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Can the height of fall predict long bone fracture in children under 24 months?
1University of Edinburgh Medical, Edinburgh, UK.
Insights
Falls are a common cause of injury in young children. This study found that a fall height of 56 cm is associated with significant fractures in children under 24 months, requiring critical evaluation for falls under 50 cm.
Area of Science:
- Pediatric Orthopedics
- Injury Biomechanics
- Childhood Trauma
Background:
- Determining the mechanism of injury in infants and toddlers under 24 months can be challenging.
- Falls represent the most frequent cause of injury among children.
- Understanding the relationship between fall height and fracture severity is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the correlation between the reported height of a fall and the occurrence of long bone fractures in children aged 24 months and under.
- To establish a potential threshold height for falls that may indicate a significant injury.
Main Methods:
- A prospective study identified children under 24 months with fractures in 2003 from a departmental database.
- These children were age- and sex-matched with a control group of children who had fallen but not sustained fractures.
- Statistical analysis, including Pearson's correlation and Receiver Operating Characteristic (ROC) analysis, was employed.
Main Results:
- Sixty-three children under 24 months were studied. The median fall height was 48 cm for the fracture group versus 20 cm for the control group (P<0.001).
- A significant correlation was found between fall height and injury severity (r=0.255).
- ROC analysis suggested a fall height of 56 cm is associated with significant fractures requiring intervention (80% sensitivity, 79% specificity).
Conclusions:
- Fall height is a significant but not the sole factor in assessing fracture risk in young children.
- Falls from heights less than 50 cm in this age group warrant critical evaluation for potential significant injury.
- Further research may be needed to identify specific injury thresholds.
Aims:
It can be difficult to determine the exact mechanism of injury in infants and babies aged 24 months and under. Falls are the most common mechanism of injury in children. The purpose of this study is to identify the relationship between reported height of fall and long bone fracture.
Methods:
All children aged under 24 months who sustained a fracture (in the year 2003) were identified prospectively on the departmental fracture database. These children were matched for age and sex with children identified as having fallen but not having sustained a fracture.
Results:
Sixty-three children aged 24 months and under were studied. The median height of fall in this group was 48 cm and that in the control group was 20 cm, P<0.001. A significant correlation was observed between the height of fall (cm) and severity of injury (Pearson's correlation coefficient=0.255). Receiver operating characteristic analysis indicates that the likelihood of significant fracture requiring admission and/or manipulation under anaesthesia occurs with a fall from a height of 56 cm [sensitivity 80% (confidence interval 29-97%), specificity 79% (confidence interval 70-86%)]. It was not possible to identify a height at which the risk of any fracture injury became significantly more likely.
Conclusion:
Height of fall is only one factor that must be considered in dealing with fracture injury in children aged 24 months or under. However, significant injury presenting with falls from less than 50 cm should be critically evaluated.
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