• Falls from Beds - Article Summaries

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    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.

    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.

    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.

    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.

    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.

    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.

    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.