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Imaging evaluation of children after falls from a height: review of 45 cases
J E Roshkow1, J O Haller, G C Hotson
1Department of Radiology, State University of New York Health Science Center, Brooklyn 11203.
Insights
Pediatric fall injuries differ from adult patterns, necessitating distinct imaging protocols. Initial evaluation should focus on cervical spine and chest radiography, with selective computed tomography (CT) scans for head injuries.
Area of Science:
- Pediatric Traumatology
- Emergency Medicine Imaging
- Radiology Protocols
Background:
- Pediatric fall injuries present unique patterns compared to adults.
- Current imaging protocols for injured adults are not optimal for children.
- Establishing a tailored imaging approach for pediatric fall victims is crucial.
Purpose of the Study:
- To analyze injury patterns in children falling from height.
- To inform the development of a specific pediatric imaging protocol.
- To compare pediatric and adult injury characteristics and imaging needs.
Main Methods:
- Retrospective review of medical and imaging records.
- Inclusion of 45 children and infants (≤12 years) with falls from one to six stories.
- Analysis of injury types, locations, and correlation with fall height.
Main Results:
- Extremity fractures (20/45) and head injuries (19/45) were most common.
- Abdominal injuries were rare (1/45).
- Fall height did not predict injury severity or type.
Conclusions:
- Initial imaging for pediatric falls should include cervical spine and chest radiography.
- Consider computed tomographic (CT) scans of the head more readily in children than adults.
- Further imaging (pelvis, spine, extremities, abdomen CT) should be individualized, not protocol-driven.
Abstract:
The injury pattern in the child who falls from a height is markedly different from that in the adult, so a different imaging protocol is needed. To help establish such a protocol, the authors reviewed the charts and imaging records of 45 children and infants 12 years of age and younger who had fallen one to six stories. Extremity fractures were the most common injury, occurring in 20 patients. Head injuries (including skull fractures) occurred in 19 patients. Abdominal injuries were present in only one patient. Pneumothoraces were seen in four patients and lung contusions in two patients. Fractures of the pelvis, spine, and os calcis were uncommon. The height of the fall did not enable prediction of either the severity or type of injury. The authors recommend radiography of the cervical spine and chest alone in the initial evaluation of the injured child and greater willingness to obtain computed tomographic (CT) scans of the head in children than in adults. Radiographs of the pelvis, thoracolumbar spine, and lower extremities, as well as CT scans of the head and abdomen, should be obtained on a case-by-case basis, and not according to protocol, as is often the situation in adults.