Patterns and Association of Pediatrics Head Injury Due to Fall in Accordance to Height

Abstract

Background and Purpose: The authors conducted a study to describe the patterns and association of fall related head injuries in pediatric population and also to compare it with the western world.
Methods: We performed a retrospective analysis of all patients less than 15 years of age treated for fall – related trauma between June, 2009 and September, 2011. Falls were classified as low (12 feet) and high level (more than12 feet).
Results: Eight hundred and sixty cases were identified with a mortality rate of 6.7%. A fall of greater than 12 feet (high – level fall) was associated with a higher mortality rate than low – level falls 52 (5.7% Compared with 5 (1.0%), respectively). Two Hundred and twenty eight patients had sustained a skull fracture (150 children had a depressed skull fracture) and 80 patients had basal skull fracture, 46 patients had suffered a cerebral contusion, 25 subarachnoid hemorrhage, 42 subdural hematoma, and 82 had an epidural / extradural hematoma. One hundred twenty patients required surgery for traumatic injuries of these, 80 underwent craniotomy for evacuation of a blood clot. Height was not predictive of the Glasgow Coma Scale (GCS) score. In all 15 deaths resulting from a low – level fall there was an admission GCS score of 4/15, and abnormal findings were demonstrated on computerized tomography scanning. Death from high – level falls was attributable to either intracranial injuries (50%) or severe extra-cranial injuries (50%). Intracranial injury is the major source of fall – related death in children and, unlike extra-cranial insults, brain injuries are sustained with equal frequency from low – and high – level falls in this population. Height was not predictive of the Glasgow Coma Scale (GCS) score. In all 15 deaths resulting from a low – level fall there was an admission GCS score of 4/15, and abnormal findings were demon-strated on computerized tomography scanning.
Conclusion: The GCS scores obtained in patients who sustained a Low – level fall were a poor predictor of intracranial bleeding. In 47% of these patients with intracranial bleeding an Emergency room GCS score of 13 to 15 was determined. A high GCS score does not therefore; eliminate the need for performing head CT scanning, even after the patient suffers a low level fall. We found a high percentage of intracranial bleeding/cranial frac-tures in patients falling from low height. Physicians should obtain a brain CT scan in pediatric fall victims. A proper trauma protocol should be followed and made in accordance of our need and standards.