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Head injury from falls in children younger than 6 years of age
  1. P Burrows1,
  2. L Trefan1,
  3. R Houston2,
  4. J Hughes1,
  5. G Pearson3,
  6. R J Edwards4,
  7. P Hyde5,
  8. I Maconochie6,
  9. R C Parslow7,
  10. A M Kemp1
    1. 1Institute of Primary Care and Public Health, Cardiff School of Medicine, Cardiff, Wales, UK
    2. 2Placements Manager at Kids Company, London, UK
    3. 3Department of Anaesthesia and Intensive Care, University of Birmingham
    4. 4Department of Neurosurgery, Bristol Hospital for Children, Bristol, UK
    5. 5Paediatric Intensive Care Unit, Southampton Childrens Hospital, Southampton, UK
    6. 6National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London
    7. 7Division of Epidemiology and Biostatistics, Leeds Institute of Genetics, Health and Therapeutics (LIGHT), University of Leeds, Leeds, UK
    1. Correspondence to Dr Alison Kemp, Institute of Primary Care and Public Health, Cardiff School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff, Wales CF14 4YS, UK; KempAM{at}cf.ac.uk

    Abstract

    The risk of serious head injury (HI) from a fall in a young child is ill defined. The relationship between the object fallen from and prevalence of intracranial injury (ICI) or skull fracture is described.

    Method Cross-sectional study of HIs from falls in children (<6 years) admitted to UK hospitals, analysed according to the object fallen from and associated Glasgow Coma Score (GCS) or alert, voice, pain, unresponsive (AVPU) and CT scan results.

    Results Of 1775 cases ascertained (median age 18 months, 54.7% boys), 87% (1552) had a GCS=15/AVPU=alert. 19.3% (342) had a CT scan: 32% (110/342) were abnormal; equivalent to 5.9% of the overall population, 16.9% (58) had isolated skull fractures and 13.7% (47) had ICI (49% (23/47) had an associated skull fracture). The prevalence of ICI increased with neurological compromise; however, 12% of children with a GCS=15/AVPU=alert had ICI. When compared to falls from standing, falls from a person's arms (233 children (mean age 1 year)) had a significant relative OR for a skull fracture/ICI of 6.94 (95% CI 3.54 to 13.6), falls from a building (eg, window or attic) (mean age 3 years) OR 6.84 (95% CI 2.65 to 17.6) and from an infant or child product (mean age 21 months) OR 2.75 (95% CI 1.36 to 5.65).

    Conclusions Most HIs from a fall in these children admitted to hospital were minor. Infants, dropped from a carer's arms, those who fell from infant products, a window, wall or from an attic had the greatest chance of ICI or skull fracture. These data inform prevention and the assessment of the likelihood of serious injury when the object fallen from is known.

    • Accident & Emergency
    • Injury Prevention
    • Epidemiology

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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