Age-dependent injury mechanisms and injury patterns in pediatric window falls

Pediatric defenestration is a high-energy trauma mechanism in which age influences injury patterns and clinical severity. While previous studies have focused primarily on epidemiology and mortality, detailed analyses of age-related injury distribution and surgical burden remain limited. This study aimed to characterize age-dependent injury patterns, neurological severity, and hospital resource utilization following pediatric window falls.

We conducted a retrospective single-center cohort study including all children aged 0-18 years admitted for defenestration between 2008 and 2023. Demographic data, fall height, intentionality, injury distribution, Glasgow Coma Scale (GCS), fracture patterns, and number of surgical procedures were collected. Multivariable logistic regression identified predictors of severe neurological impairment (GCS ≤ 8), and Poisson regression assessed determinants of surgical burden.

A total of 333 children were included. Age distribution was bimodal, with predominantly accidental falls in young children (median 4.6 years) and intentional falls in adolescents (median 13.7 years). Younger children more frequently sustained craniofacial injuries and presented with lower admission GCS values, whereas adolescents more often sustained combined lower limb and spinal injuries. Fall height correlated negatively with GCS (ρ = -0.32) and positively with hospital length of stay. Independent predictors of GCS ≤ 8 were fall height (OR 1.41 per floor), traumatic brain injury (OR 46.6), and abdominal trauma (OR 2.59). Surgical burden was independently associated with lower limb fractures (IRR 1.86) and fall height (IRR 1.11 per floor).

Pediatric window falls demonstrate distinct age-related injury profiles associated with neurological severity and orthopedic surgical burden. Recognition of these patterns may support age-adapted trauma assessment and multidisciplinary management strategies.