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de Cos V, Galvez A, Rooney AS, Sykes A, Krzyzaniak A, Lazar D, Thangarajah H, Bansal V, Sise M, Ignacio RC. A Window of Opportunity: Understanding Pediatric Falls Using Area Deprivation Index. J Pediatr Surg 2024; 59:331-336. [PMID: 37953160 DOI: 10.1016/j.jpedsurg.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The purpose of our study is to assess neighborhood socioeconomic disadvantage (NSD) as a risk factor for window falls (WF) in children. METHODS A single institution retrospective review was performed of patients ≤18 years old with fall injuries treated at a Level I trauma center between 2018 and 2021. Demographic, injury, and NSD characteristics which were collected from a trauma registry were analyzed and compared between WF versus non-window falls. Area Deprivation Index (ADI) was used to measure NSD levels based on patients' home address 9-digit zip code, with greater NSD being defined as ADI quintiles 4 and 5. Property type was used to compare falls that took place at single-family homes versus apartment buildings. RESULTS Among 1545 pediatric fall injuries, 194 were WF, of which 60 % were male and 46 % were Hispanic. WF patients were younger than NWF patients (median age WF 3.2 vs. age 4.3, p<0.047). WF patients were more likely to have a depressed Glasgow Coma Scale (GCS score ≤12, WF 9 % vs. 3 %) and sustain greater head/neck injuries (median AIS 3vs. AIS 2, p<0.001) when compared to NWF. WF patients had longer hospital and ICU lengths of stay than NWF patients (p<0.001 and p<0.001, respectively). WF patients were more likely to live in areas of greater NSD than NWF patients (53 % vs. 35 %, p<0.001), and 73 % of all WF patients lived in apartments or condominiums. CONCLUSIONS Window fall injuries were associated with lower GCS, greater severity of head/neck injuries, and longer hospital and ICU length of stay than non-window falls. ADI research can provide meaningful data for targeted injury prevention programs in areas where children are at higher risk of window falls. STUDY TYPE Retrospective review. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Víctor de Cos
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Anthony Galvez
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | | | - Alicia Sykes
- Naval Medical Center San Diego Department of General Surgery, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| | | | - David Lazar
- University of California-San Diego School of Medicine, Department of Surgery, Division of Pediatric Surgery, 3020 Children's Way, San Diego, CA 92123, USA
| | - Hari Thangarajah
- University of California-San Diego School of Medicine, Department of Surgery, Division of Pediatric Surgery, 3020 Children's Way, San Diego, CA 92123, USA
| | - Vishal Bansal
- Scripps Mercy Hospital, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Michael Sise
- Scripps Mercy Hospital, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Romeo C Ignacio
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California-San Diego School of Medicine, Department of Surgery, Division of Pediatric Surgery, 3020 Children's Way, San Diego, CA 92123, USA.
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Apostolopoulou K, Setia V, Pettorini B, Parks C, Ellenbogen J, Dawes W, Mallucci C, Mehta B, Sinha A. Secure windows for child safety: a retrospective study of window falls in children, aiming to raise prevention awareness. Childs Nerv Syst 2023; 39:3195-3205. [PMID: 37093265 PMCID: PMC10124675 DOI: 10.1007/s00381-023-05964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of the study is to enhance understanding, raise awareness and inform prevention programmes regarding potential factors that lead to severe paediatric injuries caused by unintentional falls from windows. METHODS This is a retrospective review from a major Trauma Centre, covering the majority of North West England and North Wales and included children under the age of 16 that had sustained falls from windows and were hospitalised between April 2015 and June 2020. RESULTS Overall, 825 patients' records have been reviewed, 39% of which exhibited neurosurgical injuries (322 admissions). The most common cause of injury was falls (42%), out of which 19% was identified as falls from windows which was eventually the core focus of this review (25 patients). The records showed that 72% of the falls were not witnessed by another individual, suggesting that children were being left unattended. Average GCS recorded at presentation was 11.2 and 56% of cases were identified as severe major traumas. With a mean stay of 2.2 days in ICU, 1.6 days in HDU and 6 days in the neurosurgical clinic, average treatment costs per patient were £4,493, £651 and £4,156 respectively. Finally, 52% of patients were identified to require long-term physiotherapy/occupational therapy due to permanent disabilities, 20% long-term antiepileptic treatment for seizures and 44% long-term psychological services input. CONCLUSION This study presents our experience at a major tertiary trauma centre in the UK over a 5-year period, from a paediatric neurosurgical injuries perspective due to fall from windows. We aim to raise awareness and highlight the importance of establishing prevention programmes which would hopefully decrease the incidence of paediatric window falls.
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Affiliation(s)
| | - Vikrant Setia
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Chris Parks
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jonathan Ellenbogen
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - William Dawes
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Bimal Mehta
- A&E Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ajay Sinha
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Risk factors for falls among children aged 0-18 years: a systematic review. World J Pediatr 2022; 18:647-653. [PMID: 35587855 DOI: 10.1007/s12519-022-00556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Accidental falls are the most common cause of injury in children. These falls not only result in pain and injury to children but also can pose a significant financial burden to their families and society. The aim of this study is to identify risk factors for falls in children. METHODS We conducted a systematic review of the literature describing falls in children aged 0-18 years. Studies of falls from a height of 1 m or more were excluded from the analysis. We analyzed the included studies to identify risk factors for falls. RESULTS A total of 1496 articles were initially retrieved, leading to an included set of nine articles, which were published from 1995 to 2021. Risk factors related to fall injury in children aged 0-18 years included age, sex, extroversion, rural areas, history of falls, family factors, caregiver factors, medication use, intravenous therapy, tests requiring movement, disease factors and long hospital stay. CONCLUSION We identified 12 risk factors affecting falls in children, including individual characteristics and family and social factors.
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Jeffries K, Puls HT, Hall M, Bettenhausen JL, Markham JL, Synhorst DC, Dowd MD. Racial and ethnic differences in pediatric unintentional injuries requiring hospitalization. J Hosp Med 2022; 17:19-27. [PMID: 35504583 DOI: 10.1002/jhm.2735] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVE This study aims to comprehensively examine racial and ethnic differences in pediatric unintentional injuries requiring hospitalization by age across injury mechanisms. STUDY DESIGN This was a retrospective, nationally representative cross-sectional analysis of discharge data within the 2016 Kids' Inpatient Database for 98,611 children ≤19 years with unintentional injuries resulting in hospitalization. Injury categories included passengers and pedestrians injured in a motor vehicle crash, falls, drownings, burns, firearms, drug and nondrug poisonings, suffocations, and other injuries. Relative risk (RR) for injuries requiring hospitalization were calculated for children of Black, Hispanic, and Other races and ethnicities compared with White children, and then RR were further stratified by age. Excessive hospitalizations were calculated as the absolute number of hospitalizations for each race and ethnicity group that would have been avoided if each group had the same rate as White children. RESULTS Black children were significantly more likely to be hospitalized compared with White children for all injury mechanisms except falls, and in nearly all age groups with the greatest RR for firearm injuries (RR 9.8 [95% confidence interval: 9.5-10.2]). Differences were associated with 6263 excessive hospitalizations among all racial and ethnic minority children compared with White children. CONCLUSIONS Racial and ethnic minority children represent populations at persistent disproportionate risk for injuries resulting in hospitalization; risk that varies in important ways by injury mechanism and children's age. These findings suggest the importance of the environmental and societal exposures that may drive these differences, but other factors, such as provider bias, may also contribute.
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Affiliation(s)
- Kristyn Jeffries
- Department of Pediatrics, Division of Hospital Medicine, Children's Mercy Hospitals, Kansas City, Missouri, USA
| | - Henry T Puls
- Department of Pediatrics, Division of Hospital Medicine, Children's Mercy Hospitals, Kansas City, Missouri, USA
| | - Matthew Hall
- Department of Pediatrics, Division of Hospital Medicine, Children's Mercy Hospitals, Kansas City, Missouri, USA
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Jessica L Bettenhausen
- Department of Pediatrics, Division of Hospital Medicine, Children's Mercy Hospitals, Kansas City, Missouri, USA
| | - Jessica L Markham
- Department of Pediatrics, Division of Hospital Medicine, Children's Mercy Hospitals, Kansas City, Missouri, USA
| | - David C Synhorst
- Department of Pediatrics, Division of Hospital Medicine, Children's Mercy Hospitals, Kansas City, Missouri, USA
| | - M D Dowd
- Department of Pediatrics, Division of Emergency Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- University of Kansas Medical Center, Kansas City, Missouri, USA
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