Deaths from falls in children: how far is fatal?
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D L Chadwick1, S Chin, C Salerno
1Center for Child Protection, Children's Hospital-San Diego, California.
Insights
Fatal injuries in children from falls under 4 feet often involve incorrect caretaker history. Longer falls, especially outdoors, provide more reliable data for child injury studies.
Area of Science:
- Pediatrics
- Trauma Surgery
- Forensic Medicine
Background:
- Childhood falls are a common cause of injury presenting to trauma centers.
- Determining the reliability of caretaker-provided fall history is crucial for accurate injury assessment.
- Previous studies have not fully differentiated injury outcomes based on fall height and history veracity.
Purpose of the Study:
- To analyze the relationship between fall height, caretaker history accuracy, and injury outcomes in children.
- To identify factors associated with fatal injuries in pediatric falls.
- To assess the reliability of fall history in different fall scenarios.
Main Methods:
- Retrospective review of 317 children presenting to a pediatric trauma center with fall-related injuries.
- Inclusion of cases with questioned or unquestioned caretaker fall histories.
- Analysis of injury outcomes, including mortality, stratified by fall height and history assessment.
Main Results:
- Seven deaths occurred in 100 children who fell 4 feet or less, with other factors suggesting false histories in all cases.
- One death occurred in 117 children who fell 10 feet to 45 feet.
- Fatal injuries from falls under 4 feet were associated with incorrect histories, while longer outdoor falls provided reliable data.
Conclusions:
- Incorrect caretaker history is strongly suggested in fatal pediatric injuries from falls less than 4 feet.
- Longer falls, particularly those with an outdoor component, are more likely to have reliable histories and serve as dependable data points for injurability studies.
Abstract:
The outcome of injury was determined in 317 children who were brought to a children's trauma center with a history from the caretaker that the child had fallen. Cases in which the clinicians' judgment was that an incorrect history had been given were included along with cases in which the history was not questioned. Seven deaths occurred in 100 children who fell 4 feet or less. One death occurred in 117 children who fell 10 feet to 45 feet. The 7 children who died in short falls all had other factors in their cases which suggested false histories. When children incur fatal injuries in falls of less than 4 feet, the history is incorrect. Long falls with an outdoor component are likely to be reliable data points for studies of children's injuribility.