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Determinants of severe fall-related injuries among children and youth: a systematic review and meta-analysis
Janyce Eunice Gnanvi1, Magali Cortenbach1, Alexa Gareau1
1Universite Laval Faculte de Medecine, Québec City, Quebec, Canada.
Insights
Severe fall injuries in children are poorly understood. This review found limited evidence on determinants, with no significant link to socioeconomic status but potential higher risks in Indigenous children and rural areas.
Area of Science:
- Pediatric injury prevention
- Public health research
- Epidemiology of unintentional injuries
Background:
- Falls are a primary cause of child injury worldwide.
- Determinants of severe and fatal pediatric falls are not well-characterized.
Purpose of the Study:
- To systematically review and synthesize evidence on determinants of severe and fatal unintentional fall injuries in children and youth up to 19 years.
- Focus on studies with quantitative measures of association.
Main Methods:
- Searched MEDLINE, Embase, CINAHL, Web of Science.
- Included observational cohort studies examining severe/fatal unintentional fall injuries in children and youth.
- Assessed study quality and performed meta-analyses using random-effects models.
Main Results:
- Included 20 studies with over 4 million severe unintentional fall injuries.
- Area-based socioeconomic status showed no significant association with severe fall injuries.
- Higher risks observed in Indigenous children and rural settings, though with imprecision and uncertainty.
Conclusions:
- Evidence on determinants of severe pediatric fall injuries is limited and heterogeneous.
- Future research needs standardized definitions and broader assessment of determinants.
- Improved understanding is crucial for targeted prevention strategies.
Background:
Falls are a leading cause of injury-related morbidity among children worldwide, yet determinants of severe and fatal falls remain poorly characterised.
Objective:
To systematically review and synthesise evidence on the determinants of severe and fatal unintentional fall injuries among children and youth ≤19 years, focusing on studies reporting quantitative measures of associations.
Methods:
We searched MEDLINE, Embase, CINAHL and Web of Science from inception to April 2026. Eligible studies included observational cohort studies involving children and youth ≤19 years and examining factors associated with severe (requiring hospitalisation or Abbreviated Injury Scale ≥3) and fatal unintentional fall injuries. Two reviewers screened studies, extracted data and assessed quality using the Cochrane Risk Of Bias In Non-randomised Studies-of Exposure tool. Random-effects models were used for meta-analyses.
Results:
20 studies (n=4 12 330 severe unintentional fall injuries) were included. Area-based socioeconomic status (SES), ethnicity and residential setting were the only determinants assessed across multiple studies. Meta-analysis showed no significant association between area-based SES and severe fall injuries, with substantial heterogeneity. Two studies reported higher risks of severe fall injuries among Indigenous compared with non-Indigenous children, although estimates were imprecise. Compared with major urban centres, risks appeared higher in rural or non-metropolitan areas, although estimates were uncertain due to wide or unreported CIs.
Conclusion:
Evidence on determinants of severe paediatric unintentional fall injuries is limited and heterogeneous. Future studies should use standardised, context-specific definitions of falls and assess a broader range of determinants using quantitative measures of associations to better identify high-risk populations and inform prevention strategies.
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