title: Traumatic television tip-overs in the pediatric patient population.
abstract: BACKGROUND
  Head trauma is the leading cause of injury in the pediatric patient population. Although falls are the most common reason for head injury, blunt objects are a significant contributor. The Consumer Product Safety Commission (CPSC) released the top five hidden hazards of the home in 2007 and listed "tip-overs" as the third leading cause of morbidity and mortality. We, therefore, hypothesize that televisions continue to be a significant source of injury to children. Our intent is to examine the most common mechanisms, resulting injuries, and factors associated with television-related injuries so as to increase public awareness of this threat.
  
  
  METHODS
  Trauma patients admitted to our institution are entered into a state-mandated performance-improvement data collection system. After obtaining IRB approval, the medical records of all children admitted to our Level I Pediatric Trauma Center between 1/1/1999 and 7/27/2009 with television-related injuries were reviewed. Data points extracted included standard demographics, as well as television size, television support, final trauma level, Glasgow coma scale (GCS), injury severity score (ISS), intensive care unit (ICU) requirements, surgical procedures, final diagnoses, and hospital length of stay (LOS). Descriptive statistics were performed for the demographic data and intervals. Tests of significance were performed using Student's t-test and χ(2)/Fisher's exact test as appropriate. A P value < 0.05 was considered to be statistically significant.
  
  
  RESULTS
  Fifty-two children were seen at our institution with television tip-over related injuries during the study period. Nearly all injuries (50/52) occurred in the home, and 83% were an unwitnessed event. The mean age was 36 mo. The most common television size responsible for insult was 27 in., and the majority of these (26/52) were supported by a dresser. The mean ISS was 8.3. Patients admitted to the ICU had a higher ISS (12.2 [8.0-16.4] versus 6.8 [5.-8.4]; P = 0.003); however, there was no statistically significant association between television size and ISS (7.5 [4.6-10.4] < 27 in. versus 7.5 [7.8-13.4] ≥ 27 in.; P = 0.111). Injuries to the head were by far the most common (43/52) followed by orthopedic (n = 6) and blunt abdominal (n = 3). There was one death in the study population, and this resulted from a closed head injury.
  
  
  CONCLUSIONS
  Television tip-overs continue to pose a threat to children and can result in significant injury. Most often affected are the toddlers learning to walk and exploring their surrounding environments. The use of a dresser as a stand appears to convey the greatest risk. These injuries are potentially preventable by adequately securing televisions to appropriate stands.
authors.affiliation: Department of Pediatric General and Thoracic Surgery, The Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: John Daniel
authors.initials: JD
authors.lastname: Rutkoski
authors.forename: Megan
authors.initials: M
authors.lastname: Sippey
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Gaines
mesh_terms: D000061:Accidents, Home / Q000706:statistics & numerical data*; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000453:epidemiology*; D006266:Health Education; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007374:Interior Design and Furnishings / Q000706:statistics & numerical data*; D008297:Male; D009017:Morbidity; D009043:Motor Activity; D012307:Risk Factors; D013690:Television / Q000706:statistics & numerical data*