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Accidental head trauma during care activities in the first year of life: a neurosurgical comparative study



This study aims to describe clinical–epidemiological data regarding accidental fall injuries occurring during homecare activities among children up to 1 year of age and to compare their outcomes according to the type of trauma.


We searched four different hospital databases on head injuries from 1999 to 2009. Patients recorded under the descriptors “accidental fall” and “home-related” in the subtext were selected. Patients were classified into two groups: those who flipped over and fell from a changing table (n = 253) and those who fell from the bed sustaining a direct impact from the floor (n = 483).


There was no difference between both groups with respect to age, gender, and Glasgow Coma Scale score. However, children who suffered injuries after an accidental fall from the changing table were more likely to require surgery (26/483 vs. 57/253, p < 0.0001), had a mean longer length of stay (LOS, 4 vs. 1 day), and a higher incidence of depressed skull fractures (12/483 vs. 24/253, p < 0.0001). Children with a direct impact from the floor after falling off the bed were expected to suffer from simple linear skull fractures, while those who flipped over the changing table were more likely to present facial, soft tissue, or skeletal injuries.


Children who flipped over a changing table during their homecare activities were more likely to require surgery, showed a higher morbidity, and showed a longer LOS than those who fell down from the bed. These results probably reflect the different impact energy according to each injury mechanism.

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  1. Dedoukou X, Spyridopoulos T, Kedikoglou S, Alexe DM, Dessypris N, Petridou E (2004) Incidence and risk factors of fall injuries among infants: a study in Greece. Arch Pediatr Adolesc Med 158:1002–1006

    Article  PubMed  Google Scholar 

  2. Emanuelson I (2003) A prospective population based study of mild TBI in children in Sweden (abstract). Brain Inj 17(Suppl 1):7–8

    Google Scholar 

  3. Flavin M, Dostaler S, Simpson K, Brison R, Pickett W (2006) Stages of development and injury patterns in the early years: a population-based analysis. BMC Publ Health 6:187

    Article  Google Scholar 

  4. Hawley CA, Ward AB, Magnay AR, Long J (2002) Children’s brain injury: a postal follow-up of 525 children from one health region in the U.K. Brain Inj 16:969–985

    Article  PubMed  Google Scholar 

  5. Lallier M, Bouchard S, St-Vill D, Dupont J, Tucci M (1999) Falls from heights among children: a retrospective review. J Pediatrs Surg 34:1060–1063

    Article  CAS  Google Scholar 

  6. Romner B, Ingebrigtsen T, Kock-Jensen C (2000) Scandinavian guidelines for initial management of minimal, mild and moderate head injuries. The Scandinavian Neurotrauma Committee. J Trauma 48:760–766

    Article  PubMed  Google Scholar 

  7. Adelson D, Kochanek P (1997) Head injury in children, topical review. J Child Neurol 13:1–15

    Google Scholar 

  8. Feickert HJ, Drommer S, Heyer R (1999) Severe head injury in children: impact of risk factors on outcome. J Trauma 47:33–38

    Article  PubMed  CAS  Google Scholar 

  9. Kraus JF (1995) Epidemiological features of brain injury in children. In: Broman SH, Michel ME (eds) Traumatic head injury in children. Oxford University Press, Oxford, pp 165–187

    Google Scholar 

  10. Barlow B, Niemirska M, Gandhi RP, Leblanc W (1983) Ten years of experience with falls from a height in children. J Pediatri Surg 18:509–511

    Article  CAS  Google Scholar 

  11. Bulut M, Koksal O, Korkmaz A, Turan M, Ozguc H (2006) Childhood falls: characteristics, outcome, and comparison of the Injury Severity Score and New Injury Severity Scores. Emerg Med J 23:540–545

    Article  PubMed  CAS  Google Scholar 

  12. Chadwick DL, Chin S, Salerno C, Landsverk J, Kitchen L (1991) Deaths from falls in children: how far is fatal? J Trauma 31:1353–1355

    Article  PubMed  CAS  Google Scholar 

  13. Bertocci GE, Pierce MC, Deemer E, Aguel F, Janosky JE, Vogeley E (2004) Influence of fall height and impact surface on biomechanics of feet-first free falls in children. Injury 35:417–424

    Article  PubMed  Google Scholar 

  14. Mack KA, Gilchrist J, Ballesteros MF (2008) Injuries among infants treated in emergency departments in the United States, 2001–2004. Pediatrics 121:930–937

    Article  PubMed  Google Scholar 

  15. Settle F, Lawrence D, Kummerow M (2005) Pre-ambulatory infants with head trauma: a three-year retrospective study. J Paediatr Child Health 41:130–135

    Article  PubMed  CAS  Google Scholar 

  16. Consumer rights for child safety products-European Child Safety Alliance European Consumer Safety Association Final Report. Available at: Accessed 22 Oct 2011

  17. WHO Statistical Information System (WHOSIS). Available at: Accessed 11 Oct 2011

  18. Austrian EHLASS 2003 data, Institute Sicher Leben. Available at: Accessed 22 Oct 2011

  19. Kim KA, Wang MY, Griffith PM, Summers S, Levy ML (2000) Analysis of pediatric head injury from falls. Neurosurg Focus 8(1):e3

    Article  PubMed  CAS  Google Scholar 

  20. National Center for Injury Prevention and Control. Unintentional fall deaths and rates per 100,000: United States, 2001. Available at: Accessed 11 Oct 2011

  21. Belechri M, Petridou E, Trichopoulos D (2002) Bunk versus conventional beds: a comparative assessment of fall injury risk. J Epidemiol Community Health 56:413–417

    Article  PubMed  CAS  Google Scholar 

  22. Barnard AM, Nelson NG, Xiang H, McKenzie LB (2010) Pediatric mobility aid-related injuries treated in US emergency departments from 1991 to 2008. Pediatrics 125:1200–1207

    Article  PubMed  Google Scholar 

  23. Agran PF, Anderson C, Winn D, Trent R, Walton-Haynes L, Thayer S (2003) Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age. Pediatrics 111:e683–e692

    Article  PubMed  Google Scholar 

  24. Ibrahim NG, Margulies SS (2010) Biomechanics of the toddler head during low-height falls: an anthropomorphic dummy analysis. J Neurosurg Pediatr 6:57–68

    Article  PubMed  Google Scholar 

  25. Nimityongskul P, Anderson LD (1987) The likelihood of injuries when children fall out of bed. J Pediatr Orthop 7:184–186

    Article  PubMed  CAS  Google Scholar 

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The authors would like to thank the operating room staff of the hospitals participating in this study.

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Correspondence to Marcelo Galarza.

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Galarza, M., Gazzeri, R., Barceló, C. et al. Accidental head trauma during care activities in the first year of life: a neurosurgical comparative study. Childs Nerv Syst 29, 973–978 (2013).

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