Injuries from falls in the pediatric population: an analysis of 729 cases.
OBJECTIVE
Falls are classified as low or high level for triage purposes. Because triage criteria dictate less urgency for low-level falls, this classification scheme has important implications for pediatric emergency care.


METHODS
Retrospective analysis was conducted of 729 (393 low-level and 336 high-level) pediatric patients treated for fall-related trauma (1992 through 1998). Falls were classified as low (<15 feet) or high-level (> or =15 feet). All falls were reported as accidental or unintentional.


RESULTS
The overall mortality rate was 1.6% (2.4% for high-level falls compared with 1.0% for low-level falls). All 4 patients who died of a low-level fall had an abnormal head computed tomography (CT) scan and intracranial hypertension. Half of deaths from high-level falls were attributable to intracranial injuries, and half were caused by severe extracranial injuries. Common extracranial injuries were upper extremity fracture (6.2%), lower extremity fracture (5.6%), pulmonary contusion (1.8%), pneumothorax (1.1%), liver laceration (1.1%), bowel injury (1.0%), and splenic injury (2.1%). Orthopedic and thoracic injuries resulted more commonly from high-level falls, whereas abdominal injuries were as likely to occur after a low-level fall.


CONCLUSIONS
Intracranial injury accounts for the majority of deaths from falls. Children suffering low-level falls were at similar risk for intracranial and abdominal injuries compared with those who fell from greater heights. Pediatric trauma triage criteria should account for these findings.
Wang
M Y
MY
Division of Neurosurgery and the Trauma Program, Children's Hospital of Los Angeles & the Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
Kim
K A
KA
Griffith
P M
PM
Summers
S
S
McComb
J G
JG
Levy
M L
ML
Mahour
G H
GH
D000007:Abdominal Injuries / Q000453:epidemiology / Q000209:etiology; D000058:Accidental Falls / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D020198:Intracranial Hemorrhage, Traumatic / Q000453:epidemiology / Q000209:etiology; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000453:epidemiology / Q000209:etiology; D013898:Thoracic Injuries / Q000453:epidemiology / Q000209:etiology; D014218:Triage; D014947:Wounds and Injuries / Q000453:epidemiology*