Stairway Falls - Article Summaries

Joffe M, Ludwig S. Stairway injuries in children . Pediatrics 1998;82:457-461.

Methods:

  • 363 patients 1 month-18.7 years of age with injuries from falls down steps who presented to the emergency department
  • Mean age was 55 months (54 patients were <1 year of age)
  • “cases of child abuse definitely identified by social workers or physicians were withdrawn”

Results:

  • 6 percent of patients had fractures: 72 percent extremity fractures and 28 percent skull fractures
  • No rib or vertebrae or pelvis or femoral fractures were seen
  • No intracranial hemorrhages or cerebral contusions were seen
  • Of infants who fell in the arms of caretakers, 40 percent (4 / 10) sustained skull fractures

Conclusions:

  • No correlation between severity of injury and number of steps fallen down
  • Stairway injuries are much less severe than free falls of the same total vertical distance; they consist of mild-moderately severe initial impact followed by a series of low-energy non-injurious falls down the remaining steps.
  • Multiple, truncal and proximal extremity injuries are unusual in stairway falls

Chiaviello CT, et al. Stairway-related injuries in children . Pediatrics 1994;94:679-681.

Methods:

  • Sixty-nine children <5 years of age who presented to emergency department with history of fall down stairs
  • walker-related injuries were excluded

Results:

  • 15 (22 percent) suffered significant injuries:
    • 11 (16 percent) concussions
    • five (7 percent) skull fractures
    • two (3 percent) cerebral  contusion
    • one subdural hematoma
    • one C-2 fracture
  • Included in this group are three infants who fell while being carried:
    • one sustained a skull fracture
    • one sustained a skull fracture and brain contusion
    • one sustained a subdural hematoma

Conclusions:

  • Significant injuries can occur when children fall down steps
  • There were more significant injuries in this study compared to Joffe’s study. This may be due to different thresholds for obtaining imaging studies in 1994 compared to 1988.

Docherty E, Hassan A, Burke D.  Things that go bump . . . bump . . . bump: an analysis of injuries from falling down stairs in children based at Sheffield Children’s Hospital.  Emerg Med J  2010; 27:207-208. 

Methods: 

Retrospective analysis of emergency department visits reporting falls down stairs.

Results: 

  • A total of 239 cases were found with patients aged 0 to 15 years.
  • eight patients were admitted, but none needed neurosurgical intervention, and no head injuries were significant enough to require any kind of intervention.
  • 7 percent of patients were reported to be dropped while being carried down stairs, all of which sustained injuries. 
    • A tibial fracture, two femur fractures, and five skull fractures were found in this group

Conclusion: 

  • The most common injury is to the head, but these are typically minor. 
  • The severity of injury is not associated with the number of stairs, but patients reported to have been dropped should be closely evaluated.