title: Television-Related Head Injuries in Children: A Secondary Analysis of a Large Cohort Study of Head-Injured Children in the Pediatric Emergency Care Applied Research Network.
abstract: OBJECTIVE
  The objective of the study was to describe the epidemiology, cranial computed tomography (CT) findings, and clinical outcomes of children with blunt head trauma after television tip-over injuries.
  
  
  METHODS
  We performed a secondary analysis of children younger than 18 years prospectively evaluated for blunt head trauma at 25 emergency departments (EDs) in the Pediatric Emergency Care Applied Research Network from June 2004 to September 2006. Children injured from falling televisions were included. Patients were excluded if injuries occurred more than 24 hours before ED evaluation or if neuroimaging was obtained before evaluation. Data collected included age, race, sex, cranial CT findings, and clinical outcomes. Clinically important traumatic brain injuries (ciTBIs) were defined as death from TBI, neurosurgery, intubation for more than 24 hours for the TBI, or hospital admission of 2 nights or more for the head injury, in association with TBI on CT.
  
  
  RESULTS
  A total of 43,904 children were enrolled into the primary study and 218 (0.5%; 95% confidence interval [CI], 0.4% to 0.6%) were struck by falling televisions. The median (interquartile range) age of the 218 patients was 3.1 (1.9-4.9) years. Seventy-five (34%) of the 218 underwent CT scanning. Ten (13.3%; 95% CI, 6.6% to 23.2%) of the 75 patients with an ED CT had traumatic findings on cranial CT scan. Six patients met the criteria for ciTBI. Three of these patients died. All 6 patients with ciTBIs were younger than 5 years.
  
  
  CONCLUSIONS
  Television tip-overs may cause ciTBIs in children, including death, and the most severe injuries occur in children 5 years or younger. These injuries may be preventable by simple preventive measures such as anchoring television sets with straps.
authors.affiliation: From the Department of Pediatrics, University of Maryland School of Medicine, Baltimore.
authors.forename: Richard
authors.initials: R
authors.lastname: Lichenstein
authors.affiliation: Department of Emergency Medicine, Howard County General Hospital, Columbia, MD.
authors.forename: David
authors.initials: D
authors.lastname: Monroe
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Quayle
authors.affiliation: Department of Pediatrics and the PECARN Data Coordinating Center, University of Utah, Salt Lake City, UT.
authors.forename: Michelle
authors.initials: M
authors.lastname: Miskin
authors.affiliation: Department of Surgery, Columbia University Medical Center at Harlem Hospital, New York, NY.
authors.forename: Arthur
authors.initials: A
authors.lastname: Cooper
authors.affiliation: Department of Emergency Medicine, Atlantic Health System, Morristown Memorial Hospital, Morristown, NJ.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gerardi
authors.affiliation: Departments of Emergency Medicine and Pediatrics, SUNY-Upstate Medical University, Syracuse, NY.
authors.forename: James M
authors.initials: JM
authors.lastname: Callahan
authors.affiliation: Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York City, NY.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.affiliation: Departments of Emergency Medicine.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D016489:Head Injuries, Closed / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D013690:Television