Pediatric falls ages 0-4: understanding demographics, mechanisms, and injury severities.

• Type of Material: Article
• Authors: Sofia Chaudhary, Children’s Hospital of Philadelphia; Janet Figueroa, Emory University; Salah Shaikh, Emory University; Elizabeth Williams Mays, Grady Health System; Rana Bayakly, Georgia Department of Public Health; Mahwish Javed, Children’s Healthcare of Atlanta; Matthew Lee Smith, Texas A&M University; Tim Moran, Emory University; Jonathan D. Rupp, Emory University; Sharon Nieb, Emory University
• Language: English
• Date: 2018-04-10
• Publisher: SpringerOpen
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s). 2018
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://injepijournal.springeropen.com/articles/10.1186/s40621-018-0147-x
• Title of Journal or Parent Work: Injury Epidemiology
• ISSN: 2197-1714
• Volume: 5
• Issue: Suppl 1
• Start Page: 7
• End Page: 7
• Grant/Funding Information: Publication of this article was funded by the Injury Free Coalition for Kids®.; This study received no funding.
• Keywords: Falls; Pediatrics; Unintentional
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

BACKGROUND: Pediatric 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. METHODS: This 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. RESULTS: Inclusion 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). CONCLUSIONS: Pediatric 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.