Mayerson Center for Safe and Healthy Children

  • Falls from Beds - Article Summaries

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    + Bunk bed injuries

    Selbst, SM, et al. Bunk bed injuries. AJDC 1990;144:721-723.

    Methods:

    • Injury group: 68 children presenting to emergency department with bunk bed related injury
    • Control group: 54 children presenting to emergency department with another complaint and also have a bunk bed (those with previous bunk bed injuries were excluded)
    • Mean ages: 5.1 years (injury group); 6.2 years (control group)

    Findings:

    • Most frequently injured body parts: head (52 percent), lower extremity (13 percent), face (12 percent), upper extremity (10 percent)
    • Most common injuries: lacerations (40 percent), skin contusions (28 percent), concussions (12 percent), fractures (10 percent)
    • Those injured were much less likely to have carpet under bed (42 percent injured vs. 67 percent controls)
    • Six children who required hospitalization (four concussions, one skull fracture / subdural, one laceration near eye) all fell from the top bunk

    Conclusions:

    • Bunk bed injuries are common and may be serious.
    • More serious injuries occurred from top bunk.

    + Injuries resulting when small children fall out of bed

    Helfer RE, et al. Injuries resulting when small children fall out of bed. Pediatrics. 1977;60:533-535.

    Methods:

    • 246 children <5 years old divided into two groups: survey group: parents filled out survey in doctor’s office whether child had fallen off bed or sofa (n=161)
    • hospital group: fall in hospital from bed, crib or exam table (n=85)

    Results:

    • Survey group: (all falls <90cm)

      • three clavicular fractures (ages: 6 months-5 years)
      • two skull fractures (ages: <6 months)
      • one humerus fracture (age: <6 months)
    • Hospital group: (fall = 90cm) one skull fracture (“no serious  sequela”)

    Conclusions:

    • Severe head injuries did not occur when these children fell out of bed.
    • Fractures can occur when children fall out of bed.

    + Falling out of bed: A relatively benign occurrence

    Lyons TJ, Oates RK. Falling out of bed: A relatively benign occurrence. Pediatrics 1993;92:125-127.

    Methods:

    • 207 children <6 years of age who fell from a hospital crib (n=124) (32 inches with sides down; 54 inches with sides up) or bed (n=83) (25 inches; 41inches with bed rails)
    • 15 percent who fell from cribs and 18 percent who fell from beds fell over the side rails

    Results:

    • 31 injuries: 29 trivial injuries (skin contusions and small lacerations), one linear skull fracture (10-month-old  fell out of crib), one clavicle fracture (21-month-old  fell out of crib with rails up)
    • 26 (84 percent) injuries were to the head
    • Not all patients received a radiograph

    Conclusions:

    • Clinically significant head injuries are uncommon with falls from these heights.

    + The likelihood of injuries when children fall out of bed

    Nimityongskul P, Anderson LD. The likelihood of injuries when children fall out of bed. J Ped Ortho 1987;7:184-186.

    Methods:

    • 76 children <16 years of age (23 were less than 1 year of age) who fell out of bed / crib / chair / wagon while in hospital (1-3 foot fall)

    Results:

    • Most of the patients sustained minor injuries (bruises, minor lacerations)
    • 1 patient  (1 year of age) had an occipital skull fracture
    • 1 patient  (with osteogenesis imperfecta) had a non-displaced tibial fracture
    • Total of nine radiographs performed (seven skull films) in all patients

    Conclusions:

    • Severe head injuries were not seen in these children who fell out of a hospital bed, crib or chair.

    + Depressed skull fracture in a 7-month-old who fell from bed

    Wheeler DS, Shope TR. Depressed skull fracture in a 7-month-old who fell from bed. Pediatrics 1997;100:1033-1034.

    Methods:

    • Case report of 7-month-old fall from bed who sustained a 2x4x0.5 cm depressed right parietal skull fracture

    Results:

    • No underlying brain injury, no retinal hemorrhages, no other fractures
    • Scene investigation revealed a car toy-roof fit the dimensions of skull depression

    Conclusion:

    • Depressed skull fractures may occur when children fall short distances onto an object.

    + Bunk beds – a still underestimated risk for accidents in childhood?

    Mayr JM, Seebacher U, et al.  Bunk beds – a still underestimated risk for accidents in childhood? Eur J Pediatrics 2000; 159:440-3

    Methods:

    • This study retrospectively looked at 218 children aged 1 to 15 involved in non-fatal falls from bunk beds in Australia between the years 1990 and 1999
    • Patients with skull fractures were followed for an additional two to five months to rule out neurological deficits 

    Results:

    • Mean age was 4.5 years 
    • 41.7 percent had major injuries and 58.3 percent had minor injuries
    • 3.2 percent had cranial vault fracture  
    • Follow-up revealed no children with head injuries displayed neurologic or behavioral changes

    Conclusion: 

    • A small percentage of children suffered skull fractures from bunk bed falls.

    + Head trauma outcomes of verifiable falls in newborn babies

    Ruddick C, Platt MW, Lazaro C.  Head trauma outcomes of verifiable falls in newborn babiesADC Online First, published as 10.1136/adc.2008.143131.

    Methods:

    • Babies who fell accidentally to the floor in the maternity ward between 1999 and 2003 were identified, and included in the study if falls were witnessed or circumstances verifiable. 

    Results:

    • The floor of the hospital was identified as vinyl tile on concrete subfloor
    • Falls were from one meter or less, except one case which was from 1.2 meters
    • 11 cases were included.  Immediate assessment was available for each case
      • eight cases presented without clinical findings.
      • three included a presentation of bruising over the temporal area, one with swelling over the parietal area, and one case of traumatic encephalopathy. 
    • Radiographically:
      • five linear parietal skull fractures were identified. 
      • three of these fractures did not have associated scalp swelling.

    Conclusion:

    • Symptoms of underlying brain injury were not present in nearly every case.
    • Single linear parietal fractures are possible in short falls.
    • Scalp swelling does not always accompany skull fractures.