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Published on: September 21, 2017
Biomechanical characteristics of head injuries from falls in children younger than 48 months
Jonathon Hughes1, Sabine Maguire2, Michael Jones1
1Institute of Medical Engineering and Medical Physics, Cardiff School of Engineering, Cardiff University, Cardiff, UK.
Insights
Children under 12 months are at higher risk of head injury from falls. A fall height over 0.6 meters significantly increases the likelihood of skull fractures or intracranial injury (ICI).
Area of Science:
- Pediatrics
- Trauma Surgery
- Forensic Pathology
Background:
- Establishing fall-height thresholds is crucial for assessing head injury risk, including abusive head trauma.
- Understanding the relationship between fall characteristics and injury severity is vital for clinical and legal evaluations.
Purpose of the Study:
- To correlate witnessed fall characteristics with the extent of head injury in young children.
- To identify specific fall parameters associated with increased risk of skull fracture or intracranial injury (ICI).
Main Methods:
- A case-control study involving children aged 48 months or younger who experienced falls from less than 3 meters.
- Comparison of children with skull fractures or ICI (cases) against those with minor head injuries (controls).
- Analysis of injury mechanism, impact surface, head impact site, and fall height.
Main Results:
- Children with skull fractures/ICI had significantly higher mean fall heights than those with minor injuries (p<0.001).
- No skull fractures/ICI were observed in falls below 0.6 meters (head center of gravity height).
- Increased risk of skull fracture/ICI was associated with age ≤12 months, impacts to the temporal/parietal or occipital regions, wood surfaces, and falls from a carer's arms, especially on stairs.
Conclusions:
- A fall height exceeding 0.6 meters (head center of gravity) is a significant threshold for skull fracture/ICI risk in infants.
- Parietal/temporal or occipital impact locations are associated with higher injury severity.
- Recording fall height, impact site, and mechanism is essential for evaluating potential skull fracture/ICI.
Background:
A fall-height threshold is important when evaluating the likelihood of structural head injury or abusive head trauma. This study investigates witnessed falls to correlate the fall characteristics with the extent of injury.
Method:
Case-control study of children aged ≤48 months who attended one hospital following a fall from <3 m (10 ft), comparing cases who sustained a skull fracture or intracranial injury (ICI) with controls, who had minor head injuries. Characteristics included: the mechanism of injury, surface of impact, site of impact to the head and fall height.
Results:
Forty-seven children had a skull fracture or ICI, while 416 children had minor head injuries. The mean fall height for minor head injuries was significantly lower than that causing skull fracture/ICI (p<0.001). No skull fracture/ICI was recorded in children who fell <0.6 m (2 ft), based on the height of the head centre of gravity. Skull fractures/ICI were more likely in children aged ≤12 months (p<0.001) from impacts to the temporal/parietal or occipital region (p<0.001), impacts onto wood (p=0.004) and falls from a carer's arms, particularly when on stairs (p<0.001). No significant difference was reported between the mean fall heights of children who had a simple skull fracture (n=17) versus those who had a complex fracture or ICI (n=30).
Conclusions:
An infant is more likely to sustain a skull fracture/ICI from a fall above a 0.6 m (2 ft) threshold, based on the height of the head centre of gravity, or with a parietal/temporal or occipital impact. These variables should be recorded when evaluating the likelihood of skull fracture/ICI.
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