Abstract
BackgroundPediatric unintentional falls are the leading cause of injury-related emergency visits for children < 5 years old. The purpose of this study was to identify population characteristics, injury mechanisms, and injury severities and patterns among children < 5 years to better inform age-appropriate falls prevention strategies.MethodsThis retrospective database study used trauma registry data from the lead pediatric trauma system in Georgia. Data were analyzed for all patients < 5 years with an international classification of disease, 9th revision, clinical modification (ICD-9 CM) external cause of injury code (E-code) for unintentional falls between 1/1/2013 and 12/31/2015. Age (months) was compared across categories of demographic variables, injury mechanisms, and emergency department (ED) disposition using Kruskal-Wallis ANOVA and the Mann Whitney U test. The relationships between demographic variables, mechanism of injury (MOI), and Injury Severity Score (ISS) were evaluated using multinomial logistic regression.ResultsInclusion criteria were met by 1086 patients (median age = 28 months; 59.7% male; 53.8% White; 49.1% < 1 m fall height). Younger children, < 1-year-old, primarily fell from caregiver’s arms, bed, or furniture, while older children sustained more falls from furniture and playgrounds. Children who fell from playground equipment were older (median = 49 months, p < 0.01) than those who fell from the bed (median = 10 months), stairs (median = 18 months), or furniture (median = 19 months). Children < 1 year had the highest proportion of head injuries including skull fracture (63.1%) and intracranial hemorrhage (65.5%), 2-year-old children had the highest proportion of femur fractures (32.9%), and 4-year-old children had the highest proportion of humerus fractures (41.0%). Medicaid patients were younger (median = 24.5 months, p < 0.01) than private payer (median = 34 months). Black patients were younger (median = 20.5 months, p < 0.001) than White patients (median = 29 months). Results from multinomial logistic regression models suggest that as age increases, odds of a severe ISS (16–25) decreased (OR = 0.95, CI = 0.93–0.97).ConclusionsPediatric unintentional falls are a significant burden of injury for children < 5 years. Future work will use these risk and injury profiles to inform current safety recommendations and develop evidence-based interventions for parents/caregivers and pediatric providers.
Highlights
Pediatric unintentional falls are the leading cause of injury-related emergency visits for children < 5 years old
Our research identified trends for children < 1year-old having a majority of low-level falls and sustaining majority of severe head injuries
In comparison to older children, those < 1year-old had more household falls from baby carriers being placed on raised surfaces
Summary
Pediatric unintentional falls are the leading cause of injury-related emergency visits for children < 5 years old. The American Academy of Pediatrics (AAP) has been at the forefront of providing pediatric caregiver and community education as well as fall prevention strategies through Council on Injury, Violence, and Poison Prevention (COIVPP) policy statements about injuries associated with infant walkers, shopping carts, trampolines, and falls from heights (American Academy of Pediatrics, 2001a; American Academy of Pediatrics, 2006; American Academy of Pediatrics, 2012; American Academy of Pediatrics, 2001b). According to the Centers for Disease Control and Prevention, in 2010, unintentional falls in children < 5 years led to 1,077,652 emergency department (ED) visits with lifetime medical costs of over 2.5 billion dollars as well as 22,451 hospitalizations with lifetime medical costs of over 750 million dollars (Centers for Disease Control and Prevention, 2017b) These data exemplify the magnitude of the financial and medical burdens caused by pediatric fall-related injuries
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