Pediatric short-distance household falls: Biomechanics and associated injury severity

https://doi.org/10.1016/j.aap.2010.07.020Get rights and content

Abstract

Objectives

Short-distance household falls are a common occurrence in young children, but are also a common false history given by caretakers to conceal abusive trauma. The purpose of this study was to determine the severity of injuries that result from accidental short-distance household falls in children, and to investigate the association of fall environment and biomechanical measures with injury outcomes.

Methods

Children aged 0–4 years who presented to the Emergency Department with a history of a short furniture fall were included in the study. Detailed case-based biomechanical assessments were performed using data collected through medical records, interviews, and fall scene investigations. Injuries were rated using the Abbreviated Injury Scale (AIS). Each case was reviewed by a child abuse expert; cases with a vague or inconsistent history and cases being actively investigated for child abuse were excluded.

Results

79 subjects were enrolled in the study; 15 had no injuries, 45 had minor (AIS 1) injuries, 17 had moderate (AIS 2) injuries, and 2 had serious (AIS 3) injuries. No subjects had injuries classified as AIS 4 or higher, and there were no fatalities. Children with moderate or serious injuries resulting from a short-distance household fall tended to have fallen from greater heights, have greater impact velocities, and have a lower body mass index than those with minor or no injuries.

Conclusion

Children aged 0–4 years involved in a short-distance household fall did not sustain severe or life-threatening injuries, and no children in this study had moderate or serious injuries to multiple body regions. Biomechanical measures were found to be associated with injury severity outcomes in short-distance household falls. Knowledge of relationships between biomechanical measures and injury outcomes can aid clinicians when assessing whether a child's injuries were the result of a short-distance fall or some other cause.

Research highlights

▶ Children aged 0–4 years involved in a short-distance household fall did not sustain severe or life-threatening injuries. ▶ No children had moderate or serious injuries to multiple body regions. ▶ Biomechanical measures, particularly fall height, impact velocity, and child body mass index, were found to be significantly associated with injury severity.

Introduction

Short falls in children, especially from beds or other furniture, are a common false history given by caretakers to conceal abusive trauma. In up to 70% of cases of children having abusive injuries, the initial explanation for the injuries given by the caretaker is a fall (Duhaime et al., 1992, Leventhal et al., 1993, Strait et al., 1995, Shaw et al., 1997, Scherl et al., 2000). However, short household falls are also a common occurrence in young children. A study of emergency department visits by children less than one year of age found that 61% of accidental cases were injuries due to falls (Macgregor, 2003). Clinicians are commonly asked to distinguish between abusive and accidental injuries by determining whether a child's injuries are consistent with the stated cause of the injuries. An improved understanding of biomechanical factors and injury severity in short household falls may aid clinicians in this decision. Early detection of abuse may lead to prevention of further escalating injuries and, in some cases, prevent the death of the child. Additionally, there is continuing controversy in the medico-legal community regarding whether short distance falls can lead to severe injuries or death (Hall et al., 1989, Joffe and Diamond, 1990, Chadwick et al., 1991, Plunkett, 2001, Spivack, 2001).

Several studies have investigated the types of injuries associated with bed falls and other short distance falls (Helfer et al., 1977, Nimityongskul and Anderson, 1987, Williams, 1991, Lyons and Oates, 1993, Tarantino et al., 1999, Macgregor, 2000, Belechri et al., 2002). However, few studies have investigated relationships between biomechanical factors and injury outcomes in short pediatric falls (Lyons and Oates, 1993, Prange et al., 2003, Bertocci et al., 2004, Thompson et al., 2009). The purpose of this study was to determine the types and severity of injuries that result from short-distance household falls in children, and to investigate the influence of fall environment and biomechanical measures on injury outcomes. This was accomplished through detailed case-based biomechanical assessments of short-distance household falls in children who presented to the Emergency Department (ED) of a regional children's hospital. Based on a review of prior studies, the authors hypothesized that serious injuries would make up less than 10% of cases.

Section snippets

Study design

This was a prospective, descriptive study approved by the University of Louisville Institutional Review Board (IRB #08.0011) using an informed consent process. To determine injury types and severities occurring in children in common household falls, the medical records of children ages 0–4 years who presented to the ED with a given history of a fall from a bed or other similar furniture were obtained. Interviews with the caregivers and in-depth scene investigations were conducted to obtain

Results

Fig. 2 provides details of study participation. Seventy-nine cases met the criteria for analysis. The subjects ranged in age from 1 to 47 months with a mean age of 18 months. Fifty-four percent (54%) of the subjects were male. Sixty-five percent (65%) of subjects were White, 29% were African American, and 6% were Hispanic.

Discussion

Serious injuries resulting from pediatric short household falls are rare. Less than 3% of the cases seen in this study were classified as a serious injury (MAIS 3), and no severe or life-threatening injuries were seen. Seventy-six percent (76%) of the cases in this study had no injuries or only minor injuries. These results are consistent with other studies of injuries resulting from short distance pediatric falls. Previous studies report no severe or life-threatening injuries and fracture

Limitations

Our study found 21.5% of pediatric falls resulted in moderate injury and 2.5% resulted in serious injury. This number is likely an overestimate of injury severity associated with household falls because only children who presented to the ED were included. Falls are a common occurrence in young children, and often result in no injuries or only minor injuries for which the parents do not seek care (Helfer et al., 1977, Warrington and Wright, 2001). The sample size was relatively small. With a

Conclusions

This study provides a comprehensive evaluation of the biomechanics of short-distance household falls and investigated the association of biomechanical and fall environment measures with injury severity. Children aged 0–4 years involved in a short-distance household fall did not sustain severe or life-threatening injuries. No children in this study had moderate or serious injuries to multiple body regions. Furniture height, impact velocity and child BMI were found to have the greatest influence

Funding source

University of Louisville Grosscurth Biomechanics Endowment Fund (No involvement in conduct of the research or manuscript preparation).

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