Fall-related traumatic brain injury in children ages 0–4 years

Fall-related traumatic brain injury in children ages 0–4 years

Volume 70 , September 2019, Pages 127-133
Fall-related traumatic brain injury in children ages 0–4 years
Author links open overlay panel JulietHaarbauer-Krupaa
https://doi.org/10.1016/j.jsr.2019.06.003 Get rights and content
Abstract
Introduction: Falls are the leading cause of traumatic brain injury (TBI) for children in the 0–4 year age group. There is limited literature pertaining to fall-related TBIs in children age 4 and under and the circumstances surrounding these TBIs. This study provides a national estimate and describes actions and products associated with fall-related TBI in this age group. Method: Data analyzed were from the 2001–2013 National Electronic Injury Surveillance System–All Injury Program (NEISS–AIP), a nationally representative sample of emergency departments (ED). Case narratives were coded for actions associated with the fall, and product codes were abstracted to determine fall location and product type. All estimates were weighted. Results: An estimated 139,001 children younger than 5 years were treated annually in EDs for nonfatal, unintentional fall-related TBI injuries (total = 1,807,019 during 2001–2013). Overall, child actions (e.g., running) accounted for the greatest proportion of injuries and actions by others (e.g., carrying) was highest for children younger than 1 year. The majority of falls occurred in the home, and involved surfaces, fixtures, furniture, and baby products. Conclusions: Fall-related TBI in young children represents a significant public health burden. The majority of children seen for TBI assessment in EDs were released to home. Prevention efforts that target parent supervision practices and the home environment are indicated. Practical applications: Professionals in contact with parents of young children can remind them to establish a safe home and be attentive to the environment when carrying young children to prevent falls.
Figures
Nonfatal fall-related traumatic brain injury rates among children age 0–4years treated in US emergency departments - National Electronic Injury Surveillance System–All Injury Program, by year and age,...
Section snippets
Background
Falls are the leading cause of nonfatal emergency department (ED) visits among children aged birth to 14 years, accounting for 2.4 million visits annually, and the leading cause of traumatic brain injury (TBI) ED visits for children in the 0–4 year age group (Taylor et al., 2017, Wang et al., 2013). There is limited literature describing the number and circumstances of fall-related TBI in children under 5 years old. The few TBI studies available that describe injury circumstances lack reporting
Data source
Data were acquired from the 2001–2013 NEISS–AIP, which is a nationally representative stratified probability sample of 66 hospitals having at least 6 beds and providing 24-h emergency services in the United States. NEISS–AIP is a collaborative effort between the Centers for Disease Control and Prevention (CDC) and the U.S. Consumer Product Safety Commission (2000). Data are collected daily from each participating hospital resulting in approximately 500,000 nonfatal injury-related ED visits
Fall-related TBI by child characteristics
On average, between 2001 and 2013 an estimated 139,001 children age 0–4 years were treated annually in EDs in the United States for nonfatal, unintentional fall-related TBI (Table 1).
This number increased over time going from 103,432 cases in 2001 to 182,069 in 2013. TBI in this age group was primarily coded as a diagnosis indicating an internal injury to the head (87.7%). Most children were treated and released from the ED (93%) and while the percentage of children hospitalized or transferred
Discussion
This study used nationally representative data between the years 2001 and 2013 to study fall-related TBI in children ages 0–4 years. Prior research had shown that this age group had the highest rate of fall-related TBI ED visits overall (Taylor et al., 2017: Taylor, Greenspan, Xu, & Kresnow, 2015). An annualized national estimate of 139,001 ED visits per year in this age group approximates reports from other studies examining national data during this timeframe (Taylor et al., 2015). The annual
Conclusions
Fall-related TBI in young children represents a significant public health burden indicated by increased ED visits for fall-related TBI in an age group that has an increased opportunity for falls as well as greater risk for long-term impact from the injury. Prevention efforts that target environmental changes along with parental supervision practices to reduce fall risk are needed.
Practical applications
Young children are prone to falls and because of this may experience a traumatic brain injury. Professionals in contact with caregivers of young children can remind them to establish a safe home and be attentive to the environment when carrying young children to prevent falls. Reducing clutter on floors, and protecting children from hazards with barriers, such as safety gates on stairs, guards on windows above ground level, and guard rails on beds are prudent safety measures. Young children
Financial Disclosure
The authors have indicated no financial relationships relevant to this article to disclose.
Disclosure
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Declarations of Competing Interest
The authors have no conflicts of interest relevant to this article to disclose.
Acknowledgement
The authors wish to thank Christopher Taylor, PhD for his work identifying cases for analysis, determining available actions in the dataset, and his contributions to creating the action coding system.
Juliet Haarbauer-Krupa is a Senior Health Scientist on the Traumatic Brain Injury (TBI) Team in the Division of Unintentional Injury Prevention (DUIP) at the Injury Center. As a behavioral scientist, her role on the TBI team is to devise research projects and products to better understand trends in TBI in the US and to improve health outcomes for individuals living with a TBI. She is project lead on the Report to Congress on the Management of Traumatic Brain Injury in Children and the Return to
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