Falling televisions: The hidden danger for children

Toppling television injuries in children and adolescents: a systematic review and meta-analysis

CONTEXT

Toppling televisions (TVs) are a source of childhood injury but meta-analysis has not assessed the likelihood of TV injuries in children.

OBJECTIVE

To present pooled results for injuries, following a systematic review.

DATA SOURCES

MEDLINE, Scopus, Google Scholar and EMBASE databases were searched to 5 December 2022.

STUDY SELECTION

Included studies met the following criteria: (1) assessed toppling TV injuries in paediatric populations; (2) reported point estimates as an OR or enabled its calculation and (3) used a comparison group.

DATA EXTRACTION

A standardised form was used to include information on publication year, study design, population type, country, sample size, mean age, risk factors, point estimates or data used to calculate ORs.

RESULTS

A total of 12 803 TV injuries were identified (five studies). Head and neck injuries (OR: 2.13, 95% CI: 1.21 to 3.75) and hospital admission (OR: 2.28, 95% CI: 1.80 to 2.90) were more likely in children aged under 6 years than over 6 years. Conversely, torso injuries were less likely in younger children (OR: 0.60, 95% CI: 0.51 to 0.70). Children under 6 were two and a half times more likely to die or be admitted to an intensive care unit (ICU) as a result of toppling TVs, although this was not statistically significant. Males did not sustain more TV injuries than females.

CONCLUSIONS

Children aged under 6 years are more likely to die, sustain head injuries and require hospital treatment from toppling TVs. Strategies for injury prevention must go beyond warning labels to include community education, promotion and use of tip restraint devices, mandatory safety standards and a commitment from manufacturers to improve TV sets stability.

Television-Related Head Injuries in Children: A Secondary Analysis of a Large Cohort Study of Head-Injured Children in the Pediatric Emergency Care Applied Research Network

OBJECTIVE

The objective of the study was to describe the epidemiology, cranial computed tomography (CT) findings, and clinical outcomes of children with blunt head trauma after television tip-over injuries.

METHODS

We performed a secondary analysis of children younger than 18 years prospectively evaluated for blunt head trauma at 25 emergency departments (EDs) in the Pediatric Emergency Care Applied Research Network from June 2004 to September 2006. Children injured from falling televisions were included. Patients were excluded if injuries occurred more than 24 hours before ED evaluation or if neuroimaging was obtained before evaluation. Data collected included age, race, sex, cranial CT findings, and clinical outcomes. Clinically important traumatic brain injuries (ciTBIs) were defined as death from TBI, neurosurgery, intubation for more than 24 hours for the TBI, or hospital admission of 2 nights or more for the head injury, in association with TBI on CT.

RESULTS

A total of 43,904 children were enrolled into the primary study and 218 (0.5%; 95% confidence interval [CI], 0.4% to 0.6%) were struck by falling televisions. The median (interquartile range) age of the 218 patients was 3.1 (1.9-4.9) years. Seventy-five (34%) of the 218 underwent CT scanning. Ten (13.3%; 95% CI, 6.6% to 23.2%) of the 75 patients with an ED CT had traumatic findings on cranial CT scan. Six patients met the criteria for ciTBI. Three of these patients died. All 6 patients with ciTBIs were younger than 5 years.

CONCLUSIONS

Television tip-overs may cause ciTBIs in children, including death, and the most severe injuries occur in children 5 years or younger. These injuries may be preventable by simple preventive measures such as anchoring television sets with straps.

Occult Pericardial Tamponade Presenting With Altered Mental Status

In the pediatric population, cardiac tamponade may present with altered mental status without any clear signs of trauma. Bedside ultrasound is essential to the early diagnosis of this condition. We describe the case of a 5-year-old boy who sustained a potentially fatal, unrecognized trauma to his chest resulting in cardiac tamponade.

Toppled television sets and head injuries in the pediatric population: a framework for prevention

Injuries to children caused by falling televisions have become more frequent during the last decade. These injuries can be severe and even fatal and are likely to become even more common in the future as TVs increase in size and become more affordable. To formulate guidelines for the prevention of these injuries, the authors systematically reviewed the literature on injuries related to toppling televisions. The authors searched MEDLINE, PubMed, Embase, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, and Google Scholar according to the Cochrane guidelines for all studies involving children 0-18 years of age who were injured by toppled TVs. Factors contributing to injury were categorized using Haddon's Matrix, and the public health approach was used as a framework for developing strategies to prevent these injuries. The vast majority (84%) of the injuries occurred in homes and more than three-fourths were unwitnessed by adult caregivers. The TVs were most commonly large and elevated off the ground. Dressers and other furniture not designed to support TVs were commonly involved in the TV-toppling incident. The case fatality rate varies widely, but almost all deaths reported (96%) were due to brain injuries. Toddlers between the ages of 1 and 3 years most frequently suffer injuries to the head and neck, and they are most likely to suffer severe injuries. Many of these injuries require brain imaging and neurosurgical intervention. Prevention of these injuries will require changes in TV design and legislation as well as increases in public education and awareness. Television-toppling injuries can be easily prevented; however, the rates of injury do not reflect a sufficient level of awareness, nor do they reflect an acceptable effort from an injury prevention perspective.

The evaluation of suspected child physical abuse

Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.

Television-related injuries to children in the United States, 1990-2011

OBJECTIVE

To investigate the epidemiology of television (TV)-related injuries to children in the United States.

METHODS

Using data from the National Electronic Injury Surveillance System, children aged <18 years treated in United States hospital emergency departments for an injury associated with a TV from 1990 through 2011 were investigated.

RESULTS

An estimated 380,885 patients aged <18 years were treated in emergency departments for a TV-related injury during the 22-year study period, which equals an annual average of 17,313 children. The median age of patients was 3 years; children <5 years represented 64.3% of patients, and boys comprised 60.8%. The average annual injury rate was 2.43 (95% confidence interval [CI]: 2.07-2.80) injuries per 10,000 children aged <18 years, with a range of 2.15 (95% CI: 1.64-2.66) to 2.90 (95% CI: 2.31-3.49). Although the overall injury rate was steady, the number and rate of injuries associated with falling TVs increased significantly by 125.5% and 95.3%, respectively, during the study period. In addition, there was a significant 344.1% increase in the number of injuries associated with a TV falling from a dresser/bureau/chest of drawers/armoire during 1995-2011.

CONCLUSIONS

The rate of pediatric injuries caused by falling TVs is increasing, which underscores the need for increased prevention efforts. Prevention strategies include public education, provision of TV anchoring devices at the point of sale of TVs, TV anchoring device distribution programs, strengthening of standards for TV stability, and redesign of TVs to improve stability.

Pediatric crushing head injury: biomechanics and clinical features of an uncommon type of craniocerebral trauma

BACKGROUND

Head injuries constitute one of the leading causes of pediatric morbidity and mortality. Most injuries result from accidents involving an acceleration/deceleration mechanism. However, a special type of head injury occurs when the children sustain a traumatism whose main component is a static load in relation to a crushing mechanism with the head relatively immobile.

PATIENTS AND METHODS

We report a series of children who sustained a craniocerebral injury of variable severity produced by head crushing. We also analyze epidemiological and clinical data, and biomechanics in these injuries.

RESULTS

Mean age of the group (13 boys/6 girls) was 4.1 years. All patients showed external lesions (scalp wounds or hemorrhage from the nose, ears, or throat). Eleven children were initially unconscious. Six children presented cranial nerve deficits in addition to impaired hearing. Skull base fractures were seen in most cases with extension to the vault in 11 instances. Fourteen patients had an associated intracranial lesion, including two with diffuse axonal injury. Surgery was performed in three instances. Only seven patients were left with sequelae.

DISCUSSION AND CONCLUSIONS

The observed skull, brain, and cranial nerve lesions corresponded to a mechanism of bilateral compression of the children's heads mainly occasioned by a static load, although an associated component of dynamic forces was also involved. The skull and its covering and the cranial nerves were the most severely affected structures while the brain seemed to be relatively well preserved. Most crush injuries appear to be preventable by the appropriate supervision of the children.

Television-related injuries in children--the British Columbia experience

PURPOSE

In Canada, mortality from falling televisions (TVs) is the 15th leading cause of childhood death owing to injury. Frequency, characteristics, and outcomes of TV childhood injuries were examined to determine any at risk populations.

METHODS

All TV-related traumas at a tertiary children's hospital from 1997 to 2011 were identified using the Canadian Hospitals Injury Reporting and Prevention Program database and the hospital's trauma database. Charts of admitted patients were reviewed.

RESULTS

Analysis of 179 injuries (10-24 per year) revealed a high frequency of injury in the home and a preponderance of head and neck injuries. Toddlers were the most commonly injured age group. Eleven admitted patients were identified; 6 were admitted to intensive care unit with significant head injuries, 2 of whom required surgery. More than half of admitted patients were First Nations or recent immigrants. The length of stay for a ward vs intensive care unit admission was 1.3 days (range, <1-2 days) compared with 7.6 days (range, <1-20 days), respectively. One child had residual deficits requiring rehabilitation, but there were no mortalities.

CONCLUSION

Injury severity appeared higher in patients from First Nations and recent immigrant families. Television injury would likely have been prevented by a securing device or support.

Craniofacial injuries from television tip-over

BACKGROUND

Craniofacial injuries caused by television (TV) sets falling on small children are becoming a frequent event seen in emergency departments. Injuries occur primarily to the head and neck regions and range from contusions to intracerebral hemorrhage, which at times can be fatal.

OBJECTIVES

Epidemiology and potential complications from TV tip-over injuries are presented.

CASE

Three cases of craniofacial injuries are described from blunt trauma incurred from TV tip-over events.

CONCLUSIONS

It is important to teach parents about the dangers of the new large slim TV sets and the occurrence of injuries when these are not secured properly or placed away from the reach of the child.

Television tip-overs: the Starship Children's Hospital experience and literature review

BACKGROUND

Injuries sustained from television (TV) sets tipping over onto children are uncommon when compared to other forms of trauma, but because of the weight of some TVs relative to the size of small children, severe and sometimes fatal injuries can result. The international literature is limited in describing this form of trauma and none is available for the Australasian region.

AIM

The aims of the present paper are to describe the characteristics and immediate outcomes of children admitted to Starship Children's Hospital following TV tip-overs and review the international literature on this topic.

METHODS

Patients admitted to Starship Hospital were identified retrospectively from the Paediatric Trauma database, and the case notes reviewed. Structured telephone interviews were then conducted with each of the families involved.

RESULTS

Over the 28-month period (June 2006-October 2008) reviewed, 13 children under 15 years of age were identified, with an almost even sex distribution. 5 required admission to the Paediatric Intensive Care Unit (PICU). 9/13 sustained head injuries and 1 patient died from their injuries. Mechanism of injury was in keeping with behaviour to be expected of toddlers. Parents and caregivers were unaware of the dangers posed by TV sets and no precautions had been taken to prevent injury.

CONCLUSIONS

The injuries sustained by children from TV tip-overs are often serious and most commonly involve the head and upper body. This is a common finding in all papers reviewed, but numbers of patients studied are still limited. There is a need for both education of families and improvement in the design of TV sets, to prevent this form of trauma in the paediatric population.

Mortality and morbidity in children caused by falling televisions: a retrospective analysis of 71 cases

Background

Femoral artery pseudoaneurysm following cardiac catheterization is a serious groin complication requiring careful assessment and prompt intervention.

Aims

The risk of femoral artery pseudoaneurysm is estimated at 0.6 to 17% following diagnostic and interventional procedures.

Methods

The clinical use of bedside ultrasonography as part of the physical examination by attending emergency physicians has increased significantly over recent years.

Results

Bedside emergency department ultrasonography provides the clinician with critical information noninvasively, rapidly determining various anatomical structures.

Conclusions

We present the case of a patient with femoral artery pseudoaneurysm detected by bedside emergency department ultrasonography secondary to angiographic catheterization.

Traumatic television tip-overs in the pediatric patient population

BACKGROUND

Head trauma is the leading cause of injury in the pediatric patient population. Although falls are the most common reason for head injury, blunt objects are a significant contributor. The Consumer Product Safety Commission (CPSC) released the top five hidden hazards of the home in 2007 and listed "tip-overs" as the third leading cause of morbidity and mortality. We, therefore, hypothesize that televisions continue to be a significant source of injury to children. Our intent is to examine the most common mechanisms, resulting injuries, and factors associated with television-related injuries so as to increase public awareness of this threat.

METHODS

Trauma patients admitted to our institution are entered into a state-mandated performance-improvement data collection system. After obtaining IRB approval, the medical records of all children admitted to our Level I Pediatric Trauma Center between 1/1/1999 and 7/27/2009 with television-related injuries were reviewed. Data points extracted included standard demographics, as well as television size, television support, final trauma level, Glasgow coma scale (GCS), injury severity score (ISS), intensive care unit (ICU) requirements, surgical procedures, final diagnoses, and hospital length of stay (LOS). Descriptive statistics were performed for the demographic data and intervals. Tests of significance were performed using Student's t-test and χ(2)/Fisher's exact test as appropriate. A P value < 0.05 was considered to be statistically significant.

RESULTS

Fifty-two children were seen at our institution with television tip-over related injuries during the study period. Nearly all injuries (50/52) occurred in the home, and 83% were an unwitnessed event. The mean age was 36 mo. The most common television size responsible for insult was 27 in., and the majority of these (26/52) were supported by a dresser. The mean ISS was 8.3. Patients admitted to the ICU had a higher ISS (12.2 [8.0-16.4] versus 6.8 [5.-8.4]; P = 0.003); however, there was no statistically significant association between television size and ISS (7.5 [4.6-10.4] < 27 in. versus 7.5 [7.8-13.4] ≥ 27 in.; P = 0.111). Injuries to the head were by far the most common (43/52) followed by orthopedic (n = 6) and blunt abdominal (n = 3). There was one death in the study population, and this resulted from a closed head injury.

CONCLUSIONS

Television tip-overs continue to pose a threat to children and can result in significant injury. Most often affected are the toddlers learning to walk and exploring their surrounding environments. The use of a dresser as a stand appears to convey the greatest risk. These injuries are potentially preventable by adequately securing televisions to appropriate stands.

Head injuries in children resulting from the fall of television

Case records of children admitted with head injury due to TV fall in a pediatric tertiary care hospital in Chennai, during March 2007-February 2008 were analysed retrospectively. Out of the 11 children admitted 6 (54%) were in 1-2 yr age group. Bleeding from the ear, nose and throat was the commonest, finding followed by a skull fracture, seen on imaging studies. These were observed in 9 (81.81%) and 8 (72.8%) children respectively. There was no mortality.

Injuries From furniture tip-overs among children and adolescents in the United States, 1990-2007

OBJECTIVE

To describe the epidemiology of pediatric injuries associated with furniture tip-overs in the United States.

METHODS

Data from the National Electronic Injury Surveillance System were analyzed for patients < or =17 years treated in emergency departments for a furniture tip-over-related injury from 1990 through 2007.

RESULTS

An estimated 264 200 furniture tip-over-related injuries occurred during the study period, yielding an average of 14 700 injuries annually, or 20.7 per 100 000 population per year. There was a significant increase in the number and rate of these injuries during the 18-year period. Three-quarters of injuries were to children < or =6 years. Televisions were the item most commonly involved (47.4%). Head/neck injuries were the most common (42.2%) injury type among children 0 to 9 years of age.

CONCLUSIONS

The number and rate of injuries to children associated with furniture tip-overs are increasing. Pediatricians and caregivers should be aware of this important source of pediatric injury and the strategies for prevention.

Furniture injuries in children

AIMS

To determine the incidence, type and severity of furniture-related injuries in children in the Sydney region.

METHODS

Retrospective analysis of presentations to the emergency departments of two paediatric tertiary hospitals in Sydney over a 4-year period from January 2000 to December 2003 with furniture-related injuries. Deaths of children because of furniture-related injuries reported to the Coroner, from 2000-2002, were also reviewed. The main outcome measures were circumstances of injury, type and number of injuries, morbidity, and mortality.

RESULTS

52 children presented with furniture-related injuries. The median age was 2.5 years (range 9 months-15 years), with a male-to-female ratio of 3:2. Falling televisions accounted for 22 (42%) of the injuries. Median Injury Severity Score was 1 (range 1-25). One child died. The most common regions injured were the limbs and the head. Thirty-one children (60%) required medical imaging, 28 (54%) required admission to hospital and 6 were allowed home in under 12 h. Of the 22 patients admitted for longer than 12 h, 14% required intensive care. Median length of stay was 1 day (range 0-15 days). Eighteen patients (35%) suffered scarring or long-term limitations as a result of their injuries. From 2000 to 2002 there were four additional deaths in NSW because of furniture-related injuries, two because of a falling television.

CONCLUSION

Furniture-related injuries represent a cause of serious trauma and death in Australian children. There remains a need for the stability and security of televisions and large furniture items to be improved.

The terrible truth about toppling televisions

OBJECTIVE

To determine the profile of children's injuries resulting from television tipovers and to evaluate the potential in a paediatric health centre for television sets to be tipped by young children.

DESIGN

The present study was conducted by case report review, a retrospective audit of a regional subset of the Canadian Hospitals Injury Reporting and Prevention Program database, and prospective testing of all child-accessible television sets for potential tipping using a static model of a climbing child.

SETTING

Children attending the emergency department of a regional paediatric health centre who reported injuries resulting from a television tipover to the Canadian Hospitals Injury Reporting and Prevention Program were studied. All child-accessible television sets within the same regional paediatric health centre were included in the study.

MAIN OUTCOME MEASURES

The main study outcome measures were the demographics and profile of television tipover injuries encountered, and the failure rate of child-accessible televisions to maintain stability when tested using a static model of a climbing child (four years of age at the 90th weight percentile).

RESULTS

At least 104 children reported injuries related to televisions tipovers between 1990 and 2002. The majority occurred in two-to four-year-old children, and 61% occurred in boys. The most common areas to be injured were the head and neck. Within the hospital, 90% of child-accessible televisions were tippable by children four years of age or younger.

CONCLUSIONS

Television tipovers have the potential to cause significant childhood injuries. Because television sets were not safely maintained within one paediatric health centre, one can only speculate about television safety in homes. Parents need to be educated about this injury risk, and standards for the anchoring of televisions are needed.

Children injured following TV tipovers in Israel, 1997-2003

BACKGROUND

According to the US Consumer Product Safety Commission, about 7000 children, many under age five, are treated annually at emergency rooms for injuries associated with unintentional tipping of television (TV) and furniture. However, the professional literature does not reflect much inquiry regarding this source of risk. In Israel, cases of children injured following TV tipover are reported in newspapers but no studies were conducted in Israel on this issue. The aim of this report is to present data regarding frequency and characteristics of children injured following a falling TV in Israel during recent years, in order to provide more specific information for advising policymakers and raising awareness about this growing danger.

METHODS

Data were obtained from the Israeli National Trauma Registry, and included injured children (0-17) hospitalized between 1997 and 2003, because of TV-related injury. Demographic information, Injury Severity Score (ISS), injured body region, surgical intervention, admission to the intensive care unit, length of hospital stay, destination at discharge and mortality were analysed.

RESULTS

There were 116 children injured following TV tipover during the years analysed, increasing from nine in 1997 to 27 in 2003. Over half of the children (54.3%) were aged 1-2 years; 57.8% were boys. Three-quarters of the TV-related injuries were head and neck injuries; nearly one-fifth had ISS scores of over 15. The mean was 4.3 (median = 2 days); 15 children (12.9%) required surgery and four children died in the hospital.

CONCLUSION

The findings reflect the fact that TV tipover is a growing source of danger that can be serious and should be brought to the attention of the public, health professionals and policymakers. Specific, age-related recommendations should be proposed, such as placing TVs on low and stable surface and not placing the remote controls on the top of the set.

Childhood injuries caused by falling televisions

OBJECTIVES

To obtain a detailed description of the injury scene in an attempt to identify methods for prevention and to describe the morbidity and mortality of children who present to an urban pediatric emergency department (ED) with an injury caused by a falling television.

METHODS

A retrospective descriptive study from a prospectively created database was conducted over one year. All adults accompanying a child younger than 13 years of age who was injured by a falling television were directly interviewed, and the patient medical charts were reviewed.

RESULTS

Twenty-eight children were eligible, and 26 children were analyzed. The median age was 40 months (25th and 75th quartiles: 31, 51 months). None of the televisions, or the furniture that they were placed on, were secured. Most parents (85%) reported that they were unaware that injuries could occur by this mechanism. Fourteen children suffered head injuries, and nine children injured an extremity. Nine children were hospitalized, including two patients admitted to the intensive care unit (ICU).

CONCLUSIONS

Children may present to the ED with injuries caused by falling televisions. These injuries are usually not severe; however, the potential for severe injury exists, and some children may require ICU monitoring. Our data indicate a lack of parental awareness and an absence of primary prevention as a root cause for this problem. Thus, more aggressive education to warn parents about the risk of injury must be implemented so that more families will take the time to place their televisions safely.