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

Tip-over injuries among children: Data from an urban emergency department of Karachi, Pakistan

INTRODUCTION

Most unintentional injuries among children occur in the home environment. Tip-overs, defined as incidents where heavy objects fall on children due to some type of interaction, are one of the reasons for injuries inside the home. This study aims to determine injury patterns and outcomes for child injuries resulting from tip-overs in the home environment as reported in the emergency department.

METHODS

We performed a retrospective chart review of pediatric (under 18 years) tip-overs injuries occurred in years 2010 to 2015 at the Aga Khan University Hospital. Furthermore, parents of injured children participated in phone interviews to provide information about the injury scene. File review and telephonic interviews were conducted in the year 2015 and 2016.

RESULTS

A total of 75 children visited the emergency department with tip-over injuries, out of which 55 (73%) were boys. The majority of incidents (75.5%) happened inside the home, and the most common places were the living room and bedroom (32% and 21% respectively). More than half (53%) of the children were not under adult supervision at the time of the incident and less than half (47%) of the household took safety measures after the incident. Tip-over injuries were common among 3-year-old children with decreasing frequency as children grew older. The most common causes of tip-overs were TV/TV trolley (32%), followed by furniture (28%), and wall and roof (23%). The most common sites of injuries were head (n = 33, 44%) and extremities (n = 33, 44%). A majority of the cases (n = 66, 88%) were admitted to the hospital from the emergency department, under care of both general (n = 51, 68%) and critical care units (n = 15, 20%). More than a quarter (n = 27, 36%) required at least one surgical procedure during their hospital stay. The median length of hospital stay was one days (interquartile range, IQR 1-5 days). There were two cases of mortality (3%).

CONCLUSION

Most tip-over injuries among children were caused by TV, furniture, and TV trolleys. These injuries can be prevented with public education around home safety measures, such as mounting them on the wall.

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.

Furniture and television tip-over injuries to children treated in United States emergency departments

BACKGROUND

Furniture and television tip-over injuries are an important source of injury to children, especially those younger than 6 years old. A current epidemiologic evaluation of tip-over injuries is needed, especially considering changes in the voluntary safety standard for clothing storage units (CSUs) and the shift in the consumer market from cathode ray tube to flat-screen televisions (TVs), and a decline in household TV ownership during recent years. The objective of this study is to update our understanding of the epidemiologic characteristics and trends of furniture (especially CSU) and TV tip-over injuries treated in United States emergency departments among children < 18 years old.

METHODS

This study retrospectively analyzed data from the National Electronic Injury Surveillance System from 1990 to 2019. Trends in population-based rates were evaluated with regression techniques. All numbers of cases are expressed as national estimates.

RESULTS

An estimated 560,203 children < 18 years old were treated in United States emergency departments for furniture or TV tip-over injuries during the 30-year study period, averaging 18,673 children annually. CSUs were involved in 17.2% (n = 96,321) of tip-overs, and TVs accounted for 41.1% (n = 230,325), which included 16,904 tip-overs (3.0%) that involved both a CSU and TV. The rate of furniture and TV tip-over injuries among children < 18 years old increased by 53.8% (p < 0.0001) from 1990 to 2010, and then decreased by 56.8% (p < 0.0001) from 2010 to 2019. Almost half (47.0%) of injuries occurred to the head/neck; 3.4% of children were admitted to the hospital. Children < 6 years old accounted for 69.9% of furniture and TV tip-over injuries overall; they accounted for 82.5% of CSU-related and 74.7% of TV-related tip-over injuries.

CONCLUSIONS

Despite the decline in tip-over injuries since 2010, more should be done to prevent these injuries, especially among children < 6 years old, because the number of injuries remains high, outcomes can be life-threatening, and effective prevention strategies are known. Safety education, warning labels, and promotion and use of tip restraint devices, while important, are not a substitute for strengthening and enforcing the stability requirements for CSUs and TVs.

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.

Traumatic Brain Injuries Associated With Consumer Products at Home Among US Children Younger Than 5 Years of Age

This study investigated the epidemiology of traumatic brain injuries (TBIs) occurring to young children, associated with consumer products at home in the United States. Data from the National Electronic Injury Surveillance System were analyzed. There were an estimated 2 292 896 (95% CI = 1 707 891-2 877 900) children <5 years of age treated in US emergency departments for a TBI associated with a consumer product at home during 1991-2012, which equals an annual average of 104 223 (95% CI = 77 631-130 814) children. During the 22-year study period, the number and rate of TBIs increased significantly by 283.3% (estimated annual rate of change, m = 7182.6; P < .001) and 266.5% ( m = 0.35; P < .001), respectively. The number of TBIs decreased with increasing age of the child. Falls from household products were the leading mechanism of injury (53.7%). To our knowledge, this is the first nationally representative study of TBIs associated with consumer products at home among young children. These findings underscore the need for increased prevention efforts.

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.

Pediatric considerations in craniofacial trauma

In many respects, craniofacial trauma in children is akin to that in adults. The appearance of fractures and associated injuries is frequently similar. However, the frequencies of different types of fractures and patterns of injury in younger children vary depending on the age of the child. In addition, there are unique aspects that must be considered when imaging the posttraumatic pediatric face. Some of these are based on normal growth and development of the skull base and craniofacial structures, and others on the varying etiologies and mechanisms of craniofacial injury in children, such as injuries related to toppled furniture, nonaccidental trauma, all-terrain vehicle accidents, and impalement injuries.

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.

Pediatric head injuries from earthquakes

By means of some illustrations, the authors briefly report the effects of some accidental head injuries caused by diverse mechanisms occurring in children. Many of these accidents seem to be preventable, but others are completely unavoidable and escape prevention as the one that is depicted in the cover of this issue.

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.

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.