Pediatric tree house-related injuries treated in emergency departments in the United States: 1990-2006

Etiologic factors in falls from height in pediatric cases

OBJECTIVE

In this study, factors causing falls from height and precautions taken for their prevention were investigated.

METHODS

The study was carried out prospectively between June 2009 and June 2010. Patients under 18 years of age presenting at the emergency department of a university hospital, for whom the primary reason for admission was an accidental fall from a height of at least one meter, were included in the study. The demographic characteristics of the patients, the characteristics of the falls, and clinical features were recorded.

RESULTS

Data for 133 patients were evaluated. Among these patients, 72 (54.1%) were male; the median age was 4 (IQR 2-7). The most common fall site was a balcony (38%). Falls frequently happened in the spring and the summer. The mean fall height was 2.9 ± 2.5 m, the median GCS score was 15 (IQR 14-15), and the median PTS was 10 (IQR 9-11). The fall heights was higher in patients who lost consciousness (p < 0.001). Among the 95 patients who were 0-6 years old, it was found that about 55% were unaccompanied by their parents. The most common pathology in the patients was head trauma (63%), while 17.3% had multiple traumas.

CONCLUSION

Since the vast majority of the fall cases were in the pre-school age group, most were due to falls from a balcony, and more than half of the cases were unaccompanied by parents or caregivers, there are two issues that need to be addressed in relation to pediatric falls from height: family education and legal regulations considering child safety in the design of doors, windows, and balconies of buildings.

Pediatric mobility aid-related injuries treated in US emergency departments from 1991 to 2008

OBJECTIVES

Although mobility aids such as crutches, walkers, and wheelchairs are typically beneficial, they can be associated with injury. The objective of this study was to describe the incidence, patterns, and trends of pediatric mobility aid-related injuries to children and adolescents who were aged < or = 19 years and treated in US emergency departments between 1991 and 2008.

METHODS

A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System database for children and adolescents who were aged < or = 19 years. Sample weights were used to calculate national estimates of mobility aid-related injuries on the basis of 2301 actual cases.

RESULTS

An estimated 63 309 cases of children and adolescents who were aged < or = 19 years were treated in US emergency departments for mobility aid-related injuries. Approximately 70% of mobility aid- related injuries occurred while patients were using wheelchairs. Children who were aged 2 to 10 years were more likely to sustain injuries while using walkers and wheelchairs, injure their heads, and sustain traumatic brain injuries. Children who were aged 11 to 19 years were more likely to sustain injuries while using crutches, injure their lower extremities, and sustain sprains and strains. Injuries involving wheelchairs were more likely to be traumatic brain injuries and result in hospitalization. Injuries involving crutches were more likely to involve misuse and be triggered by stairs or curbs.

CONCLUSIONS

Injuries related to crutches, walkers, and wheelchairs have distinct injury patterns, mechanisms of injury, and trigger factors. Injury patterns between younger and older children were different. Additional research is needed to identify effective injury prevention strategies for the pediatric population.

Epidemiology of balcony fall-related injuries, United States, 1990-2006

BACKGROUND

Falls from heights are common in urban areas in the United States. This study describes the epidemiology of balcony fall-related injuries requiring emergency department (ED) treatment among children and adults in the United States from 1990 through 2006.

METHODS

In 2009, a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission was conducted to describe the epidemiology of balcony fall-related injuries.

RESULTS

An estimated 86,500 (95% confidence interval [CI], 68,400-104,600) balcony fall-related injuries were treated in US hospital EDs from 1990 through 2006; 70% of cases were male; 63% were adults (≥18 years old); 94% of injury events occurred at home; 24% of patients were hospitalized; and 8 patients died. The rate of balcony fall-related injuries among children decreased significantly during 1990 to 2006 and was similar to that of adults by the end of the study period. Fall heights ranged from 5 to 87.5 ft. Structural failure of the balcony was involved in an estimated 5600 cases. Patients younger than 18 years were more likely to sustain a concussion/closed head injury (relative risk, 2.42; 95% CI, 1.84-3.18) or skull fracture (relative risk, 5.86; 95% CI, 2.58-13.30) than adults.

CONCLUSIONS

This is the first study of balcony fall-related injuries requiring emergency treatment using a nationally representative sample. Balcony falls are an important cause of injury in the United States. Age, male sex, and warm months of the year were associated with balcony fall-related injuries in our study population.