Nonfatal Emergency Department Visits Associated with Fall-Related Fractured Skulls of Infants Aged 0-4 Months

Overview

Journal J Emerg Med

Publisher Elsevier

Specialty Emergency Medicine

Date 2024 May 29

PMID 38811271

Authors

Juliet Haarbauer-Krupa

Tadesse Haileyesus

Alexis B Peterson

Lindsay S Womack

Kent Hymel

Marzieh Hajiaghamemar

Joanne Klevens

Daniel Lindberg

Susan S Margulies

Affiliations

Soon will be listed here.

Abstract

Background: Children aged 0-4 years have the highest rate of emergency department (ED) visits for traumatic brain injury (TBI); falls are the leading cause. Infants younger than 2 years are more likely to sustain a fractured skull after a fall.

Objective: This study examined caregiver actions and products associated with ED visits for fall-related fractured skulls in infants aged 0-4 months.

Methods: Data were analyzed from the 2001-2017 National Electronic Injury Surveillance System-All Injury Program. Case narratives of infants aged 0-4 months who visited an ED for a fall-related skull fracture were examined to code caregiver actions preceding the fall. Product codes determined fall location and product type involved (e.g., flooring, bed, or stairs). All national estimates were weighted.

Results: There were more than 27,000 ED visits (weighted estimate) of infants aged 0-4 months for a nonfatal fall-related fractured skull between 2001 and 2017. Most were younger than 2 months (46.7%) and male (54.4%). Falls occurred primarily in the home (69.9%) and required hospitalization (76.4%). Primary caregiver actions coded involved placing (58.6%), dropping (22.7%), and carrying an infant (16.6%). Floor surfaces were the most common product (mentioned in 24.0% of the cases).

Conclusions: Fall-related fractured skulls are a health and developmental concern for infants, highlighting the importance of a comprehensive assessment at the time of the injury to better understand adult actions. Findings indicated the need to develop prevention messages that include safe carrying and placement of infants.

References

Morrongiello B, Corbett M, McCourt M, Johnston N . Understanding unintentional injury-risk in young children I. The nature and scope of caregiver supervision of children at home. J Pediatr Psychol. 2005; 31(6):529-39. DOI: 10.1093/jpepsy/jsj045. View

Berger R, Parks S, Fromkin J, Rubin P, Pecora P . Assessing the accuracy of the International Classification of Diseases codes to identify abusive head trauma: a feasibility study. Inj Prev. 2013; 21(e1):e133-7. PMC: 4757425. DOI: 10.1136/injuryprev-2013-040924. View

Cowley L, Morris C, Maguire S, Farewell D, Kemp A . Validation of a Prediction Tool for Abusive Head Trauma. Pediatrics. 2015; 136(2):290-8. DOI: 10.1542/peds.2014-3993. View

Hajiaghamemar M, Lan I, Christian C, Coats B, Margulies S . Infant skull fracture risk for low height falls. Int J Legal Med. 2018; 133(3):847-862. PMC: 6469693. DOI: 10.1007/s00414-018-1918-1. View

Cheng T, Bell J, Haileyesus T, Gilchrist J, Sugerman D, Coronado V . Nonfatal Playground-Related Traumatic Brain Injuries Among Children, 2001-2013. Pediatrics. 2016; 137(6). PMC: 5599106. DOI: 10.1542/peds.2015-2721. View

Amagasa S, Matsui H, Tsuji S, Moriya T, Kinoshita K . Accuracy of the history of injury obtained from the caregiver in infantile head trauma. Am J Emerg Med. 2016; 34(9):1863-7. DOI: 10.1016/j.ajem.2016.06.085. View

Ibrahim N, Wood J, Margulies S, Christian C . Influence of age and fall type on head injuries in infants and toddlers. Int J Dev Neurosci. 2011; 30(3):201-6. PMC: 3288448. DOI: 10.1016/j.ijdevneu.2011.10.007. View

Chahla S, Ortega H . Intracranial Injury Among Children with Abuse-Related Long Bone Fractures. J Emerg Med. 2020; 59(5):735-743. PMC: 7364151. DOI: 10.1016/j.jemermed.2020.06.006. View

Hettler J, Greenes D . Can the initial history predict whether a child with a head injury has been abused?. Pediatrics. 2003; 111(3):602-7. DOI: 10.1542/peds.111.3.602. View

10.

Dawson P, van Doorninck W, Robinson J . Effects of home-based, informal social support on child health. J Dev Behav Pediatr. 1989; 10(2):63-7. View

11.

Cowley L, Farewell D, Kemp A . Potential impact of the validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A clinical vignette study. Child Abuse Negl. 2018; 86:184-196. DOI: 10.1016/j.chiabu.2018.09.017. View

12.

Zins Z, Wheeler K, Brink F, Armstrong M, Shi J, Groner J . Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014. Child Abuse Negl. 2019; 98:104179. DOI: 10.1016/j.chiabu.2019.104179. View

13.

Benford P, Young B, Coupland C, Watson M, Hindmarch P, Hayes M . Risk and protective factors for falls on one level in young children: multicentre case-control study. Inj Prev. 2015; 21(6):381-8. DOI: 10.1136/injuryprev-2015-041581. View

14.

Hymel K, Armijo-Garcia V, Foster R, Frazier T, Stoiko M, Christie L . Validation of a clinical prediction rule for pediatric abusive head trauma. Pediatrics. 2014; 134(6):e1537-44. DOI: 10.1542/peds.2014-1329. View

15.

Apfeld J, Crichton K, Minneci P, Puls H, Cooper J . Identification of physical abuse-related hospitalizations in young children: Impact of the transition to ICD-10-CM coding. Child Abuse Negl. 2021; 118:105159. PMC: 8292224. DOI: 10.1016/j.chiabu.2021.105159. View

16.

Haarbauer-Krupa J, Haileyesus T, Gilchrist J, Mack K, Law C, Joseph A . Fall-related traumatic brain injury in children ages 0-4 years. J Safety Res. 2019; 70:127-133. PMC: 6927527. DOI: 10.1016/j.jsr.2019.06.003. View

17.

Sarmiento K, Thomas K, Daugherty J, Waltzman D, Haarbauer-Krupa J, Peterson A . Emergency Department Visits for Sports- and Recreation-Related Traumatic Brain Injuries Among Children - United States, 2010-2016. MMWR Morb Mortal Wkly Rep. 2019; 68(10):237-242. PMC: 6421963. DOI: 10.15585/mmwr.mm6810a2. View

18.

Morrongiello B, Schwebel D . Introduction to Special Section: Pediatric Psychology and Child Unintentional Injury Prevention: Current State and Future Directions for the Field. J Pediatr Psychol. 2017; 42(7):721-726. PMC: 5896613. DOI: 10.1093/jpepsy/jsx072. View

19.

Chadwick D, Bertocci G, Castillo E, Frasier L, Guenther E, Hansen K . Annual risk of death resulting from short falls among young children: less than 1 in 1 million. Pediatrics. 2008; 121(6):1213-24. DOI: 10.1542/peds.2007-2281. View

20.

Henry M, Feudtner C, Fortin K, Lindberg D, Anderst J, Berger R . Occult head injuries in infants evaluated for physical abuse. Child Abuse Negl. 2020; 103:104431. PMC: 7276264. DOI: 10.1016/j.chiabu.2020.104431. View