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Paediatric falls: An analysis of patterns of injury and associated mortality in urban India
Shlok Patel1, Riya Sawhney2, Debojit Basak3
1World Health Organization Collaborating Centre for Emergency, Critical and Operative Care, Program for Global Surgery & Trauma, The George Institute of Global Health, New Delhi, India; Department of Orthopaedics, BJ Medical College, Ahmedabad, Gujarat, India.
Insights
Falls are a major cause of childhood injury in India. Young children (2-5 years) are most affected, with traumatic brain injury and male sex linked to higher mortality rates.
Area of Science:
- Pediatric Trauma
- Injury Prevention
- Global Health
Background:
- Falls represent a significant cause of pediatric injury globally.
- Children in low- and middle-income countries (LMICs) face disproportionately higher mortality rates from falls compared to high-income countries.
- Detailed data on fall-related injuries in LMICs, particularly India, are scarce.
Purpose of the Study:
- To investigate the patterns of fall-related injuries and mortality in children in urban India.
- To identify demographic and injury-specific factors associated with mortality.
- To inform targeted fall prevention strategies and improve access to care.
Main Methods:
- Retrospective analysis of the Towards Improved Trauma Care Outcomes (TITCO) database.
- Inclusion of 16,000 trauma patients from four tertiary Indian centers (July 2013 - December 2015).
- Analysis of demographics, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), injury patterns, and survival probability using Kaplan-Meier analysis for children under 18 admitted after a fall.
Main Results:
- Of 1281 children admitted after a fall, 40% were aged two-to-five years.
- Nearly all sustained blunt trauma (99%).
- In-hospital mortality was 7.8%, with isolated traumatic brain injury (TBI) being the most common cause of death (71%). Mortality was higher in males (9%) than females (5%).
Conclusions:
- The study highlights that children aged two-to-five years are most frequently admitted for fall-related injuries in urban Indian hospitals.
- Isolated TBI and male sex are significant risk factors for increased mortality.
- Findings support the development of age-specific fall prevention strategies and targeted resource allocation to reduce fall-related mortality in India.
Background:
Falls are some of the most common childhood injuries. However, for vulnerable children in low- and middle-income countries (LMICs) such as India, mortality from a fall is nearly three times that of high-income countries. Despite fall being a leading cause of paediatric injury, detailed data from LMICs remain sparse. This study aims to assess fall-related patterns of injury and mortality in children in urban India.
Methods:
We conducted a retrospective analysis from the Towards Improved Trauma Care Outcomes (TITCO) database, comprising 16,000 trauma patients admitted to four tertiary centres in India, between July 2013 and December 2015. We analysed demographics, Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), and the pattern of injury sustained for patients under 18-years admitted with fall and assessed survival probability in different age groups using Kaplan-Meier survival analysis and log-rank tests.
Results:
Of 1281 children admitted after a fall, two-to-five-year-olds formed the majority (40 %). Nearly all children (99 %) had blunt trauma. The median ISS was 9 (IQR 9-11) and median GCS was 15. Overall in-hospital mortality was 7.8 % and isolated traumatic brain injury (TBI) was the most common (71 %) injury in those who died. Mortality was significantly higher in male children (9 %) than in female children (5 %) (p = 0.009). There was no significant difference in survival between age groups (p = 0.9).
Conclusion:
The majority of paediatric patients admitted to urban hospitals in India after a fall were between the ages of two-to-five years, with isolated TBI and male sex associated with greater mortality. These findings have the potential to aid age-specific fall prevention strategies and resource allocation towards targeted initiatives to improve access to care, and consequently, mortality from fall in urban India.
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