Chadwick DL, et al. Deaths from falls in children: how far is fatal? J Trauma 1991;31:1353-1355.
Methods:
Results: Case fatality rate by fall height:
Fall Height (feet) |
Number died |
Total |
Case fatality rate (%) |
1-4 |
7 |
100 |
7.0 |
5-9 |
0 |
65 |
0.0 |
10-45 |
1 |
118 |
0.8 |
For patients who died from a fall from 1-4 feet, histories given for the type of fall:
Type of fall |
Number |
Associated Injuries |
Standing fall |
2 |
(none) |
Fall from bed / table |
2 |
(none) |
Fall down stairs |
1 |
bruising on arms, labia majora, thighs |
Fall in arms of adult |
2 |
(1) bruising on scalp, ear; SDH; RH and (2) RH; SDH; old tibia fracture |
Conclusions:
Reiber GD. Fatal falls in childhood . Am J Forensic Med Path 1993;14:201-207.
Methods:
Results:
Conclusions:
Hall JR, Reyes HM, Horvat M, et al. The mortality of childhood falls . J Trauma 1989;29:1273-1275.
Methods:
Results:
In the group who fell <3 feet:
Conclusions:
Plunkett J. Fatal pediatric head injuries caused by short-distance falls . Am J Forens Med Pathol 2001;22:1-12.
Objective:
Methods:
Results:
More than 75,000 cases were reviewed:
18 deaths from head injury secondary to a fall associated with the use of playground equipment were recorded.
Age range of patients: 1-13 years
Cases:
Fall distance = “distance of closest body part from ground at beginning of fall”
Case 1
Age: 12 months
Mechanism: Fell sideways and backwards off of a porch swing
Fall distance: 5-6 feet
Witnessed*: No
Conscious: “unconscious immediately”
CT Imaging: Subgaleal hematoma at vertex; comminuted fracture of vault; parafalcine subdural hemorrhage; right parietal subdural hemorrhage
Eye exam: Not recorded
Autopsy: None
* definition of witnessed: by a non-caretaker
Case 2
Age: 14 months
Mechanism: Fell backwards off of a seesaw
Fall distance: 22.5 inches
Witnessed: No
Conscious: “conscious but crying … Within 10 to 15 minutes he became lethargic and limp, vomited”
CT Imaging: Occipital subgaleal hematoma; left sided cerebral edema
Eye exam: Normal
Autopsy: None
Case 3
Age: 17 months
Mechanism: Fell from swing on its downstroke
Fall distance: (estimated) 5-6 feet
Witnessed: No
Conscious: “immediately unconscious”
CT Imaging: Left sided subdural hematoma with extension to the interhemispheric fissure and falx
Eye exam: Not recorded
Autopsy: Symmetrical contusions on buttocks and posterior thorax; left subdural hematoma; cerebral edema with anoxic encephalopathy; uncal and cerebellar tonsillar herniation
Case 4
Age: 20 months
Mechanism: Fell from platform of jungle gym striking head on support post
Fall distance: 67 inches from ground; 42 inches from support post
Witnessed: No
Conscious: “initially conscious and talking, but within 5 to 10 minutes became comatose”
CT Imaging: Right occipital depressed skull fracture; right subdural and subarachnoid hemorrhage along the tentorium and posterior falx
Eye exam: “extensive bilateral retinal and preretinal hemorrhage”
Autopsy: (limited) Impact subgaleal hematoma overlying the fracture
Case 5
Age: 23 months
Mechanism: Fell head-first off of a plastic gym set on to plush carpet over a concrete floor
Fall distance: 28 inches
Witnessed: Yes (videotaped)
Conscious: “cried after the fall but was alert and talking … approximately 5 minutes later she vomited and became stuporous”
CT Imaging: Right-sided subdural hematoma and minimal subfalcine herniation
Eye exam: “Bilateral retinal hemorrhages”
Autopsy: Right subdural hematoma; cerebral edema with cerebellar tonsillar herniation
Case 6
Age: 26 months
Mechanism: Fell backwards off of a playground swing
Fall distance: 3-6 feet
Witnessed: Yes
Conscious: “immediately unconscious”
CT Imaging: Subdural hematoma; acute cerebral edema
Eye exam: “extensive bilateral retinal hemorrhage, vitreous hemorrhage in the left eye”
Autopsy: Right parietal impact injury; small bilateral subdural hemorrhage; cerebral edema with herniation; focal hemorrhage in the right posterior midbrain and pons; retinal hemorrhage
Case 7
Age: 3 years, history of thrombocytopenia-absent radius syndrome
Mechanism: Fell off of platform, striking his face
Fall distance: 3 feet
Witnessed: Yes
Conscious: “initially conscious and able to walk; approximately 10 minutes later he had projectile vomiting and became comatose”
CT Imaging: Subdural hematoma; diffuse cerebral edema with uncal herniation
Eye exam: Not recorded
Autopsy: None
Other findings: Platelet count 24,000
Case 8
Age: 3 years
Mechanism: Fell forward off of a slide ladder step striking her head
Fall distance: 22 inches
Witnessed: Yes
Conscious: “crying … Approximately 15 minutes later she began to vomit”
CT Imaging: Performed but results not described
Eye exam: Not recorded
Autopsy: Complex fracture of left frontal bone and bilateral temporal bones; associated subgaleal hematoma; small epidural and subdural hematomas; marked cerebral edema with uncal herniation
Case 9
Age: 4 years
Mechanism: Fell off slide landing on buttocks then falling on left side striking head
Fall distance: 7 feet
Witnessed: Yes
Conscious: “no loss of consciousness … began vomiting and complained of left neck and head pain approximately 3 hours later”
CT Imaging: Left parietal epidural hematoma with a midline shift
Eye exam: Not recorded
Autopsy: Small epidural hematoma; cerebral edema with cerebellar tonsillar and uncal herniation and hypoxic encephalopathy
Case 10
Age: 5 years
Mechanism: Fell off of horizontal ladder of monkey bar
Fall distance: 7 feet
Witnessed: No
Conscious: “laying face down on the ground and not moving”
CT Imaging: Right temporal fracture with underlying subdural hematoma; subdural hematoma along right parietal and temporal lobes; right sided edema with midline shift
Eye exam: Not recorded
Autopsy: None
Case 11
Age: 6 years
Mechanism: Fell off swing but actual fall not witnessed
Fall distance: 2-8 feet
Witnessed: No
Conscious: “initially conscious and talking but within 10 minutes became comatose”
CT Imaging: Left frontoparietal subdural hematoma with extension into the interhemispheric fissure and midline shift
Eye exam: “no retinal hemorrhages”
Autopsy: None
Case 12
Age: 6 years
Mechanism: Fell from crossbar of monkey bars landing flat on his back
Fall distance: (approximately) 10 feet
Witnessed: No
Conscious: “was conscious and alert” … approximately 30 minutes later, “he suddenly collapsed”
CT Imaging: (initially) Normal
(20 hours after the fall) Diffuse cerebral edema
Eye exam: Not recorded
Autopsy: None
Case 13
Age: 6 years
Mechanism: Slid quickly down pole of monkey bar striking ground with feet, buttocks, back and then head
Fall distance: 7 feet 10 inches
Witnessed: Yes
Conscious: “seemed fine” following incident, but six hours later “was incoherent and drooling”
CT Imaging: Right parieto-occipital skull fracture, subdural and subarachnoid hemorrhage; right cerebral hemisphere infarct”
Eye exam: Not recorded
Autopsy: Right parieto-temporal subgaleal hematoma; right parietal skull fracture; subdural hematoma and cerebral edema
Case 14
Age: 7 years
Mechanism: Fell off horizontal bar of monkey bars; unclear if hit forehead on bars of ladder
Fall distance: 4-8 feet
Witnessed: Yes
Conscious: Unclear if initial loss of consciousness; two days after fall was stumbling and had slurred speech
CT Imaging: (initial) Occipital subgaleal hematoma
(two days later) Left carotid artery occlusion and left parietal and temporal lobe infarcts
Eye exam: Not recorded
Autopsy: Infarcts of left parietal, temporal and occipital lobes; acute cerebral edema with herniation; thrombosis of left vertebral artery
Case 15
Age: 8 years
Mechanism: Fell from a retaining wall striking back and head after swinging to wall from monkey bars
Fall distance: 34 inches
Witnessed: Yes
Conscious: “initially cried and complained of a headache but continued playing” … approximately 14.5 hours later “complained of a severe headache then became unresponsive and had a seizure”
CT Imaging: Not done
Eye exam: Not reported
Autopsy: Right temporoparietal subdural hematoma
Case 16
Age: 10 years
Mechanism: Fell off swing (seat detached from chain) striking the back of his head
Fall distance: 3-5 feet
Witnessed: Yes
Conscious: “remained conscious although groggy … He suddenly lost consciousness approximately 10 minutes later”
CT Imaging: Right frontoparietal subdural hematoma with transtentorial herniation
Eye exam: “extensive bilateral confluent and stellate, posterior and peripheral preretinal and subhyaloid hemorrhage”
Autopsy: Right parietal subarachnoid arteriovenous malformation; subdural hemorrhage; cerebral edema with herniation
Case 17
Age: 12 years
Mechanism: Fell off swing while standing on seat as it was twisting; struck back and back of head
Fall distance: 3-6 feet
Witnessed: Yes
Conscious: “immediately unconscious”
CT Imaging: Not performed
Eye exam: Not recorded
Autopsy: Comminuted occipital fracture and contusions of inferior frontal and temporal lobes
Case 18
Age: 13 years
Mechanism: Fell backwards while standing on the seat of a swing
Fall distance: 2-6 feet
Witnessed: Yes
Conscious: “immediately unconscious”
CT Imaging: Interhemispheric subdural hemorrhage and generalized cerebral edema
Eye exam: Not recorded
Autopsy: Linear occipital skull fracture; subdural hemorrhage; contusion of left cerebellar hemisphere and bifrontal lobes; cerebral edema
Conclusions:
Chadwick DL, Bertocci G, et al. Annual risk of death resulting from short falls among children: less than 1 in 1 million. Pediatrics 2008; 121:1213-24.
Methods
Results:
Conclusion: