Injuries from falls in the pediatric population: An analysis of 729 cases

Background/Purpose: Falls are classified as low or high level for triage pu rposes. Because triage criteria dictate less urgency for low-level falls, t his classification scheme has important implications for pediatric emergenc y care. Methods: Retrospective analysis was conducted of 729 (393 low-level and 336 high-level) pediatric patients treated for fall-related trauma (1992 throu gh 1998). Falls were classified as low (< 15 feet) or high-level (greater t han or equal to 15 feet). All falls were reported as accidental or unintent ional. Results: The overall mortality rate was 1.6% (2.4% for high-level falls com pared with 1.0% for low-level falls). All 4 patients who died of a low-leve l fall had an abnormal head computed tomography (CT) scan and intracranial hypertension. Half of deaths from high-level falls were attributable to int racranial injuries, and half were caused by severe extracranial injuries. C ommon extracranial injuries were upper extremity fracture (6.2%), lower ext remity fracture (5.6%), pulmonary contusion (1.8%), pneumothorax (1.1%), li ver laceration (1.1%), bowel injury (1.0%), and splenic injury (2.1%). Orth opedic and thoracic injuries resulted more commonly from high-level fails, whereas abdominal injuries were as likely to occur after a low-level fall. Conclusions: Intracranial injury accounts for the majority of deaths from f alls. Children suffering low-level falls were at similar risk for intracran ial and abdominal injuries compared with those who fell from greater height s. Pediatric trauma triage criteria should account for these findings. Copy right (C) 2001 by W B. Saunders Company.