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A silent epidemic: childhood falls from height
  1. N Prince1,
  2. I Russell2,
  3. M Ford-Adams2
  1. 1Child Health, Kings College Hospital NHS Trust, London, UK
  2. 2Child Health and Safeguarding, Kings College Hospital NHS Trust, London, UK

Abstract

Introduction Falls from height are a leading cause of morbidity and mortality in children over 1 year of age. The authors suspected a high incidence of childhood falls from buildings and windows in the region served by our hospital. Significant falls lead to acute injury including loss of life and long-term disability. The burden to the hospital and NHS is large.

Aim Determine the incidence of children and babies (less than 16 years of age) attending hospital following falls from buildings. Evaluate the burden of injury and cost. Explore causes and prevention strategies.

Method Retrospective case notes review of all children (<16 years) who presented to our emergency department having fallen from a building in the 18-month period between March 2008 and august 2009.

Results Average of one child per month who has fallen from a building (n=20)

Age of patients: range 8 months–14 years

Cost per patient £6000 or £71 000/year

Each patient occupies 1 psychiatric intensive care unit, 1.3 high dependency unit and 4.4 standard bed-days on average.

Injuries sustained

limb fracture 8

Skull fracture 3

Intracranial bleed 3

Spinal fracture 2

Pelvic/thoracic/abdominal injury 3

Surgery

Orthopaedic 3

Neurosurgery 3

Discussion Many falls were from relatively low heights of two storeys or less. People may be more casual about safety on the upper floors of low buildings. Precipitating factors included a lack of appropriate supervision and a potentially dangerous home environment. Injuries sustained include the expected spectrum of limb, head and organ injuries. Documentation was limited but revealed a lack of window security. The locks supplied to our hospital cost £4.35 per lock (bulk). Pressley and Barlow1 found that window guards are associated with reduced falls from windows and recommended that they should be mandatory through legislation in multifamily dwellings where small children reside. Keogh et al2 found that frequency of falling was related to urban deprivation, poor building maintenance and lack of safety information for residents. A health education programme in New York City began in 1972 to address their high incidence of children falling from windows. Entitled “Children Can't Fly”, the programme was a clear success with a 50% reduction in falls over a two-year period.

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