PC3029: Falls from Homes, It’s Not Just a Window Problem

Background: Falls are the leading cause of unintentional injury for children in the US. Three million children require care for fall-related injuries. Preschool-aged children have highest risk of falling with predisposition of males, window falls, and summer months. Studies show window screens do not provide adequate protection against window falls. Injury prevention for all children who sustain window falls should be addressed.

Methods: Retrospective chart review of 47 eligible pediatric patients who fell from a building, window, roof, balcony, or other structure between January 1, 2015 and October 31, 2020. Exclusion criteria included any patient >15 years of age as per the definition of a pediatric trauma patient. Falls were excluded if related to structural damage, small height from a deck or furniture such as highchair, and/or external structures like a treehouse. Data was collected via the Trauma Registry and electronic medical record. The purpose of the review is to evaluate demographics, seasonal trends, type of residence, status of window, and severity of injury in relation to the height of fall and landing surface.

Results: Of the 47 patients, 31 (66%) patients were male (table 1), and summer was the most predominant season (47%). The most common falls were from windows (94%) without window guards (100%). Single family homes (49%) were the most common dwelling. Active children (5-9 years) were more likely to fall from greater heights (P=.047) as compared to young children (0-4 years) (table 2). A significant association in the patients' Injury Severity Score (ISS) when compared to height of the fall was found (P=.002). Patients who fell from heights >30 feet experienced severe and very severe ISS at a higher-than-expected frequency compared to patients falling from lower heights (table 2). The association between landing surface and ISS was found to be significant (P=0.018). All falls that resulted in severe or very severe ISS landed onto cement, while 76% of non-cement falls resulted in minor ISS. Four patients who fell from heights of >30 feet sustained significant head trauma (100%) and/or internal organ injury (75%). Two deaths occurred. Despite 39 patients (83%) falling from heights >11 feet, many did not sustain significant injuries.

Conclusion: We found comparable findings to literature regarding gender and seasonality trends. Children who fell greater distances onto cement sustained more severe injuries. At Lehigh Valley Reilly Children's Hospital, patients who sustain a fall >10 feet trigger a pediatric level two trauma alert for response by a multidisciplinary team who provides a comprehensive approach to childhood injury. Providing care to an injured patient with the intent of reducing injury-related disability and/or death remains a priority. Injury prevention is imperative, especially in active children to prevent future, irreversible consequences related to falls from homes.