 children (< 18 years) from the Los Angeles county trauma database who were evaluated for a fall. Exposure was fall height, dichotomized into < 10 ft/low-risk fall and > 10 ft/high-risk fall. Primary outcome was age of fall. Secondary outcomes were disposition from emergency department, injuries, resource utilization, and mortality. Of all falls, 4481 (95%) were low-risk and 232 (5%) high-risk. High-risk falls were more frequent in children 1–3 years old (58 vs. 30%, p < 0.01), associated with higher frequency of intracranial hemorrhage (19 vs. 10%, p < 0.01), intubation (11 vs. 1%, p < 0.01), and neurosurgical procedure (2 vs. 0.8%, p = 0.04). There was no difference in mortality (0.86 vs. 0.13%, p = 0.06). In Los Angeles County, children 1–3 years old are most likely to suffer high-risk falls, which are associated with serious injury. Integration of fall prevention education into routine anticipatory guidance should be strongly considered for children 1–3 years old.
Keywords
Pediatric falls Injury prevention Unintentional injuryNotes
Funding
This Research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
Ethical approval was obtained form University of Southern California/Children’s Hospital Los Angeles Institutional Review Board #CHLA-15-00359.
References
- 1.Tracy, E. T., Englum, B. R., Barbas, A. S., Foley, C., Rice, H. E., & Shapiro, M. L. (2013). Pediatric injury patterns by year of age. Journal of Pediatric Surgery, 48(6), 1384–1388. https://doi.org/10.1016/j.jpedsurg.2013.03.041.CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Borse, N., & Sleet, D. A. (2009). CDC Childhood Injury Report: Patterns of unintentional injuries among 0- to 19-year olds in the United States, 2000–2006. Family & Community Health, 32(2), 189. https://doi.org/10.1097/01.FCH.0000347986.44810.59.CrossRefGoogle Scholar
- 3.Kraus, J. F., Fife, D., Cox, P., Ramstein, K., & Conroy, C. (1986). Incidence, severity, and external causes of pediatric brain injury. American Journal of Diseases of Children, 140(7), 687–693.PubMedGoogle Scholar
- 4.Kuppermann, N., Holmes, J. F., Dayan, P. S., Hoyle, J. D., Atabaki, S. M., & Holubkov, R., … Pediatric Emergency Care Applied Research Network (PECARN). (2009). Identification of children at very low risk of clinically-important brain injuries after head trauma: A prospective cohort study. Lancet, 374(9696), 1160–1170. https://doi.org/10.1016/S0140-6736(09)61558-0.CrossRefPubMedGoogle Scholar
- 5.Burrows, P., Trefan, L., Houston, R., Hughes, J., Pearson, G., Edwards, R. J., … Kemp, A. M. (2015). Head injury from falls in children younger than 6 years of age. Archives of Disease in Childhood, 100(11), 1032–1037. https://doi.org/10.1136/archdischild-2014-307119.CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Ibrahim, N. G., Wood, J., Margulies, S. S., & Christian, C. W. (2012). Influence of age and fall type on head injuries in infants and toddlers. International Journal of Developmental Neuroscience, 30(3), 201–206. https://doi.org/10.1016/j.ijdevneu.2011.10.007.CrossRefPubMedGoogle Scholar
- 7.Murray, J. A., Chen, D., Velmahos, G. C., Alo, K., Belzberg, H., Asensio, J. A., … Berne, T. V. (2000). Pediatric falls: is height a predictor of injury and outcome? The American Surgeon, 66(9), 863–865.PubMedGoogle Scholar
- 8.Harris, V. A., Rochette, L. M., & Smith, G. A. (2011). Pediatric injuries attributable to falls from windows in the United States in 1990–2008. Pediatrics, 128(3), 455–462. https://doi.org/10.1542/peds.2010-2687.PubMedGoogle Scholar
- 9.Wang, M. Y., Kim, K. A., Griffith, P. M., Summers, S., McComb, J. G., Levy, M. L., & Mahour, G. H. (2001). Injuries from falls in the pediatric population: an analysis of 729 cases. Journal of Pediatric Surgery, 36(10), 1528–1534. https://doi.org/10.1053/jpsu.2001.27037.CrossRefPubMedGoogle Scholar
- 10.Vish, N. L., Powell, E. C., Wiltsek, D., & Sheehan, K. M. (2005). Pediatric window falls: not just a problem for children in high rises. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention, 11(5), 300–303. https://doi.org/10.1136/ip.2005.008664.CrossRefGoogle Scholar
- 11.Love, P. F., Tepas, J. J., Wludyka, P. S., & Masnita-Iusan, C. (2009). Fall-related pediatric brain injuries: the role of race, age, and sex. The Journal of Trauma, 67(1 Suppl), 12–15. https://doi.org/10.1097/TA.0b013e3181ac7f22.CrossRefGoogle Scholar
- 12.Thompson, A. K., Bertocci, G., Rice, W., & Pierce, M. C. (2011). Pediatric short-distance household falls: biomechanics and associated injury severity. Accident; Analysis and Prevention, 43(1), 143–150. https://doi.org/10.1016/j.aap.2010.07.020.CrossRefPubMedGoogle Scholar
- 13.Mayer, L., Meuli, M., Lips, U., & Frey, B. (2006). The silent epidemic of falls from buildings: Analysis of risk factors. Pediatric Surgery International, 22(9), 743–748. https://doi.org/10.1007/s00383-006-1731-7.CrossRefPubMedGoogle Scholar
- 14.Benoit, R., Watts, D. D., Dwyer, K., Kaufmann, C., & Fakhry, S. (2000). Windows 99: A source of suburban pediatric trauma. The Journal of Trauma, 49(3), 477–481; discussion 481–482.CrossRefPubMedGoogle Scholar
- 15.Unni, P., Locklair, M. R., Morrow, S. E., & Estrada, C. (2012). Age variability in pediatric injuries from falls. The American Journal of Emergency Medicine, 30(8), 1457–1460. https://doi.org/10.1016/j.ajem.2011.12.001.CrossRefPubMedGoogle Scholar
- 16.Lallier, M., Bouchard, S., St-Vil, D., Dupont, J., & Tucci, M. (1999). Falls from heights among children: A retrospective review. Journal of Pediatric Surgery, 34(7), 1060–1063.CrossRefPubMedGoogle Scholar
- 17.Spiegel, C. N., & Lindaman, F. C. (1995). Children can’t fly: A program to prevent childhood morbidity and mortality from window falls. Injury Prevention, 1(3), 194–198.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Boston Public Health Commission. (1993). Window falls prevention. Retrieved from http://bphc.org/whatwedo/childrens-health/injury-prevention/safe-at-home/Documents/1251%20Eng%20Brochure%20(2).pdf.
- 19.Bright Futures/American Academy of Pediatrics. (2017). Guidelines for health supervision of infants, children, and adolescents: Evidence and rationale. Retrieved from https://www.aap.org/en-us/professional-resources/practice-transformation/managing-patients/Pages/Periodicity-Schedule.aspx.
- 20.Prevention, C. on I. and P. (2001). Falls from heights: Windows, roofs, and balconies. Pediatrics, 107(5), 1188–1191. https://doi.org/10.1542/peds.107.5.1188.CrossRefGoogle Scholar
- 21.American College of Surgeons Committee on Trauma, American College of Emergency Physicians Pediatric Emergency Medicine Committee, National Association of Ems Physicians, American Academy of Pediatrics Committee on Pediatric Emergency Medicine, & Fallat, M. E. (2014). Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest. Pediatrics, 133(4), e1104–e1116. https://doi.org/10.1542/peds.2014-0176.CrossRefGoogle Scholar
- 22.Park, S.-H., Cho, B.-M., & Oh, S.-M. (2004). Head injuries from falls in preschool children. Yonsei Medical Journal, 45(2), 229–232. https://doi.org/10.3349/ymj.2004.45.2.229.CrossRefPubMedGoogle Scholar
- 23.Carter, E. A., Waterhouse, L. J., Xiao, R., & Burd, R. S. (2016). Use of payer as a proxy for health insurance status on admission results in misclassification of insurance status among pediatric trauma patients. The American Surgeon, 82(2), 146–151.PubMedGoogle Scholar
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