Falls From Heights

ABSTRACT & COMMENTARY

Synopsis: Falls from heights, a major cause of visits to urban emergency departments, are rarely mortal, particularly when the fall is less than 20 feet. A majority occur in boys, occur in the home, and occur in the summer months. Head injuries and extremity fractures are the most frequent injuries.

Source: Lallier M, et al. Falls from heights among children: A retrospective review. J Pediatr Surg 1999;34:1063-1064.

A retrospective study of children younger than 18 years of age seen in the emergency department (ED) of the Sainte-Justine Hospital in Montreal between April 1994 and March 1997 because of falls was reviewed retrospectively. There were a total of 28,000 ED visits for falls during this period; of these, 1410 patients (5.3%) were admitted to the hospital for fall-related injuries, observation, and treatment. Of the 1410 children who were hospitalized, 64 had falls of more than 10 feet and data were analyzed for these children. Of this group of 64 children, there were 45 boys and 19 girls. The mean age was 7.4 ± 4.6 years. Thirty-six percent of the children were younger than 4 years and 70% were younger than 10 years of age. Fifty patients fell from 20 feet or less (less than 2 stories) and 14 from a height of more than 20 feet. More than 60% of falls occurred in private residences and during the summer season. Fifteen falls (23%) were from balconies, 13 (20%) were from windows, nine (14%) were from trees, six (9%) were from roofs, and six (9%) were from stairs. Sixty falls were accidental and three were self-inflicted, including two suicide attempts and one occurring after alcohol use.

Two patients (3%) had minimal or no injuries, 55 (86%) sustained only a single major injury, and seven (11%) had multiple-system injuries. Multiple injuries were more frequent in children who fell greater distances. Head injuries (skull fractures, concussions, and intracranial injuries) were most frequent and occurred in 25 patients (39%). Fractures (maxillofacial, extremities, pelvis, and spine) occurred in 22 children (34%). Abdominal injuries occurred in eight children (12%). Surgical intervention was required for 43% of intracranial trauma, 39% of musculoskeletal injuries, 60% of facial trauma, and 50% of spine fractures. The overall survival of this group was 98%. The only death was a child who fell more than 50 feet.

Comment by David T. Bachman, MD, FAAP

There is no doubt that fall-related injuries are a major cause of ED visits and admissions in any pediatric hospital or service. This interesting review from Montreal, Canada, has many similarities to previous reports. Significant injuries were infrequent in children who fell from less than 20 feet and most injuries involved the head and/or musculoskeletal system. In the 14 children who fell more than 20 feet, multiple and severe injuries were more frequent. The only death occurred in a child who fell from the fifth floor. The high number of falls from balconies as well as from rather modest heights may reflect the kind of housing that is common in urban Montreal. Lallier and colleagues correctly point out that many falls should be preventable and suggest that pediatricians should be proactive in preventing them. Parents of young children should be counseled about supervision during play activities, especially in areas with access to stairs, balconies, or open windows. Mandatory placement of secure window guards with governmental enforcement is also important, especially in multistoried dwellings.

Childhood injuries resulting from falls:

a. most frequently occur in private residences.

b. most frequently occur during the winter months.

c. occur in more girls than boys.

d. are often associated with multiple injuries when the fall is less than 20 feet.