Analysis of Unintentional Falls in Pediatric Population and Predictors of Morbidity

Paediatric falls: An analysis of patterns of injury and associated mortality in urban India

BACKGROUND

Falls are some of the most common childhood injuries. However, for vulnerable children in low- and middle-income countries (LMICs) such as India, mortality from a fall is nearly three times that of high-income countries. Despite fall being a leading cause of paediatric injury, detailed data from LMICs remain sparse. This study aims to assess fall-related patterns of injury and mortality in children in urban India.

METHODS

We conducted a retrospective analysis from the Towards Improved Trauma Care Outcomes (TITCO) database, comprising 16,000 trauma patients admitted to four tertiary centres in India, between July 2013 and December 2015. We analysed demographics, Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), and the pattern of injury sustained for patients under 18-years admitted with fall and assessed survival probability in different age groups using Kaplan-Meier survival analysis and log-rank tests.

RESULTS

Of 1281 children admitted after a fall, two-to-five-year-olds formed the majority (40 %). Nearly all children (99 %) had blunt trauma. The median ISS was 9 (IQR 9-11) and median GCS was 15. Overall in-hospital mortality was 7.8 % and isolated traumatic brain injury (TBI) was the most common (71 %) injury in those who died. Mortality was significantly higher in male children (9 %) than in female children (5 %) (p = 0.009). There was no significant difference in survival between age groups (p = 0.9).

CONCLUSION

The majority of paediatric patients admitted to urban hospitals in India after a fall were between the ages of two-to-five years, with isolated TBI and male sex associated with greater mortality. These findings have the potential to aid age-specific fall prevention strategies and resource allocation towards targeted initiatives to improve access to care, and consequently, mortality from fall in urban India.

Do Racial and Ethnic Disparities Exist in Intensity of Intracranial Pressure-Directed Therapies and Outcomes Following Pediatric Severe Traumatic Brain Injury?

INTRODUCTION

Studies suggest disparities in outcomes in minoritized children after severe traumatic brain injury. We aimed to evaluate for disparities in intracranial pressure-directed therapies and outcomes after pediatric severe traumatic brain injury.

METHODS

We conducted a secondary analysis of the Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial, which enrolled pediatric severe traumatic brain injury patients (Glasgow Coma Scale score  ≤8) with an intracranial pressure monitor from 2014 to 2018. Patients admitted outside of the United States were excluded. Patients were categorized by race and ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White, and "Other"). We evaluated outcomes by assessing mortality and 3-month Glasgow Outcome Score-Extended for Pediatrics. Our analysis involved parametric and nonparametric testing.

MAIN RESULTS

A total of 671 children were analyzed. Significant associations included older age in non-Hispanic White patients (P < .001), more surgical evacuations in "Other" (P < .001), and differences in discharge location (P = .040). The "other" cohort received hyperventilation less frequently (P = .046), although clinical status during Paco2 measurement was not known. There were no other significant differences in intracranial pressure-directed therapies. Hispanic ethnicity was associated with lower mortality (P = .004) but did not differ in unfavorable outcome (P = .810). Glasgow Outcome Score-Extended for Pediatrics was less likely to be collected for non-Hispanic Black patients (69%; P = .011).

CONCLUSIONS

Our analysis suggests a general lack of disparities in intracranial pressure-directed therapies and outcomes in children after severe traumatic brain injury. Lower mortality in Hispanic patients without a concurrent decrease in unfavorable outcomes, and lower availability of Glasgow Outcome Score-Extended for Pediatrics score for non-Hispanic Black patients merit further investigation.

A Pilot Randomized Trial Evaluating the Cool 2 Be Safe Junior Playground Safety Program for Preschool Children

OBJECTIVE

Unintentional injury is the leading cause of death to children worldwide, and playgrounds pose a significant risk of injury. Those aged 5 and 6 years are particularly vulnerable to playground injuries. Previous interventions have typically targeted environmental modifications or increased supervision to reduce playground injuries; however, minimal research has focused on implementing behavioral interventions that seek to change children's safety knowledge and risk-taking behaviors on the playground. The current randomized trial addressed these gaps in the literature and sought to increase preschool children's hazard awareness skills and knowledge of unsafe playground behaviors and decrease their intentions to engage in risk-taking behaviors on the playground.

METHOD

A total of 77 children aged 5 and 6 years were tested at a laboratory on a university campus, using a parallel group design, with 38 randomized to the playground intervention group and 39 randomly assigned to a control group. The intervention was manualized and delivered to small groups of children (3-5) over several sessions.

RESULTS

Statistical analyses revealed significant group differences. Intervention experience led to significant increases in hazard awareness skills and knowledge of unsafe playground behaviors, and significant decreases in children's risk-taking behavioral intentions, whereas those in the control group showed no significant changes in these scores. Attention scores for those in the intervention group highlighted that the program content was successful in maintaining children's attention and engagement, and memory scores indicated excellent retention of lesson content.

CONCLUSION

The program shows promise in addressing the issue of unintentional playground injuries in young children.

Evaluation of unintentional falls among children and adolescents treated in emergency medical services

Introduction: Unintentional falls are the leading cause of traumatic injuries, without fatal consequences, with significant morbidity in the population of children and adolescents. Goal: The main goal of this research was to analyze the manner of falling in relation to age and gender, and to assess the type of injury and the anatomical region of the body affected by the injury sustained during a fall in patients ≤19 years of age treated in the emergency medical services in the Republic of Srpska. Material and methods: A cross-section study with retrospective analysis of the national e-database WebMedic from 11 emergency medical services between January 2018 and December 2020 was conducted. Research included patients with diagnosis of unintentional injury caused by a fall, aged ≤19 years. Descriptive statistics and the Chi-square test were used for comparisons between groups. Results: During the observed period, 857 cases of unintentional falls were identified, where 87.5% were referred for hospitalization. The group of children aged 0 to 9 years (55.7%) was more often treated for falls (p<0.001), and boys were affected 6.7 times more often than girls (p<0.001). Falls from the same level caused different types of injuries depending on the age and gender of the children (p<0.001). According to the type of injury, superficial injuries (36.8%) and open wounds (29.4%) were most often identified, and the most frequently affected body region was the head (52.0%). Conclusion: The group of children up to the age of nine and males were more often affected by superficial injuries and open wounds, with head injuries being predominant in all age groups. These results could indicate the necessity of creating programs with targeted prevention.