title: Childhood Injuries Due to Hay-Hole Falls: A 19-Year Experience at a Rural Pediatric Trauma Center.
abstract: OBJECTIVE
  Children who live, work, and play on farms with barn design that includes hay-holes are at risk for a particular type of fall. This study retrospectively reviews all children admitted to a pediatric trauma center with injuries due to fall through a hay-hole over a 19-year period. This study is the first to specifically describe hay-hole fall injuries.
  
  
  METHODS
  A retrospective review from a 19-year period at a rural pediatric trauma center identified 66 patients who sustained injuries from a hay-hole fall. Charts were reviewed for patient demographics, injuries, interventions, and hospital course.
  
  
  RESULTS
  Sixty-six patients sustained injuries from hay-hole falls. Median patient age was 4 years, and median Injury Severity Score was 14. Forty-one percent of patients were admitted to the intensive care unit, and 26% of patients were intubated. Injuries included skull fracture (73%), facial fracture (27%), intracranial hemorrhage (53%), and noncraniofacial injuries (12%). Eighteen percent required a therapeutic intervention. There was 1 fatality (2%).
  
  
  CONCLUSIONS
  Hay-hole fall appears to be a distinct injury mechanism, and patients present with different injury patterns than other types of falls. In this study, a high proportion of patients were young, and craniofacial injuries accounted for the majority of injuries. Only a small proportion of patients sustained noncraniofacial injuries. Injury prevention strategies should be targeted to this unique agrarian injury.
authors.affiliation: From the Divisions of *Pediatric Surgery, †Pediatric Neurosurgery, and ‡Newborn Medicine, Penn State Hershey Children's Hospital, Penn State Milton S. Hershey Medical Center, Hershey, PA.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Engbrecht
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.forename: Mark
authors.initials: M
authors.lastname: Dias
authors.forename: James W
authors.initials: JW
authors.lastname: Kendig
authors.forename: Robert E
authors.initials: RE
authors.lastname: Cilley
mesh_terms: D000058:Accidental Falls; D000383:Agriculture; D002675:Child, Preschool; D005147:Facial Bones / Q000293:injuries; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006780:Hospitals, Rural; D006801:Humans; D015601:Injury Severity Score; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000628:therapy; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012887:Skull Fractures / Q000209:etiology / Q000628:therapy; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000209:etiology* / Q000628:therapy*