J. A. Zagory1, M. Mallicote1, H. Arbogast1, J. Upperman1, M. Fenlon1, A. Jensen1 1Children’s Hospital Los Angeles,Surgery,Los Angeles, CA, USA
Introduction: Children suffering fall related injury sustain significant morbidity and mortality and require significant resource utilization. Currently, there are no injury prevention programs in the greater Los Angeles area targeted to prevent pediatric falls. We aim to identify injury patterns, resource utilization, and complication rates in children sustaining falls. We hypothesize that falls from significant height occur in children as they become mobile, and an at-risk age can be identified for injury prevention targeting.
Methods: We conducted a 10-year retrospective review (2004-2014) of a prospectively collected countywide trauma database for children (age <18y) who sustained injury related to a fall mechanism. Mechanism codes were utilized to identify <15 ft/low-risk (LR) and >15ft/high-risk (HR) falls for comparison. Statistical analysis was conducted with independent t-test or χ2 as appropriate.
Results: 4451 children sustained LR and 229 HR falls. HR falls were more likely to be younger (4.3±3.7 v 5.6±4.4) , non-white (11.3% v 12.2%), have greater Injury Severity Score (ISS)(7±7.5 v 6±4.2), and sustain injury to their head (skull/facial fracture, intracranial hemorrhage, closed head injury)(70% v 43%)(p<0.001). Of all falls in children under 1y, less than 1.5% were HR, while in children 1-4y 8% of falls were HR. Children 1-4y represent 62% of all HR falls. Resource utilization (computed tomography, length of stay, Intensive Care Unit admission, intubation) and complications (decubitus ulcer, need for respiratory support, pneumonia) were higher in HR (p<0.0001) (Table). Two deaths were in LR and due to non-accidental trauma.
Conclusion: Non-white children 1-4y are at especially high risk for falls from a significant height, with higher ISS, resource consumption, and complications. Injury prevention education should be part of well-child visits as children begin to ambulate, and structured targeted community-based programs should be developed and paired with health policy efforts.
