Analysis of pediatric head injury from falls

The authors conducted a study to describe the incidence and types of fall-related head injury observed at a pediatric trauma center. We performed a retrospective analysis of all patients under 15 years of age treated for fall-related trauma between 1992 and 1998. Falls were classified as low (< 15 feet) and high level (> or = 15 feet). Seven hundred twenty-nine cases were identified with a mortality rate of 1.7%. A fall of greater than 15 feet (high-level fall) was associated with a higher mortality rate than low-level falls (2.4% compared with 1.0%, respectively). Ninety-eight patients had sustained a calvarial fracture and 93 experienced a basal skull fracture. Twenty-six patients had suffered a cerebral contusion, 25 a subarachnoid hemorrhage, 22 a subdural hematoma, and 12 had an epidural hematoma. Forty-nine patients required surgery for traumatic injuries; of these, 10 underwent craniotomy for evacuation of a blood clot. Height was not predictive of the Glasgow Coma Scale (GCS) score. In all four deaths resulting from a low-level fall there was an admission GCS score of 3, and abnormal findings were demonstrated on computerized tomography scanning. Death from high-level falls was attributable to either intracranial injuries (50%) or severe extracranial injuries (50%). Intracranial injury is the major source of fall-related death in children and, unlike extracranial insults, brain injuries are sustained with equal frequency from low- and high-level falls in this population. The only cause of mortality from low-level falls was intracranial injury. Trauma triage criteria must account for these differences in the pediatric population.