Low Risk of Clinically Important Traumatic Brain Injury in Children Who Tumble Down Stairs

Area of Science:

• Pediatric Emergency Medicine
• Neurotrauma Research
• Clinical Risk Stratification

Background:

• Pediatric trauma management aims to reduce unnecessary head CT scans while identifying critical head injuries.
• The PECARN system categorizes pediatric head injury risk but is often misapplied to falls down stairs (TDS).
• TDS is frequently assessed using free-fall criteria, despite evidence suggesting lower injury risk.

Purpose of the Study:

• To evaluate the incidence of clinically important traumatic brain injuries (ciTBI) in pediatric patients following tumbling down stairs (TDS).
• To model the risk stratification of pediatric TDS patients using modified PECARN criteria based on step height.
• To determine if TDS should be considered a severe mechanism requiring the same risk assessment as free falls.

Main Methods:

• A retrospective chart review of 344 pediatric patients who experienced TDS.
• Development of three PECARN-based risk stratification models: TDS-12 (12-inch steps), TDS-8 (8-inch steps), and TDS-0 (TDS not a severe mechanism).
• Analysis of injury mechanism, clinical presentation, imaging, and ciTBI incidence.

Main Results:

• No patients in the study (0%) sustained a ciTBI, including 88 who fell 12 or more steps.
• The TDS-0 model significantly reduced the number of patients classified as high- or intermediate-risk (6.7%) compared to TDS-12 (97.7%) and TDS-8 (98.1%).
• Under the TDS-8 model, 34% of patients shifted to the low-risk category, and under TDS-0, 79% shifted to low-risk.

Conclusions:

• The risk of ciTBI in pediatric patients following TDS is low.
• Current application of PECARN criteria designed for free falls may lead to over-triage in pediatric TDS cases.
• TDS should be re-evaluated as a distinct mechanism in pediatric head injury risk assessment, separate from free falls.