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Chadwick DL, et al. Deaths from falls in children: how far is fatal? J Trauma 1991;31:1353-1355.
Results: Case fatality rate by fall height:
Fall Height (feet)
Case fatality rate (%)
For patients who died from a fall from 1-4 feet, histories given for the type of fall:
Type of fall
Fall from bed / table
Fall down stairs
bruising on arms, labia majora, thighs
Fall in arms of adult
(1) bruising on scalp, ear; SDH; RH and (2) RH; SDH; old tibia fracture
Reiber GD. Fatal falls in childhood. Am J Forensic Med Path 1993;14:201-207.
Hall JR, Reyes HM, Horvat M, et al. The mortality of childhood falls. J Trauma 1989;29:1273-1275.
In the group who fell <3 feet:
Plunkett J. Fatal pediatric head injuries caused by short-distance falls . Am J Forens Med Pathol 2001;22:1-12.
More than 75,000 cases were reviewed:18 deaths from head injury secondary to a fall associated with the use of playground equipment were recorded.
Age range of patients: 1-13 years
Cases:Fall distance = “distance of closest body part from ground at beginning of fall”
Case 1Age: 12 monthsMechanism: Fell sideways and backwards off of a porch swingFall distance: 5-6 feetWitnessed*: NoConscious: “unconscious immediately”CT Imaging: Subgaleal hematoma at vertex; comminuted fracture of vault; parafalcine subdural hemorrhage; right parietal subdural hemorrhageEye exam: Not recordedAutopsy: None
* definition of witnessed: by a non-caretaker
Case 2Age: 14 monthsMechanism: Fell backwards off of a seesawFall distance: 22.5 inchesWitnessed: NoConscious: “conscious but crying … Within 10 to 15 minutes he became lethargic and limp, vomited”CT Imaging: Occipital subgaleal hematoma; left sided cerebral edemaEye exam: NormalAutopsy: None
Case 3Age: 17 monthsMechanism: Fell from swing on its downstrokeFall distance: (estimated) 5-6 feetWitnessed: NoConscious: “immediately unconscious”CT Imaging: Left sided subdural hematoma with extension to the interhemispheric fissure and falxEye exam: Not recordedAutopsy: Symmetrical contusions on buttocks and posterior thorax; left subdural hematoma; cerebral edema with anoxic encephalopathy; uncal and cerebellar tonsillar herniation
Case 4Age: 20 monthsMechanism: Fell from platform of jungle gym striking head on support postFall distance: 67 inches from ground; 42 inches from support postWitnessed: NoConscious: “initially conscious and talking, but within 5 to 10 minutes became comatose”CT Imaging: Right occipital depressed skull fracture; right subdural and subarachnoid hemorrhage along the tentorium and posterior falxEye exam: “extensive bilateral retinal and preretinal hemorrhage”Autopsy: (limited) Impact subgaleal hematoma overlying the fracture
Case 5Age: 23 monthsMechanism: Fell head-first off of a plastic gym set on to plush carpet over a concrete floorFall distance: 28 inchesWitnessed: Yes (videotaped)Conscious: “cried after the fall but was alert and talking … approximately 5 minutes later she vomited and became stuporous”CT Imaging: Right-sided subdural hematoma and minimal subfalcine herniationEye exam: “Bilateral retinal hemorrhages”Autopsy: Right subdural hematoma; cerebral edema with cerebellar tonsillar herniation
Case 6Age: 26 monthsMechanism: Fell backwards off of a playground swingFall distance: 3-6 feetWitnessed: YesConscious: “immediately unconscious”CT Imaging: Subdural hematoma; acute cerebral edemaEye exam: “extensive bilateral retinal hemorrhage, vitreous hemorrhage in the left eye”Autopsy: Right parietal impact injury; small bilateral subdural hemorrhage; cerebral edema with herniation; focal hemorrhage in the right posterior midbrain and pons; retinal hemorrhage
Case 7Age: 3 years, history of thrombocytopenia-absent radius syndromeMechanism: Fell off of platform, striking his faceFall distance: 3 feetWitnessed: YesConscious: “initially conscious and able to walk; approximately 10 minutes later he had projectile vomiting and became comatose”CT Imaging: Subdural hematoma; diffuse cerebral edema with uncal herniationEye exam: Not recordedAutopsy: NoneOther findings: Platelet count 24,000
Case 8Age: 3 yearsMechanism: Fell forward off of a slide ladder step striking her headFall distance: 22 inchesWitnessed: YesConscious: “crying … Approximately 15 minutes later she began to vomit”CT Imaging: Performed but results not describedEye exam: Not recordedAutopsy: Complex fracture of left frontal bone and bilateral temporal bones; associated subgaleal hematoma; small epidural and subdural hematomas; marked cerebral edema with uncal herniation
Case 9Age: 4 yearsMechanism: Fell off slide landing on buttocks then falling on left side striking headFall distance: 7 feetWitnessed: YesConscious: “no loss of consciousness … began vomiting and complained of left neck and head pain approximately 3 hours later”CT Imaging: Left parietal epidural hematoma with a midline shiftEye exam: Not recordedAutopsy: Small epidural hematoma; cerebral edema with cerebellar tonsillar and uncal herniation and hypoxic encephalopathy
Case 10Age: 5 yearsMechanism: Fell off of horizontal ladder of monkey barFall distance: 7 feetWitnessed: NoConscious: “laying face down on the ground and not moving”CT Imaging: Right temporal fracture with underlying subdural hematoma; subdural hematoma along right parietal and temporal lobes; right sided edema with midline shiftEye exam: Not recordedAutopsy: None
Case 11Age: 6 yearsMechanism: Fell off swing but actual fall not witnessedFall distance: 2-8 feetWitnessed: NoConscious: “initially conscious and talking but within 10 minutes became comatose”CT Imaging: Left frontoparietal subdural hematoma with extension into the interhemispheric fissure and midline shiftEye exam: “no retinal hemorrhages”Autopsy: None
Case 12Age: 6 yearsMechanism: Fell from crossbar of monkey bars landing flat on his backFall distance: (approximately) 10 feetWitnessed: NoConscious: “was conscious and alert” … approximately 30 minutes later, “he suddenly collapsed”CT Imaging: (initially) Normal(20 hours after the fall) Diffuse cerebral edemaEye exam: Not recordedAutopsy: None
Case 13Age: 6 yearsMechanism: Slid quickly down pole of monkey bar striking ground with feet, buttocks, back and then headFall distance: 7 feet 10 inchesWitnessed: YesConscious: “seemed fine” following incident, but six hours later “was incoherent and drooling”CT Imaging: Right parieto-occipital skull fracture, subdural and subarachnoid hemorrhage; right cerebral hemisphere infarct”Eye exam: Not recordedAutopsy: Right parieto-temporal subgaleal hematoma; right parietal skull fracture; subdural hematoma and cerebral edema
Case 14Age: 7 yearsMechanism: Fell off horizontal bar of monkey bars; unclear if hit forehead on bars of ladderFall distance: 4-8 feet Witnessed: YesConscious: Unclear if initial loss of consciousness; two days after fall was stumbling and had slurred speechCT Imaging: (initial) Occipital subgaleal hematoma(two days later) Left carotid artery occlusion and left parietal and temporal lobe infarctsEye exam: Not recordedAutopsy: Infarcts of left parietal, temporal and occipital lobes; acute cerebral edema with herniation; thrombosis of left vertebral artery
Case 15Age: 8 yearsMechanism: Fell from a retaining wall striking back and head after swinging to wall from monkey barsFall distance: 34 inchesWitnessed: YesConscious: “initially cried and complained of a headache but continued playing” … approximately 14.5 hours later “complained of a severe headache then became unresponsive and had a seizure”CT Imaging: Not doneEye exam: Not reportedAutopsy: Right temporoparietal subdural hematoma
Case 16Age: 10 yearsMechanism: Fell off swing (seat detached from chain) striking the back of his headFall distance: 3-5 feetWitnessed: YesConscious: “remained conscious although groggy … He suddenly lost consciousness approximately 10 minutes later”CT Imaging: Right frontoparietal subdural hematoma with transtentorial herniationEye exam: “extensive bilateral confluent and stellate, posterior and peripheral preretinal and subhyaloid hemorrhage”Autopsy: Right parietal subarachnoid arteriovenous malformation; subdural hemorrhage; cerebral edema with herniation
Case 17Age: 12 yearsMechanism: Fell off swing while standing on seat as it was twisting; struck back and back of headFall distance: 3-6 feetWitnessed: YesConscious: “immediately unconscious”CT Imaging: Not performedEye exam: Not recordedAutopsy: Comminuted occipital fracture and contusions of inferior frontal and temporal lobes
Case 18Age: 13 yearsMechanism: Fell backwards while standing on the seat of a swingFall distance: 2-6 feetWitnessed: YesConscious: “immediately unconscious”CT Imaging: Interhemispheric subdural hemorrhage and generalized cerebral edemaEye exam: Not recordedAutopsy: Linear occipital skull fracture; subdural hemorrhage; contusion of left cerebellar hemisphere and bifrontal lobes; cerebral edema
Chadwick DL, Bertocci G, et al. Annual risk of death resulting from short falls among children: less than 1 in 1 million. Pediatrics 2008; 121:1213-24.
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