Falls from heights among children: a retrospective review

Paediatric falls: An analysis of patterns of injury and associated mortality in urban India

BACKGROUND

Falls are some of the most common childhood injuries. However, for vulnerable children in low- and middle-income countries (LMICs) such as India, mortality from a fall is nearly three times that of high-income countries. Despite fall being a leading cause of paediatric injury, detailed data from LMICs remain sparse. This study aims to assess fall-related patterns of injury and mortality in children in urban India.

METHODS

We conducted a retrospective analysis from the Towards Improved Trauma Care Outcomes (TITCO) database, comprising 16,000 trauma patients admitted to four tertiary centres in India, between July 2013 and December 2015. We analysed demographics, Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), and the pattern of injury sustained for patients under 18-years admitted with fall and assessed survival probability in different age groups using Kaplan-Meier survival analysis and log-rank tests.

RESULTS

Of 1281 children admitted after a fall, two-to-five-year-olds formed the majority (40 %). Nearly all children (99 %) had blunt trauma. The median ISS was 9 (IQR 9-11) and median GCS was 15. Overall in-hospital mortality was 7.8 % and isolated traumatic brain injury (TBI) was the most common (71 %) injury in those who died. Mortality was significantly higher in male children (9 %) than in female children (5 %) (p = 0.009). There was no significant difference in survival between age groups (p = 0.9).

CONCLUSION

The majority of paediatric patients admitted to urban hospitals in India after a fall were between the ages of two-to-five years, with isolated TBI and male sex associated with greater mortality. These findings have the potential to aid age-specific fall prevention strategies and resource allocation towards targeted initiatives to improve access to care, and consequently, mortality from fall in urban India.

Falls from height in children: epidemiology and outcome

INTRODUCTION

Childhood injury is one of the leading causes of death globally, with falls being the sixth leading cause. This study aimed to examine the demographics, patterns of injury and temporal risk factors for falls from height above 3 m in Singapore.

METHODS

This is a retrospective study conducted on patients who presented after a fall to a paediatric emergency department at a tertiary hospital between January 2011 and July 2017. Electronic medical records were reviewed to extract demographics and data on the patterns of injuries. Criteria for inclusion were patients under 18 years of age and the occurrence of fall from a height of 3 m or above.

RESULTS

A total of 149 children met the inclusion criteria. The median age was 10 years and 69.1% were boys. Death occurred in two (1.3%) cases; 84 (56.4%) were admitted and survived. Of those admitted, five (3.4%) required care in the intensive care unit and 11 (7.4%) required surgery. Falls occurred mostly at homes or residential buildings (n = 59, 39.6%). The two cases of mortality were due to falls from windows at homes. Twenty (33.9%) children fell from windows at homes, with two requiring admission to the intensive care unit.

CONCLUSION

Our study shows that falls from windows of homes are an important cause of mortality. Height of fall was also an important predictor of morbidity that led to a higher level of hospitalisation care. Preventive measures should be implemented to ensure safety in high-rise residential buildings to prevent paediatric falls from heights.

Pediatric Traumatic Injuries Due to Agrarian Hay-Hole Falls

Hay-holes are a design feature in many traditionally built barns that serve as a portal through which stored hay is passed to the lower level where animals are fed. Unfortunately, children sometimes fall through the hay-hole to the concrete or packed earth below. Available data on the frequency and types of hay-hole injuries is limited. The purpose of this study was to better characterize the resultant injuries and identify prognostic factors that predict outcomes from them. We performed a retrospective review of 53 children admitted to the Penn State Hershey Children's Hospital at the Penn State Hershey Medical Center with injuries due to a fall through a hay-hole over 15 years. Compared to urban trauma, hay-hole falls more frequently involve younger children and craniofacial injuries. Although they may result in significant injuries, they are rarely fatal. Greater fall height is associated with longer length of stay (LOS) but not with a greater frequency of intubation, intracranial hemorrhage, or skull fracture. A re-examination of barn design may help to reduce the frequency of this injury type.

Knowledge and attitude of children safety at home among population in Saudi Arabia

Background:

Unintentional injury to children at home is a public health problem and it is a significant cause of death and disabilities. It accounts for 40% of all child deaths. To our knowledge, there have been no similar studies done on Arabic countries that show the prevalence of home injuries among children.

Aim:

We aimed to assess the adults’ knowledge and attitude toward child safety at home in Saudi Arabia.

Methods:

A cross-sectional study was conducted among 1,301 participants, during August 2017, who are older than 18 years old and have at least one child in the family. Data were collected by an online questionnaire assessing the believes, knowledge, and behavior of the participants. Analysis was carried out using IBM SPSS Software version 21, using descriptive analysis, t-test, and one-way ANOVA.

Results:

It was found that gender, age, marital status, employment status, and the type of accommodation played key roles in the awareness of children safety at home, the study showed that females and age group above 25, married, employees, and those who lived in flats had more awareness than the other groups, respectively.

Conclusion:

The majority of the population had good awareness about children’s safety at home. Despite the good level of awareness, more public health education is recommended to improve the awareness and the prevention methods of these injuries.

Pediatric Rib Fractures Identified by Chest Radiograph: A Comparison Between Accidental and Nonaccidental Trauma

OBJECTIVE

The objective of this study was to determine the prevalence of rib fractures (RFs) identified by chest x-ray (CXR) among children younger than 2 years who sustained accidental versus nonaccidental injuries. It is hypothesized that RFs are uncommon among all accidental pediatric trauma mechanisms (eg, falls, motor vehicle crashes) as compared with the prevalence of RFs in the setting of nonaccidental trauma (NAT).

METHODS

A retrospective chart review of sequential CXRs of children younger than 2 years evaluated at a pediatric level 1 trauma center for accidental trauma and possible NAT was conducted from January 1, 2011, to October 31, 2016. Data collected included demographics, CXR indication and findings, history of cardiopulmonary resuscitation, trauma mechanism, associated injuries, final diagnoses, and outcomes.

RESULTS

Two (<1%) of 226 CXRs obtained to evaluate accidental trauma demonstrated acute RFs. Ten (19.6%) of 51 CXRs obtained in the setting of concern for NAT revealed RFs (9/10 identified only healing RFs and 1/10 identified acute RFs). Among patients with a final diagnosis of NAT (ie, not neglect, accidental trauma, etc; n = 38), the overall prevalence increased to 26.3%.

CONCLUSIONS

The presence of RFs in pediatric accidental trauma is uncommon even in the setting of high-force mechanisms, and when identified, these RFs are acute. Comparatively, the overall prevalence of RFs identified on CXR among cases with a final diagnosis of NAT was much higher and almost exclusively healing RFs. These data provide support that identification of RFs is highly concerning for NAT even if an accidental mechanism is provided. When RFs are identified, a full NAT work-up should be considered.

The impact of errors in infant development: Falling like a baby

What is the role of errors in infants' acquisition of basic skills such as walking, skills that require immense amounts of practice to become flexible and generative? Do infants change their behaviors based on negative feedback from errors, as suggested by "reinforcement learning" in artificial intelligence, or do errors go largely unmarked so that learning relies on positive feedback? We used falling as a model system to examine the impact of errors in infant development. We examined fall severity based on parent reports of prior falls and videos of 563 falls incurred by 138 13- to 19-month-old infants during free play in a laboratory playroom. Parent reports of notable falls were limited to 33% of infants and medical attention was limited to 2% of infants. Video-recorded falls were typically low-impact events. After falling during free play in the laboratory, infants rarely fussed (4% of falls), caregivers rarely showed concern (8% of falls), and infants were back at play within seconds. Impact forces were mitigated by infants' effective reactive behaviors, quick arrest of the fall before torso or head impact, and small body size. Moreover, falling did not alter infants' subsequent behavior. Infants were not deterred from locomotion or from interacting with the objects and elevations implicated in their falls. We propose that a system that discounts the impact of errors in early stages of development encourages infants to practice basic skills such as walking to the point of mastery.

Observational study of falls in children from windows and balconies: What has changed?

AIM

To describe patterns of injury from window and balcony falls in children presenting to a tertiary paediatric trauma centre in New South Wales.

METHODS

A retrospective review of cases of children <15 years who had sustained injuries in a fall from a building, identified from the trauma database between 1998 and 2019.

RESULTS

A total of 381 falls from windows and balconies were recorded over the 22-year study period. There were 218 falls from windows (57%) and 163 from balconies. The majority (64%) were children under 4 years of age. The male to female ratio was 2:1. While many children sustained simple abrasions, contusions and lacerations, 17% sustained injuries with an injury severity scores of ≥12. There were four deaths.

CONCLUSIONS

This study identified that children falling from buildings remains a problem in Australia. Although many injuries were minor, severe injuries and fatalities continue to occur.

Nonfatal Pediatric Injuries Associated With Consumer Products and Sports and Recreational Activities in the United States

OBJECTIVE

The aim of this study was to investigate the epidemiology of nonfatal consumer product- and sports and recreational activity-related injuries among US children.

METHODS

National Electronic Injury Surveillance System data regarding children younger than 18 years who were treated in US emergency departments (EDs) for nonfatal consumer product- or sports and recreational activity-related injuries were analyzed.

RESULTS

From 1990 through 2012, an estimated 121,489,024 (95% confidence interval, 104,226,323-138,751,726) children younger than 18 years were treated in US EDs for nonfatal injuries meeting study criteria, yielding an average of 5,282,131 children annually, or 74.12 injuries per 1000 children. During 1990 to 2005, the overall annual injury rate decreased by 14.0% (P < 0.001), followed by an increase of 7.3% (P = 0.157) during 2005 to 2012. The concussion/closed head injury rate increased by 199.3% (P < 0.001) from 1996 to 2012. Injury rates were highest among children 0 to 4 years old and lowest among children 5 to 9 years old. Sports and recreational activities accounted for 46.5% of all injuries. Falls (40.2%) and "struck-by" (22.6%) were the leading mechanisms of injury, and 62.3% of all injuries were among boys. Injuries often occurred to the head/neck (37.8%) or upper extremities (31.9%), were frequently diagnosed as lacerations (29.0%) or soft tissue injuries (21.0%), and 2.7% were admitted to the hospital.

CONCLUSIONS

On average, a child was treated in a US ED for a nonfatal consumer product- or sports and recreational activity-related injury every 6 seconds. Although injury rates decreased early in the study period, there was a nonsignificant increasing trend from 2005 to 2012. Multilevel injury prevention efforts are recommended.

Characterization of children hospitalized with traumatic brain injuries after building falls

Background

Unintentional falls cause a substantial proportion of pediatric traumatic brain injury (TBI), with building falls carrying particularly high risk for morbidity and mortality. The cohort of children sustaining building fall-related TBI has not been well-examined. We sought to characterize children hospitalized with building fall-related TBIs and evaluate if specific factors distinguished these children from children hospitalized with TBI due to other fall mechanisms. We secondarily assessed if TBI severity among children injured due to a building fall varied between children from urban versus non-urban areas.

Methods

This was a secondary analysis of the Pediatric Health Information System (PHIS), an administrative database from pediatric hospitals. We identified children < 15 years old, hospitalized between 2009 and 2014, with an associated TBI-related diagnosis due to a fall as determined by International Classification of Diseases, Clinical Modification, Ninth revision (ICD9-CM) diagnosis codes. Urban versus non-urban status was determined using PHIS-assigned Rural-Urban Commuting Area codes. Injury severity (i.e. Injury Severity Score (ISS) and head Abbreviated Injury Scale (AIS) score) were calculated. Head AIS scores were dichotomized into minor/moderate (1–2) and serious/severe (3–6) for analysis. Frequencies, descriptive statistics, Chi-square analysis, and Mann-Whitney U analysis characterized populations and determined group differences.

Results

The study cohort included 23,813 children, of whom 933 (3.9%) fell from buildings. Within the building fall cohort, 707 (75.8%) resided in urban areas, 619 (66.3%) were male, 513 (55.0%) were white, and 528 (56.6%) had government insurance; the mean age was 3.8 years (SD 2.9). There was a larger proportion of children with serious/severe TBI among those injured from building falls relative to other falls (63.4% vs 53.9%, p <  0.01). Among children injured from building falls, those from non-urban areas were more likely to sustain a serious/severe TBI relative to urban children (58.9% vs 53.6%, p <  0.01).

Conclusions

Children hospitalized following buildings falls with TBI sustained more severe injuries relative to other fall types. Although a majority of children hospitalized with building fall related-TBIs were from urban areas, those from non-urban areas frequently sustained serious head injuries. Future research should target expanding prevention efforts to include non-urban areas.

Injuries sustained in falling fatalities in relation to different distances of falls

BACKGROUND

Falling from a distance is an important issue worldwide, which happens in different ages, genders and circumstances. It is usually not considered a medicolegal case in many countries hence no autopsy is performed. This study focused on analyzing injuries sustained in victims of falling in relation to different distances of fall.

METHODS

Retrospective study of 352 autopsy reports of falling victims brought to the forensic pathology department at Jordan University Hospital during the period from January 1990 to March 2016.

RESULTS

Among 352 cases, 256 (72.7%) were males and 96 (27.3%) were females. 303 (86.1%) cases showed accidental fall, 31 (8.8%) were suicidal, 2 (0.6%) were homicidal and un-clarified death in 16 (4.5%). Time of death was directly proportionate with the distance of fall. Victims fell from distances less than 3 m were 123 (35%), most of them were children less than 7 years 50 (40.5%) and unemployed adults more than 45 years were 48 (39.1%). They showed multiple abrasions (62.6%), few contusions (64.2%) and absent laceration of the skin (84.5%). Victims fell from distances of 3-9 m were 123 (35%), most of them were male workers 56 (60.2%). They showed multiple abrasions (63.5%), few contusions (71%) and few lacerations of skin (50.5%). Victims fell from distances more than 9 m were 136 (38.6%), most of them were male workers 71 (52.2%) and female servants 23 (17%). They showed few abrasions (80.9%), multiple contusions (64.7%) and few lacerations of skin (48.5%). The number of fractured limbs increases obviously with distances more than 3 m. Skull vault fractures were found in all distances, while skull base fractures showed in distances of 3-9 m and more than 9 m. Head injury was the most common fatal injury in all distances. Chest injuries were prominent mainly in distances more than 3 m. While abdominal injuries were mainly prominent in distances more than 9 m.

CONCLUSIONS

This study showed the effect of different distances of fall in causing different types of injuries in falling fatalities. Internal injuries were in a direct proportion with distances of fall, while external injuries showed a great importance in interpretation of the way of fall.

Preliminary results of a novel hay-hole fall prevention initiative

BACKGROUND

Hay-hole falls are a prevalent source of trauma among Anabaptists-particularly Anabaptist youth. We sought to decrease hay-hole falls in South Central Pennsylvania through the development and distribution of all-weather hay-hole covers to members of the at-risk Anabaptist community.

METHODS

Following the creation of a rural trauma prevention syndicate, hay-hole cover prototypes co-designed and endorsed by the Pennsylvania Amish Safety Committee were developed and distributed throughout South Central Pennsylvania. Preintervention and postintervention surveys were distributed to recipients to gain an understanding of the hay-hole fall problem in this population, to provide insight into the acceptance of the cover within the community, and to determine the efficacy of the cover in preventing falls.

RESULTS

A total of 231 hay-hole covers were distributed throughout eight rural trauma-prone counties in Pennsylvania. According to preintervention survey data, 52% of cover recipients reported at least one hay-hole fall on their property, with 46% reporting multiple falls (median fall rate, 1.00 [1.00-2.00] hay-hole falls per respondent). The median self-reported distance from hay-hole to ground floor was 10.0 (8.00-12.0) feet, and the median number of hay-holes present on-property was 3.00 (2.00-4.00) per respondent. Postintervention survey data found 98% compliance with hay-hole cover installation and no subsequent reported hay-hole falls.

CONCLUSION

With the support of the Pennsylvania Amish Safety Committee, we developed a well-received hay-hole cover which could effectively reduce fall trauma across other rural communities in the United States.

LEVEL OF EVIDENCE

Epidemiological study, Level III.

Facial and Orbital Fractures: A Fifteen Years Retrospective Evaluation of North East Sicily Treated Patients

Background:

Orbital fractures are classified as diseases usually related to common midface trauma. It represents the most challenging treatment due to the complex anatomy, physiology, and aesthetic role. A midface trauma involves also the zygomatic complex and the nose, however the orbit fracture seems to be a more frequent disease due to its anatomical features.

Objective:

The purpose of this work is to retrospectively evaluate and record the frequency of the midfacial traumas and orbital fractures observed in the North Eastern Sicily. The results of the present data may be useful for the clinicians in order to recognize the kind of fracture just from the first general visit having a quick diagnosis and management.

Methods:

In the years between 2001 and 2016, about 1200 patients with midfacial trauma and about 100 patients involving the orbital floor have been evaluated. All those patients underwent the surgical fracture reduction and a CT scan follow up control at one month, three months, six months and one year.

Results:

Data showed high percentage of orbital floor, nose and mandibular body and ramus fractures; moreover the most frequent causes of fractures seem to be related to motor vehicle accident, followed by assaults, work and fall.

Conclusion:

The results have highlighted the changing trends in the causes of facial injuries, particularly the increasing incidence of assaults and the falling incidence of motor vehicle accidents in developed countries. The quick diagnosis and management proved fundamental for the successful treatment. Clinicians should be able to recognize the first symptoms in order to avoid possible complications.

Traumatic fractures as a result of falls in children and adolescents: A retrospective observational study

The aim of this study is to investigate the incidence and pattern of traumatic fractures (TFs) as a result of falls in a population of children and adolescents (≤18 years old) in China.This was a cross-sectional study. We retrospectively reviewed 1412 patients who were children and adolescents with TFs as a result of falls admitted to our university-affiliated hospitals in China from 2001 to 2010. Etiologies included high fall (height ≥2) and low fall (height <2 m). The incidence and pattern were summarized with respect to different age groups, year of admission, etiologies, genders, and the neurological function.This study enrolled 1054 males (74.6%) and 358 females (25.4%) aged 10.8 ± 4.7 years. The etiologies were low fall (1059, 75.0%) and high fall (353, 25.0%). There were 2073 fractures in total and 92 patients (6.5%) presented with multiple fractures. The most common fracture sites were upper extremity fractures in 814 patients (57.6%) and lower extremity fractures in 383 patients (27.1%), followed by craniofacial fractures in 233 patients (16.5%). A total of 231 (16.4%) patients suffered a nerve injury. The frequencies of early and late complications/associated injuries were 19.5% (n = 275) and 9.2% (n = 130). The frequencies of emergency admission, nerve injury, spinal fracture, lower extremity fractures, craniofacial fracture, sternum and rib fracture, and early complications/ASOIs were significantly larger in high fall than low fall (all P <.001, respectively). The frequencies of medical insurance rate (P = .042) and upper extremity fractures (P <.001) were significantly larger in low fall than high fall. The frequencies of spinal fracture (P = .039), lower extremity fractures (P = .048), and craniofacial fracture (P = .041) were significantly larger in female than the male patients. The frequency of upper extremity fractures (P <.001) and the mean age (P <.001) was significantly larger in male than female patients. The frequencies of emergency admission, high fall, spinal fracture, and craniofacial fracture were significantly larger in patients with nerve injury than other patients without nerve injury (all P <.001, respectively).Low falls and upper extremity fractures were the most common etiologies and sites, respectively. High fall, spinal fracture and craniofacial fracture were risk factors for nerve injury. Therefore, we should focus on patients who were caused by high fall and presented with spinal and craniofacial fracture to determine the presence of a nerve injury so that we can provide early, timely diagnosis and targeted treatment to children.

Childhood Injuries Due to Hay-Hole Falls: A 19-Year Experience at a Rural Pediatric Trauma Center

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.

[Epidemiology and risk factors in injuries due to fall in infants under one year-old]

OBJECTIVES

To describe the epidemiological characteristics of unintentional injuries due to falls in children under one year and to analyse the risk factors associated with severe injuries.

PATIENTS AND METHODS

This multicentre, observational and cross-sectional study included all children less than one year treated for unintentional fall in the Emergency Departments of 8 Spanish Hospitals, belonging to the «Unintentional Paediatric Injury Workshop» of the Spanish Paediatric Emergency Society, between March 1st, 2014 and February 28th, 2015.

RESULTS

Out of 289,887 emergency department cases, 1,022 were due to unintentional falls. The median age was 8 months and 52.5% were males. Fall injuries were more frequent among children aged 9-12 months (37.6%), and 83.5% occurred at home. The most common mechanism was fall from nursery equipment (69.4%), and 47.8% occurred from a height under 50cm. More than two-thirds (68%) of falls were witnessed, but in half of the cases (329) the caregiver was not in area. Serious injuries were seen in 12% of cases. In this study, a fall height greater than 50cm, falls in the street, from the arms of the carer, and from the stairs were identified as independent risk factors for worse outcomes.

CONCLUSIONS

The most serious injuries occur in children <3 months and from a height of >50cm, though not related to unwitnessed falls. Because the most common serious injury mechanism is the fall from the arms of the carer, from stairs, and falls in the street, these facts should be highlighted in order to avoid morbidity.

Sibling Death after Being Thrown from Window by Brother with Autism: Defenestration, an Emerging High-Risk Behavior

Children diagnosed with autistic spectrum disorders (ASD) may have serious behavioral problems such as aggression, self-injury, and violence. However, the literature on ASD either overrules any correlation between aggression and ASD or maintains the fact that the efforts to link them have so far been inconclusive. Although severe forms of violence are extremely rare in children with autism, there are a few cases reported in the literature with significant harm to siblings. We hereby report an 8-year-old boy with ASD who caused the death of his sibling by throwing her out of the window. Shared similarities of all defenestration cases indicate a pattern of high-risk behavior threatening the survival of minors. We recommend precautions against this high-risk behavior in children with ASD.

Fall-related injuries in a low-income setting: Results from a pilot injury surveillance system in Rawalpindi, Pakistan

This study assessed the characteristics and emergency care outcomes of fall-related injuries in Pakistan. This study included all fall-related injury cases presenting to emergency departments (EDs) of the three teaching hospitals in Rawalpindi city from July 2007 to June 2008. Out of 62,530 injury cases, 43.4% (N = 27,109) were due to falls. Children (0–15 years) accounted for about two out of five of all fall-related injuries. Compared with women aged 16–45 years, more men of the same age group presented with fall-related injuries (50% vs. 42%); however, compared with men aged 45 years or more, about twice as many women of the same age group presented with fall-related injuries (16% vs. 9%, P < 0.001). For each reported death due to falls (n = 57), 43 more were admitted (n = 2443, 9%), and another 423 were discharged from the EDs (n = 24,142, 91%). Factors associated with death or inpatient admission were: aged 0–15 years (adjusted odds ratio [aOR] = 1.35), aged 45 years or more (aOR = 1.94), male gender (aOR = 1.15), falls occurring at home (aOR = 3.38), in markets (aOR = 1.43), on work sites (aOR = 4.80), and during playing activities (aOR = 1.68). This ED-based surveillance study indicated that fall prevention interventions in Pakistan should target children, older adult women, homes, and work sites.

The medico-legal evaluation of injuries from falls in pediatric age groups

Blunt trauma from accidental falls or intentional jumping from great heights occurs frequently in forensic medicine. The goal of this study was to investigate injuries due to falls in children under 19 years of age. Injuries from falls are the leading cause of visits to emergency departments and to deaths due to injuries. Various methods are used in the classification of falls. In this study, we have classified falls as "high-level" (≥ 5 m), "low-level" (<5 m) and "ground-level". We have retrospectively evaluated 814 boys (61.18%) and 512 girls (38.62%), making up a total of 1326 children (under 19 years old) with the mean age of 7.85 ± 3.46, that were admitted to State Hospital between January 2009 and December 2013 due to falls from heights and falls on ground-level. Falls were low-level in 738 cases, high-level in 176 cases, and ground-level in 412 cases. Cases were categorized by gender, age, age group, fall height, Glasgow Coma Scale (GCS), injured body part(s), mortality rate, and distribution according to months. In conclusion, falls merit attention because of their high risk of mortality and morbidity, as well as their burden on medical budgets. If the medico-legal aspects of falls were evaluated with regard to preventive event or death, the importance of the topic could be better understood.

A Multi Factorial Analysis of the epidemiology of Injuries from Falls from Heights

Background:

Fall from height is a common cause of morbidity and mortality in suburban population in India. These cases are either domestic or workplace injuries with different causative factors. We analyzed different aspects of these falls to identify their risk factors.

Materials and Methods:

We conducted prospective and retrospective epidemiological study to identify various causative, contributory factors, and resultant injuries in cases of fall from height. The study group comprised of semiurban population and involved both domestic and workplace injuries presenting to a tertiary care hospital.

Results:

There were 208 cases of workplace (112) and domestic (96) fall from height. In domestic cases absence of parapet on roof was the commonest cause, most of falls occurred during summer and rainy season. Alcohol consumption prior to fall was commonest associated factor in adult males. Children mostly fell while playing on roof and climbing trees. Among workplace cases, civil construction site injuries were commonest and absence of any protective gear and long working and evening hours were commonest associated factors. Mean injury severity score was 10.86 in domestic cases and 14.87 in workplace cases. There were 17 mortalities with head injury being commonest associated cause. Only difference in incidence of alcohol consumption and permanent disability was statistically significant between workplace and domestic falls.

Conclusion:

Different factors are responsible for domestic and workplace cases of fall from height. Most of these cases are potentially preventable.

Epidemiology of trauma patients and analysis of 268 mortality cases: trends of a single center in Korea

PURPOSE

There is an increasing incidence of mortality among trauma patients; therefore, it is important to analyze the trauma epidemiology in order to prevent trauma death. The authors reviewed the trauma epidemiology retrospectively at a regional emergency center of Korea and evaluated the main factors that led to trauma-related deaths.

MATERIALS AND METHODS

A total of 17007 trauma patients were registered to the trauma registry of the regional emergency center at Wonju Severance Christian Hospital in Korea from January 2010 to December 2012.

RESULTS

The mean age of patients was 35.2 years old. The most frequent trauma mechanism was blunt injury (90.8%), as well as slip-and-fall down injury, motor vehicle accidents, and others. Aside from 142 early trauma deaths, a total of 4673 patients were admitted for further treatment. The most common major trauma sites of admitted patients were on the extremities (38.4%), followed by craniocerebral, abdominopelvis, and thorax. With deaths of 126 patients during in-hospital treatment, the overall mortality (142 early and 126 late deaths) was 5.6% for admitted patients. Ages ≥55, injury severity score ≥16, major craniocerebral injury, cardiopulmonary resuscitation at arrival, probability of survival <25% calculated from the trauma and injury severity score were independent predictors of trauma mortality in multivariate analysis.

CONCLUSION

The epidemiology of the trauma patients studied was found to be mainly blunt trauma. This finding is similar to previous papers in terms of demographics and mechanism. Trauma patients who have risk factors of mortality require careful management in order to prevent trauma-related deaths.

Pattern and prevalence of maxillofacial fractures in rural children of central maharashtra, India. A retrospective study

The aim of this study was to review the pattern and prevalence of maxillofacial fractures occurring in rural children, at Rural Dental College and Hospital, Loni, Central Maharashtra, India. A retrospective analysis of patient records and radiographs was conducted during the 5 year period between January 2005 and December 2010. Data were identified and analysed based on age group, gender and anatomic site. During the 5 year period, 156 patients with 163 maxillofacial fractures were reviewed, males formed 70 % and females formed 30 % of studied population with the peak incidence rate occurring in 10-12-year old age group. The most common fracture site in maxilla was dentoalveolar component (70 %) and in mandible common fracture site was condyle (40.9 %). Of the fractures, 43 % were from accidental fall, 24.3 % from assaults, 16 % from road traffic accidents, 13.5 % from sporting injuries and 3.2 % from other causes such as animal injuries. Our results exhibit that accidental falls were the leading cause of maxillofacial fractures, and males were three times more affected than females. There is variation of incidence and pattern of maxillofacial injuries from region to region.

Accidental head trauma during care activities in the first year of life: a neurosurgical comparative study

OBJECTIVES

This study aims to describe clinical-epidemiological data regarding accidental fall injuries occurring during homecare activities among children up to 1 year of age and to compare their outcomes according to the type of trauma.

METHODS

We searched four different hospital databases on head injuries from 1999 to 2009. Patients recorded under the descriptors "accidental fall" and "home-related" in the subtext were selected. Patients were classified into two groups: those who flipped over and fell from a changing table (n = 253) and those who fell from the bed sustaining a direct impact from the floor (n = 483).

RESULTS

There was no difference between both groups with respect to age, gender, and Glasgow Coma Scale score. However, children who suffered injuries after an accidental fall from the changing table were more likely to require surgery (26/483 vs. 57/253, p < 0.0001), had a mean longer length of stay (LOS, 4 vs. 1 day), and a higher incidence of depressed skull fractures (12/483 vs. 24/253, p < 0.0001). Children with a direct impact from the floor after falling off the bed were expected to suffer from simple linear skull fractures, while those who flipped over the changing table were more likely to present facial, soft tissue, or skeletal injuries.

CONCLUSIONS

Children who flipped over a changing table during their homecare activities were more likely to require surgery, showed a higher morbidity, and showed a longer LOS than those who fell down from the bed. These results probably reflect the different impact energy according to each injury mechanism.

Fall from a balcony--accidental or homicidal? Reconstruction by numerical simulation

In the case presented, conflicting witness accounts and the subject's injuries were highly suspicious of an assault that might have caused the balcony fall. For the reconstruction, a simulation software, originally designed for motor vehicle accident reconstruction, was used. Three scenarios were simulated using the PC-Crash multibody pedestrian model: (S1) Subject was pushed against and fell over balcony rail, (S2) subject fell off from a seated position, (S3) subject fell off from a prone position on the rail. (S1) could be ruled out due to inconsistent results in terms of landing area and minimum velocity. Realistic results were obtained for (S3) with a fall off from a prone position on the rail. After a few months, the comatose subject awoke and gave an account of what had happened being consistent with the simulation results. This case demonstrates the feasibility of multibody simulations also in cases of nontraffic incidents.

Prevention of child camel jockey injuries: a success story from the United Arab Emirates

OBJECTIVE

To study the effects of a law banning children from taking part in camel racing on child camel jockey injuries in Al-Ain City, United Arab Emirates.

DESIGN

Prospective study.

SETTING

University Teaching Hospital.

PATIENTS

All patients who were admitted to Al-Ain Hospital and were injured while riding camels were prospectively studied between January 1, 2002, and December 31, 2009.

ASSESSMENT OF RISK FACTORS

Two periods, before the law and after its introduction, were compared.

MAIN OUTCOME MEASURES

Pediatric injuries, their anatomical distribution, and severity of injury.

RESULTS

Fifty-four patients were studied, and all were males. There were 13 children and 41 adults. All children were camel jockeys except 1 child who was riding a camel for fun. None of the adult camel riders was a camel jockey. The median (range) age of patients admitted before the law was 12.5 (5-45) years, which was significantly less compared with 27.2 (20-40) years after its introduction (P = 0.001, Mann-Whitney test). All 13 children sustained their injuries before the law was implemented, whereas 12 of 41 adults sustained their injuries before the legislation was in place (P < 0.0001, Fisher exact test). The total length of hospital stay of patients was significantly reduced after the law enforcement (P < 0.01, Mann-Whitney test).

CONCLUSIONS

Our findings emphasize the important role of law enforcement in injury prevention, illustrated by the replacement of children by robot substitutes. This is possibly one of the few examples where child injury has been completely prevented by legislation.

1,454 mandibular fractures: a 3-year study in a hospital in Belo Horizonte, Brazil

OBJECTIVE

To analyze the mandibular fractures which presented over a 3-year period at an emergency hospital in Belo Horizonte, Brazil.

METHODS

The data collected included age, sex, aetiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture, and treatment. The analysis involved descriptive statistics and the Pearson's chi-square, Bonferroni, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests, and analysis of variance.

RESULTS

There were 1,454 mandibular fractures in 1,023 patients. Males of 20-29 years of age sustained the majority of fractures. Traffic accidents were the major causes of trauma, followed by violence and falls. A high incidence of fractures in women due to violence was observed. The condyle region was found to be the most common fracture site in the mandible. A surgical approach was performed in most cases. There were more accidents causing mandibular fractures on the weekends.

CONCLUSION

The individuals with mandibular fractures due to "traffic accidents" were younger than those due to "violence" and "falls". There was a significant statistical association between age and aetiology as well as between sex and aetiology of mandibular fractures.

Etiologic factors in falls from height in pediatric cases

OBJECTIVE

In this study, factors causing falls from height and precautions taken for their prevention were investigated.

METHODS

The study was carried out prospectively between June 2009 and June 2010. Patients under 18 years of age presenting at the emergency department of a university hospital, for whom the primary reason for admission was an accidental fall from a height of at least one meter, were included in the study. The demographic characteristics of the patients, the characteristics of the falls, and clinical features were recorded.

RESULTS

Data for 133 patients were evaluated. Among these patients, 72 (54.1%) were male; the median age was 4 (IQR 2-7). The most common fall site was a balcony (38%). Falls frequently happened in the spring and the summer. The mean fall height was 2.9 ± 2.5 m, the median GCS score was 15 (IQR 14-15), and the median PTS was 10 (IQR 9-11). The fall heights was higher in patients who lost consciousness (p < 0.001). Among the 95 patients who were 0-6 years old, it was found that about 55% were unaccompanied by their parents. The most common pathology in the patients was head trauma (63%), while 17.3% had multiple traumas.

CONCLUSION

Since the vast majority of the fall cases were in the pre-school age group, most were due to falls from a balcony, and more than half of the cases were unaccompanied by parents or caregivers, there are two issues that need to be addressed in relation to pediatric falls from height: family education and legal regulations considering child safety in the design of doors, windows, and balconies of buildings.

Pediatric craniofacial fractures due to violence: comparing violent and nonviolent mechanisms of injury

BACKGROUND

This study examines the epidemiologic data of pediatric craniofacial fractures secondary to violence, comparing these data to craniofacial fractures sustained from all other causes.

METHODS

A retrospective review was completed on all patients who presented to the emergency department of a major urban children's hospital from 2000 to 2005 with a craniofacial fracture. Data were compared between patients with fractures due to violent and nonviolent mechanisms. Socioeconomic analysis was performed using Geographic Information System mapping and 2000 US Census data by postal code.

RESULTS

One thousand five hundred twenty-eight patients were diagnosed with skull and/or facial fractures. Isolated skull fractures were excluded, leaving 793 patients in the study. Ninety-eight children were injured due to violence, and 695 were injured from a nonviolent cause. Patients with violence-related fractures were more likely to be older, male, and nonwhite and live in a socioeconomically depressed area. A greater number of patients with violence-related injuries sustained nasal and mandible angle fractures, whereas more patients with non-violence-related injuries sustained skull and orbital fractures. Those with violence-related craniofacial fractures had a lower percentage of associated multiorgan system injuries and a lower rate of hospital admissions and intensive care unit admissions. The rate of open reduction and internal fixation for craniofacial fractures was similar in both groups.

CONCLUSIONS

Patients with violence-related fractures had fewer associated serious injuries and lower morbidity and lived in a more socioeconomically depressed area. The information gained from this descriptive study improves our ability to characterize this population of pediatric patients and to identify the associated constellation of injuries in such fractures.

Home and other nontraffic injuries among children and youth in a high-income Middle Eastern country: a trauma registry study

A trauma registry in the United Arab Emirates was used to ascertain nontraffic injuries of 0- to 19-year-olds. The registry's value for prevention was assessed. A total of 292 children and youth with nontraffic injuries were admitted for >24 hours at surgical wards of the main trauma hospital in Al Ain region during 36 months in 2003-2006. Injuries were analyzed by external cause, location, body part, and severity. Nontraffic represented 60% (n = 292) of child and youth injuries. Incidence/100 000 person-years was 91 for males, 43 for females. Unintentional included falls 65% (n = 191), burns 17% (n = 49), animal-related (mainly camel) 3% (n = 10), and others 10% (n = 29). Intentional accounted for 4% (n = 13). Falls affected all ages, burns mainly 1- to 4-year-olds. Of the injuries, 70% occurred at home. Most frequent and severe injuries measured by the Injury Severity Score and Abbreviated Injury Scale involved extremities. Prevention of home falls for all ages and burns of 1- to 4-year-olds are priorities. Registries should cover pediatric wards and include data on fall locations and hazardous products.

Influence of age and fall type on head injuries in infants and toddlers

Age-based differences in fall type and neuroanatomy in infants and toddlers may affect clinical presentations and injury patterns.

OBJECTIVE

Our goal is to understand the influence of fall type and age on injuries to help guide clinical evaluation.

DESIGN/SETTING/PARTICIPANTS

Retrospectively, 285 children 0-48 months with accidental head injury from a fall and brain imaging between 2000 and 2006 were categorized by age (infant ≤1 year and toddler=1-4 years) and fall type: low (≤3 ft), intermediate (>3 and <10 ft), high height falls (≥10 ft) and stair falls.

OUTCOME MEASURES

Clinical manifestations were noted and head injuries separated into primary (bleeding) and secondary (hypoxia, edema). The influence of age and fall type on head injuries sustained was evaluated.

RESULTS

Injury patterns in children <4 years varied with age. Despite similar injury severity scores, infants sustained more skull fractures than toddlers (71% vs. 39%). Of children with skull fractures, 11% had no evidence of scalp/facial soft tissue swelling. Of the patients with primary intracranial injury, 30% had no skull fracture and 8% had neither skull fracture nor cranial soft tissue injury. Low height falls resulted in primary intracranial injury without soft tissue or skull injury in infants (6%) and toddlers (16%).

CONCLUSIONS

Within a given fall type, age-related differences in injuries exist between infants and toddlers. When interpreting a fall history, clinicians must consider the fall type and influence of age on resulting injury. For young children, intracranial injury is not always accompanied by external manifestations of their injury.

Pediatric injuries attributable to falls from windows in the United States in 1990-2008

OBJECTIVE

To examine the epidemiological features of pediatric injuries related to falls from windows.

METHODS

By using the National Electronic Injury Surveillance System, emergency department (ED) data for pediatric injury cases associated with window falls in 1990-2008 were reviewed.

RESULTS

An estimated 98 415 children (95% confidence interval [CI]: 82 416-114 419) were treated in US hospital EDs for window fall-related injuries during the 19-year study period (average: 5180 patients per year [95% CI: 4828-5531]). The mean age of children was 5.1 years, and boys accounted for 58.1% of cases. One-fourth (25.4%) of the patients required admission to the hospital. The annual injury rate decreased significantly during the study period because of a decrease in the annual injury rate among 0- to 4-year-old children. Children 0 to 4 years of age were more likely to sustain head injuries (injury proportion ratio [IPR]: 3.22 [95% CI: 2.65-3.91]) and to be hospitalized or to die (IPR: 1.65 [95% CI: 1.38-1.97]) compared with children 5 to 17 years of age. Children who landed on hard surfaces were more likely to sustain head injuries (IPR: 2.05 [95% CI: 1.53-2.74]) and to be hospitalized or to die (IPR: 2.23 [95% CI: 1.57-3.17]) compared with children who landed on cushioning surfaces.

CONCLUSIONS

To our knowledge, this is the first study to investigate window fall-related injuries treated in US hospital EDs by using a nationally representative sample. These injuries are an important pediatric public health problem, and increased prevention efforts are needed, including development and evaluation of innovative prevention programs.

Characteristics of falls and risk of injury in children younger than 2 years

INTRODUCTION

Although many studies have shown that short falls by children rarely result in serious injury, no recent study in the United States has assessed the prevalence and the characteristics of such falls. Because the history of a short fall often is given in the instance of suspected child abuse, data addressing the characteristics, the frequency, and the severity of such falls would assist in abuse investigations.

METHODS

Anonymous questionnaires were distributed at primary care offices to parents of children younger than 5 years. Parents answered a series of questions regarding any falls their children had sustained before the age of 2 years. Information gathered included the age of the child at the time of the fall, the details about the fall, the medical attention sought, and any injuries sustained.

RESULTS

We received a total of 307 eligible surveys. There were 209 falls reported for 122 children. Only 24% of those children sustained any injury as a result of the fall. Most (85%) of the children who sustained injuries had a bruise or a bump. Of the 20% (40 children) who were brought for medical care, only 13 children received medical treatment. The most severe injuries were in 2 children who sustained concussions; only 4 children had permanent injury (cutaneous scars). Children who fell on a hard surface were 6 times more likely to have an injury compared with children who fell on a soft surface (P = 0.001) In addition, for every 1 unit increase in fall height, risk of injury increased by a factor of 2.3.

CONCLUSIONS

In short falls, ground surface and fall height were significant predictors of injury risk. The results of this study also support the opinion that short falls rarely cause injury. Therefore, a history of a short fall in a seriously injured child should raise the suspicion of child abuse.

[Haemorrhagic shock after severe abdominal trauma in children: knowing when to change from conservative to surgical management]

Abdominal vascular injuries following a serious falling out are quite rare in children. They can lead to haemorrhagic shock whose etiological diagnosis may be difficult in children in case of multiple trauma. The current management of abdominal injuries in the child is usually conservative, surgery being indicated in haemodynamically unstable patients. We report the case of a 7-year-old girl who presented with abdominal trauma with rupture of the hepatic artery and shredding of the splenic vein following a falling out of 10 meters. Aggressive resuscitation associated with early laparotomy for haemostasis, contrary to usual practices advocated in such a context, have helped control the hemorrhagic shock and stabilize the haemodynamic status of the child. The subsequent evolution was favourable, with full recovery. While a conservative attitude usually prevails in the management of traumatic intra abdominal bleeding in children an interventional attitude with emergency surgery must be sometimes considered.

Unique features of pediatric spinal cord injury

STUDY DESIGN

Systematic review.

OBJECTIVE

The objective of this systematic review was to identify the unique features associated with pediatric spinal cord injury (SCI) with the intention of determining the most effective spinal stabilization methods and identifying the optimum treatment for post-traumatic spinal deformity in pediatric patients with a SCI.

SUMMARY OF BACKGROUND DATA

Spinal injuries occur in 1.99/100,000 children, 10% are under 15 years, 60% to 80% occur in the cervical spine, and 5.4% to 34% in the thoracolumbar spine. The most frequent incident of spinal injury (50%-56%) occurs during motor vehicle accidents.

METHODS

A systematic review of the English language literature explored articles published between 1950 and 2009. Electronic databases (Medline and Embase) and reference lists of key articles were searched to identify unique features of pediatric SCI based on 2 questions: (1) "What is the most effective means to achieve spinal stabilization in pediatric patients with a SCI?" and (2) "What is the most effective treatment of post-traumatic spinal deformities in pediatric patients with a SCI?" Three Spinal Trauma Study Group faculty members assessed the level of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria and disagreements were resolved by a modified Delphi consensus.

RESULTS

No Level 1 or 2 evidence articles were discovered. Question 1 was addressed by 417 abstracts; from those 15 were selected for inclusion. This literature proved to be controversial, mostly focused on the adult population, pediatric series were retrospective, and most treatments were based on adult experience. The evidence supporting stabilization of the spine in the pediatric SCI population is very low for both the cervical and thoracic spinal regions. Question 2 was discussed in 517 abstracts; 8 relevant articles were selected. The principal key points, regarding the most effective treatment of post-traumatic spinal deformity in the pediatric SCI patients, suggest that the deformity should be prevented before the age of 10 to 12 years, younger SCI patients are unfavorable, nearly 100% of patients with SCI will develop a deformity, and brace treatment is generally recommended. Current evidence in support of brace use is very low.

CONCLUSION

Despite the lack of well-designed prospective studies to establish the efficacy of instrumentation in these cases, there remains very low evidence that supports the use of instrumentation in unstable pediatric spines to prevent neurologic injury and maintain spinal alignment. The very low evidence of benefits from early bracing clearly outweighs the risks and complications associated with its use. Close monitoring should be initiated early so as to delay surgical correction as late as possible. There is very low evidence to support the use of surgery for the treatment of deformity triggered by a SCI. There may be evidence suggesting that the correction techniques used for neuromuscular deformities are useful for SCI patients. In conclusion, there is a strong recommendation for the use of instrumentation in the unstable pediatric spinal injured population, and there is a strong recommendation for traditional neuromuscular spinal deformity treatment techniques to be adopted as a treatment of progressive spinal deformities after a neurologic injury.

Biomechanics of the toddler head during low-height falls: an anthropomorphic dummy analysis

OBJECT

Falls are the most common environmental setting for closed head injuries in children between 2 and 4 years of age. The authors previously found that toddlers had fewer skull fractures and scalp/facial soft-tissue injuries, and more frequent altered mental status than infants for the same low-height falls (<or=3 ft).

METHODS

To identify potential age-dependent mechanical load factors that may be responsible for these clinical findings, the authors created an instrumented dummy representing an 18-month-old child using published toddler anthropometry and mechanical properties of the skull and neck, and they measured peak angular acceleration during low-height falls (1, 2, and 3 ft) onto carpet pad and concrete. They compared these results from occiput-first impacts to previously obtained values measured in a 6-week-old infant dummy.

RESULTS

Peak angular acceleration of the toddler dummy head was largest in the sagittal and horizontal directions and increased significantly (around 2-fold) with fall height between 1 and 2 ft. Impacts onto concrete produced larger peak angular accelerations and smaller impact durations than those onto carpet pad. When compared with previously measured infant drops, toddler head accelerations were more than double those of the infant from the same height onto the same surface, likely contributing to the higher incidence of loss of consciousness reported in toddlers. Furthermore, the toddler impact forces were larger than those in the infant, but because of the thicker toddler skull, the risk of skull fracture from low-height falls is likely lower in toddlers compared with infants.

CONCLUSIONS

If similar fracture limits and brain tissue injury thresholds between infants and toddlers are assumed, it is expected that for impact events, the toddler is likely less vulnerable to skull fracture but more vulnerable to neurological impairment compared with the infant.

Facial fractures in children and adolescents: a retrospective study of 3 years in a hospital in Belo Horizonte, Brazil

AIM

The purpose of this study was to review the etiology, incidence and treatment of selected oral and maxillofacial fractures in children in Belo Horizonte, Brazil, during a period of 3 years.

MATERIALS AND METHODS

The data collected for this study included age, gender, etiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture and treatment. The analysis involved descriptive statistics and chi-squared test, Bonferroni test, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests and analysis of variance.

RESULTS AND CONCLUSIONS

This study examined 566 facial fractures in 464 children of 18 years of age or less. The majority of fractures were observed in children within the age group of 13-18 years of age. Bicycle accidents were the major cause of trauma, followed by falls. The mandible was found to be the most common fractured bone in the facial skeleton, followed by the nose. A conservative approach was applied in most cases.

Epidemiology of balcony fall-related injuries, United States, 1990-2006

BACKGROUND

Falls from heights are common in urban areas in the United States. This study describes the epidemiology of balcony fall-related injuries requiring emergency department (ED) treatment among children and adults in the United States from 1990 through 2006.

METHODS

In 2009, a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission was conducted to describe the epidemiology of balcony fall-related injuries.

RESULTS

An estimated 86,500 (95% confidence interval [CI], 68,400-104,600) balcony fall-related injuries were treated in US hospital EDs from 1990 through 2006; 70% of cases were male; 63% were adults (≥18 years old); 94% of injury events occurred at home; 24% of patients were hospitalized; and 8 patients died. The rate of balcony fall-related injuries among children decreased significantly during 1990 to 2006 and was similar to that of adults by the end of the study period. Fall heights ranged from 5 to 87.5 ft. Structural failure of the balcony was involved in an estimated 5600 cases. Patients younger than 18 years were more likely to sustain a concussion/closed head injury (relative risk, 2.42; 95% CI, 1.84-3.18) or skull fracture (relative risk, 5.86; 95% CI, 2.58-13.30) than adults.

CONCLUSIONS

This is the first study of balcony fall-related injuries requiring emergency treatment using a nationally representative sample. Balcony falls are an important cause of injury in the United States. Age, male sex, and warm months of the year were associated with balcony fall-related injuries in our study population.