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Short Falls in Childhood Occasionally Cause Major Brain Injuries Because of Unusual Circumstances
Kenneth W Feldman, Michael Sokoloff1, Jeffrey P Otjen
1Pediatric Intensive Care, Sacred Heart Hospital, Spokane, WA.
Insights
Short falls can cause serious head injuries in young children, though rarely. Preexisting conditions and unusual mechanisms can lead to severe head trauma, necessitating thorough evaluation to distinguish from abusive head injury.
Area of Science:
- Pediatric Traumatology
- Neurology
- Radiology
Background:
- Major head injuries in children under 6 from falls under 4 feet are uncommon.
- Evaluating these injuries is crucial to differentiate accidental trauma from non-accidental trauma.
Purpose of the Study:
- To investigate the incidence and characteristics of major head injuries in young children resulting from short falls.
- To identify potential risk factors and injury patterns associated with short falls in pediatric patients.
Main Methods:
- Retrospective review of medical records and imaging for children under 6 hospitalized between 2015-2020.
- Inclusion criteria: major closed head injury following falls less than 4 feet.
- Subjects identified through abuse consultations and hospital registries in Seattle and Spokane, Washington.
Main Results:
- Twelve children sustained major head injuries from short falls.
- Seven developed space-occupying epidural hemorrhages; other injuries included hydrocephalus, stroke, and skull fractures.
- One case involved a child with a platelet disorder, initially raising abuse concerns that were resolved by diagnosis.
Conclusions:
- Young children rarely sustain severe head injuries from short falls.
- Unusual injury mechanisms or underlying medical conditions can result in serious head trauma.
- Comprehensive evaluation is essential to differentiate unintentional falls from abusive head injury.
Methods:
Records and imaging were reviewed for children younger than 6 years, hospitalized between 2015 and 2020 for major closed head injuries following less than 4-ft falls. Major injury was defined as intensive care admission more than 2 days, neurosurgical intervention, death, or disability at hospital discharge. Subjects were identified through Seattle and Spokane, Washington abuse consultations. Harborview Medical Center's trauma registry and Seattle Children's Hospital's Hemophilia Treatment Program and Radiology were searched for subjects.
Results:
We identified 12 young children who sustained major closed head injury due to short falls. Seven developed major space-occupying epidural hemorrhages. One child developed internal hydrocephalus after intraventricular hemorrhage. One child with prior meningomyelocele, Chiari 2 malformation, and ventriculoperitoneal shunt developed shunt decompensation after an acute-on-chronic subdural hemorrhage. One child developed an internal capsule stroke because of a previously undiagnosed calcifying angiopathy. Another child developed space-occupying subdural hemorrhage associated with previously unrecognized platelet pool disorder. Only this child had abuse concerns, which were resolved with his coagulopathy diagnosis. One child had a diastatic skull fracture leading to pseudomeningocele.At Harborview Medical Center, 140 children were seen for short falls in the emergency department or inpatient service. Among the 40 needing intensive care, 4 (12.5%) had major injuries after short falls. Our hemophilia treatment program did not see any children who had sustained major injury following a short fall in a 5½ year period.
Conclusions:
Although young children rarely sustain major head injury following short falls, serious head injuries do occasionally occur because of unusual injury mechanisms or preexisting conditions. It is important to fully evaluate these patients to differentiate these unintentional falls from abusive head injury.
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