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Published on: September 13, 2024
Childhood Falls With Occipital Impacts
Norrell Atkinson, Rick R van Rijn1, Suzanne P Starling
1Emma Children's Hospital-Academic Medical Center Amsterdam, the Netherlands.
Insights
Short falls with occipital impact can cause subdural hemorrhage (SDH) in young children. Accidental injury should be considered in trauma evaluations when a fall history is present.
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Child Abuse Pediatrics
Background:
- Falls are frequently reported in children with brain injuries, both accidental and inflicted.
- Short falls are typically associated with minor injuries, but this study examines a specific scenario.
Purpose of the Study:
- To describe a series of short fall cases involving occipital impact resulting in subdural hemorrhage (SDH).
- To investigate the potential for accidental injury in cases of pediatric SDH following occipital impact.
Main Methods:
- Analysis of 8 witnessed cases of young children diagnosed with SDH after a short fall with occipital impact.
- Survey of child-abuse physicians regarding evaluation of children under 24 months with SDH after witnessed falls.
Main Results:
- Median age of affected children was 12.5 months; all fell backward onto hard surfaces.
- Most children had enlarged head circumferences and unilateral convexity SDH; all had retinal hemorrhages.
- The majority of children recovered to baseline within 24 hours of hospitalization.
Conclusions:
- Accidental injury should be considered in trauma workups when a history of a fall with occipital impact is elicited.
- Further research is needed to fully understand the spectrum of injuries from such falls.
Objectives:
Falls are commonly reported in children who present with both accidental and inflicted brain injuries. Short falls rarely result in serious or life-threatening injuries. Our purpose is to describe a series of cases of short falls with occipital impact leading to subdural hemorrhage (SDH).
Methods:
We present a series of 8 witnessed accounts of young children diagnosed as having SDHs after striking the back of their heads during a short fall. Child-abuse physicians were surveyed to determine if they had evaluated a child younger than 24 months diagnosed as having SDH, with or without retinal hemorrhages, following a witnessed fall with occipital impact. Submitted cases were analyzed.
Results:
The median age of the children was 12.5 months. All fell backward from a standing or seated position onto a hard surface and immediately developed symptoms. There was an average of 4 witnesses per case. Physical examinations were normal; however, the majority of children had enlarged head circumferences. All were previously healthy. Six of 8 children had unilateral convexity SDH. All children had varying degrees of retinal hemorrhage but no retinoschisis. The majority of children had returned to their baseline within 24 hours of hospitalization.
Conclusions:
Although a larger study is needed to identify the full spectrum of injuries, we postulate that, if a history of a fall with an occipital impact is elicited during a trauma workup, accidental injury should be considered.
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