Analysis of pediatric head injury from falls.
The authors conducted a study to describe the incidence and types of fall-related head injury observed at a pediatric trauma center. We performed a retrospective analysis of all patients under 15 years of age treated for fall-related trauma between 1992 and 1998. Falls were classified as low (< 15 feet) and high level (> or = 15 feet). Seven hundred twenty-nine cases were identified with a mortality rate of 1.7%. A fall of greater than 15 feet (high-level fall) was associated with a higher mortality rate than low-level falls (2.4% compared with 1.0%, respectively). Ninety-eight patients had sustained a calvarial fracture and 93 experienced a basal skull fracture. Twenty-six patients had suffered a cerebral contusion, 25 a subarachnoid hemorrhage, 22 a subdural hematoma, and 12 had an epidural hematoma. Forty-nine patients required surgery for traumatic injuries; of these, 10 underwent craniotomy for evacuation of a blood clot. Height was not predictive of the Glasgow Coma Scale (GCS) score. In all four deaths resulting from a low-level fall there was an admission GCS score of 3, and abnormal findings were demonstrated on computerized tomography scanning. Death from high-level falls was attributable to either intracranial injuries (50%) or severe extracranial injuries (50%). Intracranial injury is the major source of fall-related death in children and, unlike extracranial insults, brain injuries are sustained with equal frequency from low- and high-level falls in this population. The only cause of mortality from low-level falls was intracranial injury. Trauma triage criteria must account for these differences in the pediatric population.
Kim
K A
KA
Division of Neurosurgery and Trauma Program, Children's Hospital of Los Angeles, Los Angeles, California, USA.
Wang
M Y
MY
Griffith
P M
PM
Summers
S
S
Levy
M L
ML
D000058:Accidental Falls / Q000401:mortality* / Q000706:statistics & numerical data; D000293:Adolescent; D017677:Age Distribution; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D020202:Cerebral Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D003399:Craniotomy / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D017678:Sex Distribution; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000401:mortality; D014057:Tomography, X-Ray Computed; D014218:Triage / Q000592:standards / Q000706:statistics & numerical data