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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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Houlton AY, Manglick P, Soundappan SSV, Douglass C, Wicks S, Holland AJA, Cass DT. Observational study of falls in children from windows and balconies: What has changed? J Paediatr Child Health 2021; 57:425-430. [PMID: 33107150 DOI: 10.1111/jpc.15240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/14/2020] [Accepted: 09/26/2020] [Indexed: 12/01/2022]
Abstract
AIM To describe patterns of injury from window and balcony falls in children presenting to a tertiary paediatric trauma centre in New South Wales. METHODS A retrospective review of cases of children <15 years who had sustained injuries in a fall from a building, identified from the trauma database between 1998 and 2019. RESULTS A total of 381 falls from windows and balconies were recorded over the 22-year study period. There were 218 falls from windows (57%) and 163 from balconies. The majority (64%) were children under 4 years of age. The male to female ratio was 2:1. While many children sustained simple abrasions, contusions and lacerations, 17% sustained injuries with an injury severity scores of ≥12. There were four deaths. CONCLUSIONS This study identified that children falling from buildings remains a problem in Australia. Although many injuries were minor, severe injuries and fatalities continue to occur.
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Affiliation(s)
- Adelene Y Houlton
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Patricia Manglick
- Centre for Trauma Care, Prevention, Education and Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Soundappan S V Soundappan
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Centre for Trauma Care, Prevention, Education and Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, The Children's Hospital at Westmead Clinical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Candace Douglass
- Kids Health, Child Health Promotion Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Suzanne Wicks
- Kids Health, Child Health Promotion Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Centre for Trauma Care, Prevention, Education and Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, The Children's Hospital at Westmead Clinical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Danny T Cass
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Centre for Trauma Care, Prevention, Education and Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, The Children's Hospital at Westmead Clinical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Epidemiological investigation of traumatic upper extremity fractures in children who applied to emergency department. JOURNAL OF CONTEMPORARY MEDICINE 2018. [DOI: 10.16899/gopctd.454562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wang H, Yu H, Zhou Y, Li C, Liu J, Ou L, Zhao Y, Song G, Han J, Chen Y, Xiang L. Traumatic fractures as a result of falls in children and adolescents: A retrospective observational study. Medicine (Baltimore) 2017; 96:e7879. [PMID: 28906368 PMCID: PMC5604637 DOI: 10.1097/md.0000000000007879] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aim of this study is to investigate the incidence and pattern of traumatic fractures (TFs) as a result of falls in a population of children and adolescents (≤18 years old) in China.This was a cross-sectional study. We retrospectively reviewed 1412 patients who were children and adolescents with TFs as a result of falls admitted to our university-affiliated hospitals in China from 2001 to 2010. Etiologies included high fall (height ≥2) and low fall (height <2 m). The incidence and pattern were summarized with respect to different age groups, year of admission, etiologies, genders, and the neurological function.This study enrolled 1054 males (74.6%) and 358 females (25.4%) aged 10.8 ± 4.7 years. The etiologies were low fall (1059, 75.0%) and high fall (353, 25.0%). There were 2073 fractures in total and 92 patients (6.5%) presented with multiple fractures. The most common fracture sites were upper extremity fractures in 814 patients (57.6%) and lower extremity fractures in 383 patients (27.1%), followed by craniofacial fractures in 233 patients (16.5%). A total of 231 (16.4%) patients suffered a nerve injury. The frequencies of early and late complications/associated injuries were 19.5% (n = 275) and 9.2% (n = 130). The frequencies of emergency admission, nerve injury, spinal fracture, lower extremity fractures, craniofacial fracture, sternum and rib fracture, and early complications/ASOIs were significantly larger in high fall than low fall (all P <.001, respectively). The frequencies of medical insurance rate (P = .042) and upper extremity fractures (P <.001) were significantly larger in low fall than high fall. The frequencies of spinal fracture (P = .039), lower extremity fractures (P = .048), and craniofacial fracture (P = .041) were significantly larger in female than the male patients. The frequency of upper extremity fractures (P <.001) and the mean age (P <.001) was significantly larger in male than female patients. The frequencies of emergency admission, high fall, spinal fracture, and craniofacial fracture were significantly larger in patients with nerve injury than other patients without nerve injury (all P <.001, respectively).Low falls and upper extremity fractures were the most common etiologies and sites, respectively. High fall, spinal fracture and craniofacial fracture were risk factors for nerve injury. Therefore, we should focus on patients who were caused by high fall and presented with spinal and craniofacial fracture to determine the presence of a nerve injury so that we can provide early, timely diagnosis and targeted treatment to children.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning
- State Key Laboratory of Materials Processing and Die & Mould Technology, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital
| | | | - Jun Liu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Lan Ou
- Department of Radiology, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Yiwen Zhao
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning
| | - Guoli Song
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning
| | - Jianda Han
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning
| | - Yu Chen
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
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Pérez-Suárez E, Jiménez-García R, Iglesias-Bouzas M, Serrano A, Porto-Abad R, Casado-Flores J. Caídas desde grandes alturas en Pediatría. Epidemiología y evolución de 54 pacientes. Med Intensiva 2012; 36:89-94. [DOI: 10.1016/j.medin.2011.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/09/2011] [Accepted: 08/30/2011] [Indexed: 11/25/2022]
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Vish NL, Powell EC, Wiltsek D, Sheehan KM. Pediatric window falls: not just a problem for children in high rises. Inj Prev 2006; 11:300-3. [PMID: 16203839 PMCID: PMC1730276 DOI: 10.1136/ip.2005.008664] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Window falls are a frequent cause of injury (15/100,000) among Chicago preschool children. In Boston and New York, public health efforts have successfully decreased window fall injuries. Local data are needed to develop appropriate interventions for Chicago. OBJECTIVE To describe the housing characteristics and types of injuries among children who fell from windows treated in a Chicago pediatric trauma center. METHODS Children treated in a pediatric trauma center for injuries related to window falls between 1995 and 2002 were identified retrospectively. We reviewed family demographics, the circumstances of the fall, and types of injuries. Site visits were performed to determine the height and type of building and type of window where the fall took place. RESULTS The authors reviewed 90 cases; 55 were male. The median age was 2 years. Ninety eight percent of falls were reported to be from the third floor or lower. Site visits (n=77) showed that 96% of the buildings were four storeys or lower. The median length of hospital stay was two days (range 0--24 days). The most common injuries were head trauma and extremity fractures. Three patients died, and an additional three patients were discharged to rehabilitation centers. CONCLUSIONS Some window falls result in serious injury. In Chicago, most falls were from modest heights (2nd/3rd floor windows) in buildings of four or fewer storeys, rather than from "high rises". Strategies to prevent window falls should be directed to the owners and occupants of this type of housing.
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Affiliation(s)
- N L Vish
- Division of Pediatric Emergency Medicine, Cininnati Children's Hospital, Cincinnati, OH, USA.
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Abstract
OBJECTIVE To examine incidence, demographic risk factors, and patterns of injury resulting from falls from buildings and structures in areas with and without a legislation based prevention programme. DESIGN AND SETTING The Health Care Cost and Utilization Project (KID-HCUP) was used to produce national estimates of hospital admissions due to falls from buildings in the US. Areas of New York with and without window guard legislation were identified through the New York Statewide Planning and Research Cooperative System (SPARCS). SUBJECTS Children and adolescents aged 0-18 years. INTERVENTIONS Legislation based window fall prevention programme with enforcement. MAIN OUTCOME MEASURES Hospitalization for injury as a result of falls from buildings and structures in areas with and without enforced mandatory window guard legislation. RESULTS New York City has a higher proportion of the population residing in multi-family dwellings with 10 or more units compared with the nation (53.8% v 12.6%, p<0.0001), but the incidence of injury resulting from falls from buildings is nearly half that observed in the US. For young children, warm weather risks begin earlier and extend later than previously reported. Incidence in very young minority children is nearly twice that of whites. Nearly 90% of children aged 0--4 years fall at home, but the proportion decreases linearly with age. CONCLUSIONS Window guards are associated with reduced injury resulting from falls from buildings and should be mandated in multi-family dwellings where small children reside. Prevention programmes for young children should be initiated in early spring and continued through fall.
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Affiliation(s)
- J C Pressley
- Injury Free Coalition for Kids, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Thélot B, Rigou A, Bonaldi C, Ricard C, Meyer P. Épidémiologie des chutes accidentelles de grande hauteur chez les enfants en Île-de-France entre mai et septembre 2005. SANTE PUBLIQUE 2006; 18:523-32. [PMID: 17294756 DOI: 10.3917/spub.064.0523] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
SUMMARY A survey conducted between May and September 2005 in the Paris Region collected 67 cases of accidental "falls from heights" among the children under the age of 15. Most of the injured children were under the age of 6 (72%), the majority were boys (72%). More than half of the children's families were from extra-European origin, mostly from Sub-Saharan Africa. In 32% of the cases, the fall occurred as the opening had a protection. A piece of furniture was in place beneath the window or was disposed by the child in 55% of the cases; 33% of the children climbed the parapet or the opening. In third of the falls, there was an adult present with the child in the room. Seven children died (10%) and eight (12%) had sequelae. The risk of fall due to the lack of surveillance is not enough known by adults. It is therefore recommended to organise prevention campaigns. To prevent falls, one should revise the regulations for building the parapet and the mechanisms for opening the windows.
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Affiliation(s)
- B Thélot
- Département maladies chroniques et traumatismes, Institut de veille sanitaire, 12, rue du Val d'Osne, 94415 Saint Maurice, France
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Istre GR, McCoy MA, Stowe M, Davies K, Zane D, Anderson RJ, Wiebe R. Childhood injuries due to falls from apartment balconies and windows. Inj Prev 2004; 9:349-52. [PMID: 14693898 PMCID: PMC1731019 DOI: 10.1136/ip.9.4.349] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Falls from balconies and windows are an important cause of childhood injury. This study investigated the circumstances around such falls and attempted to identify possible measures for their prevention. POPULATION Children <15 years living in Dallas County, Texas. METHODS Each child treated because of a fall from a building in 1997-99 had information about the injury collected, and a parent was contacted to obtain further information. For apartment related falls, an attempt was made to visit the apartment to measure windows and balcony rails. RESULTS Ninety eight children were injured in falls from buildings during the three year period; 39 (40%) were admitted to hospital. Seventy five of the falls (77%) involved apartments, and most occurred around noon or evening meal times. Among apartment falls, 39 (52%) fell from windows, 34 (45%) from balconies, and two (3%) from unknown sites. For more than two thirds of balcony related falls, the child fell from between the balcony rails, all of which were spaced more than 4 inches (10 cm) apart. On-site measurement showed the rails were an average of 7.5 inches (19 cm) apart; all of these apartments were built before 1984. For more than two thirds of window related falls, the window was situated within 2 feet (61 cm) of the floor. CONCLUSIONS Two factors are important in falls from apartment windows and balconies: balcony rails more than 4 inches (10 cm) apart, and windows positioned low to the floor. Current building codes do not apply to older apartments, where most of these falls occurred. Nevertheless, these factors may be amenable to environmental modifications that may prevent most of these falls.
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Affiliation(s)
- G R Istre
- Injury Prevention Center of Greater Dallas and PID Associates, Dallas, TX 75235, USA
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Green J. From accidents to risk: Public health and preventable injury. HEALTH RISK & SOCIETY 1999. [DOI: 10.1080/13698579908407005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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