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Published on: January 20, 2023
Fall height and impact surface in relation to clinically important traumatic brain injury among children under two
Takatoshi Oishi1, Shunsuke Amagasa2, Satoko Uematsu2
1Department of Emergency and Transport Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan; Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama 330-8503, Japan.
Insights
In children under two years, fall height significantly increases the risk of clinically important traumatic brain injury (ciTBI). Impact surface type did not show a significant association with ciTBI risk.
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Public Health
Background:
- Traumatic brain injury (TBI) is a significant concern in young children.
- Understanding injury mechanisms is crucial for prevention and management.
Purpose of the Study:
- To investigate the association between fall height and impact surface with clinically important traumatic brain injury (ciTBI) in children under two years.
- To determine if fall characteristics predict ciTBI risk in pediatric head trauma cases.
Main Methods:
- Retrospective cohort study of 1893 children under two years with head trauma.
- Analysis included fall height (per 10-cm increment) and impact surface type (flooring, soft, hard).
- Multivariable logistic regression and generalized additive models (GAMs) were used for analysis, adjusting for age.
Main Results:
- Fall height was significantly associated with ciTBI risk (aOR 1.31 per 10 cm increase).
- Impact surface type was not significantly associated with ciTBI.
- Risk of ciTBI increased approximately linearly with fall height.
Conclusions:
- Fall height is a significant predictor of ciTBI in young children with head trauma.
- Impact surface type does not appear to be a significant factor in ciTBI risk.
- The linear association suggests current fall height thresholds may underestimate clinical risk.
Objectives:
To assess whether fall height and impact surface are associated with clinically important traumatic brain injury (ciTBI) in children under two years.
Methods:
We performed a single-center retrospective cohort study (Tokyo, Japan, 2017-2021) including children under two years with head trauma. We excluded those with conditions affecting ciTBI risk, unreliable clinical histories, or injury mechanisms that did not involve ground impact. The primary outcome was ciTBI; abnormal head computed tomography (CT) findings were secondary. Multivariable logistic regression modeled fall height per 10-cm increment and impact surface (flooring, soft, hard), adjusted for age and exposures. Generalized additive models (GAMs) explored potential nonlinear associations.
Results:
Among 3067 eligible children, 1893 were included in the analysis; 44 (2.3%) had ciTBI. After adjustment for age and mutual adjustment of exposures, impact surface type was not significantly associated with ciTBI (soft surface vs flooring: adjusted odds ratio [aOR] 0.30, 95% CI 0.07-1.34; hard surface vs flooring: aOR 1.10, 95% CI 0.52-2.31). Fall height was significantly associated with ciTBI risk (aOR 1.31 per 10 cm increase, 95% CI 1.19-1.45). Similar associations were observed for abnormal head CT findings. GAMs demonstrated an approximately linear increase in risk with increasing fall height, without an inflection point.
Conclusions:
In children under two years with head trauma, fall height was associated with ciTBI risk, whereas impact surface type was not. The association between fall height and ciTBI appeared approximately linear across the observed range, suggesting that fixed height thresholds may not fully reflect clinical risk.
