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A Window of Opportunity: Understanding Pediatric Falls Using Area Deprivation Index
Víctor de Cos1, Anthony Galvez1, Alexandra S Rooney2
1Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA.
Insights
Neighborhood socioeconomic disadvantage (NSD) is a significant risk factor for pediatric window falls (WF). Children experiencing WF face more severe injuries and longer hospital stays, highlighting the need for targeted prevention in high-risk areas.
Area of Science:
- Pediatric Trauma
- Injury Prevention
- Public Health
Background:
- Pediatric fall injuries are a common cause of trauma.
- Neighborhood socioeconomic disadvantage (NSD) may influence injury risk.
- Window falls (WF) represent a specific, preventable mechanism of injury.
Purpose of the Study:
- To evaluate neighborhood socioeconomic disadvantage (NSD) as a risk factor for pediatric window falls (WF).
- To compare injury severity and healthcare outcomes between window falls and other pediatric fall injuries.
- To identify demographic and environmental factors associated with WF.
Main Methods:
- Retrospective review of pediatric fall injuries (≤18 years) treated at a Level I trauma center (2018-2021).
- Analysis of demographic, injury, and NSD data using the Area Deprivation Index (ADI) based on zip codes.
- Comparison of WF versus non-window falls (NWF), including property type (single-family homes vs. apartments).
Main Results:
- Among 1545 pediatric falls, 194 were WF.
- WF patients were younger, more likely to have lower Glasgow Coma Scale (GCS) scores, and sustain severe head/neck injuries compared to NWF.
- WF patients experienced longer hospital and ICU stays and were more likely to reside in areas with greater NSD (53% vs. 35%) and live in apartments (73%).
Conclusions:
- Window falls are associated with increased injury severity and prolonged hospitalization compared to other pediatric falls.
- The Area Deprivation Index (ADI) can identify high-risk areas for targeted injury prevention programs.
- Addressing socioeconomic factors and housing types is crucial for reducing pediatric window fall injuries.
Introduction:
The purpose of our study is to assess neighborhood socioeconomic disadvantage (NSD) as a risk factor for window falls (WF) in children.
Methods:
A single institution retrospective review was performed of patients ≤18 years old with fall injuries treated at a Level I trauma center between 2018 and 2021. Demographic, injury, and NSD characteristics which were collected from a trauma registry were analyzed and compared between WF versus non-window falls. Area Deprivation Index (ADI) was used to measure NSD levels based on patients' home address 9-digit zip code, with greater NSD being defined as ADI quintiles 4 and 5. Property type was used to compare falls that took place at single-family homes versus apartment buildings.
Results:
Among 1545 pediatric fall injuries, 194 were WF, of which 60 % were male and 46 % were Hispanic. WF patients were younger than NWF patients (median age WF 3.2 vs. age 4.3, p<0.047). WF patients were more likely to have a depressed Glasgow Coma Scale (GCS score ≤12, WF 9 % vs. 3 %) and sustain greater head/neck injuries (median AIS 3vs. AIS 2, p<0.001) when compared to NWF. WF patients had longer hospital and ICU lengths of stay than NWF patients (p<0.001 and p<0.001, respectively). WF patients were more likely to live in areas of greater NSD than NWF patients (53 % vs. 35 %, p<0.001), and 73 % of all WF patients lived in apartments or condominiums.
Conclusions:
Window fall injuries were associated with lower GCS, greater severity of head/neck injuries, and longer hospital and ICU length of stay than non-window falls. ADI research can provide meaningful data for targeted injury prevention programs in areas where children are at higher risk of window falls.
Study Type:
Retrospective review.
Level Of Evidence:
III.
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