{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:52:25Z","timestamp":1792461145640,"version":"4.5.0"},"reference-count":29,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:p>The risk of serious head injury (HI) from a fall in a young child is ill defined. The relationship between the object fallen from and prevalence of intracranial injury (ICI) or skull fracture is described.<\/jats:p><jats:sec><jats:title>Method<\/jats:title><jats:p>Cross-sectional study of HIs from falls in children (&lt;6\u2005years) admitted to UK hospitals, analysed according to the object fallen from and associated Glasgow Coma Score (GCS) or alert, voice, pain, unresponsive (AVPU) and CT scan results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1775 cases ascertained (median age 18\u2005months, 54.7% boys), 87% (1552) had a GCS=15\/AVPU=alert. 19.3% (342) had a CT scan: 32% (110\/342) were abnormal; equivalent to 5.9% of the overall population, 16.9% (58) had isolated skull fractures and 13.7% (47) had ICI (49% (23\/47) had an associated skull fracture). The prevalence of ICI increased with neurological compromise; however, 12% of children with a GCS=15\/AVPU=alert had ICI. When compared to falls from standing, falls from a person's arms (233 children (mean age 1\u2005year)) had a significant relative OR for a skull fracture\/ICI of 6.94 (95% CI 3.54 to 13.6), falls from a building (eg, window or attic) (mean age 3\u2005years) OR 6.84 (95% CI 2.65 to 17.6) and from an infant or child product (mean age 21\u2005months) OR 2.75 (95% CI 1.36 to 5.65).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Most HIs from a fall in these children admitted to hospital were minor. Infants, dropped from a carer's arms, those who fell from infant products, a window, wall or from an attic had the greatest chance of ICI or skull fracture. These data inform prevention and the assessment of the likelihood of serious injury when the object fallen from is known.<\/jats:p><\/jats:sec>","DOI":"10.1136\/archdischild-2014-307119","type":"journal-article","created":{"date-parts":[[2015,8,22]],"date-time":"2015-08-22T02:10:06Z","timestamp":1440209406000},"page":"1032-1037","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":52,"title":["Head injury from falls in children younger than 6\u2005years of age"],"prefix":"10.1136","volume":"100","author":[{"given":"P","family":"Burrows","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Trefan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Houston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Pearson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R J","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Hyde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"Maconochie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R C","family":"Parslow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A M","family":"Kemp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,8,21]]},"reference":[{"key":"key-10.1136\/archdischild-2014-307119-1","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S0140-6736(09)61558-0","article-title":"Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study","volume":"374","author":"Kuppermann","year":"2009","journal-title":"Lancet"},{"key":"key-10.1136\/archdischild-2014-307119-2","author":"Statistics","year":"2012"},{"key":"key-10.1136\/archdischild-2014-307119-3","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1017\/S135561779700581X","article-title":"Longitudinal neuropsychological outcome in infants and preschoolers with traumatic brain injury","volume":"3","author":"Ewing-Cobbs","year":"1997","journal-title":"J Int Neuropsychol Soc"},{"key":"key-10.1136\/archdischild-2014-307119-4","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1136\/adc.2005.072405","article-title":"Epidemiology of traumatic brain injury in children receiving intensive care in the UK","volume":"90","author":"Parslow","year":"2005","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2014-307119-5","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1016\/j.injury.2012.07.195","article-title":"Head injuries in children under 3 years","volume":"43","author":"Crowe","year":"2012","journal-title":"Injury"},{"key":"key-10.1136\/archdischild-2014-307119-6","first-page":"684","article-title":"Brain injuries among infants, children, adolescents, and young adults","volume":"144","author":"Kraus","year":"1990","journal-title":"Am J Dis Child"},{"key":"key-10.1136\/archdischild-2014-307119-7","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/TA.0b013e318270d82e","article-title":"Patterns of structural head injury in children younger than 3 years: a ten-year review of 519 patients","volume":"74","author":"John","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"issue":"(4 Pt 1)","key":"key-10.1136\/archdischild-2014-307119-8","doi-asserted-by":"crossref","first-page":"e365","DOI":"10.1542\/peds.111.4.e365","article-title":"Injuries experienced by infant children: a population-based epidemiological analysis","volume":"111","author":"Pickett","year":"2003","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2014-307119-9","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1136\/adc.85.2.104","article-title":"Accidents and resulting injuries in premobile infants: data from the ALSPAC study","volume":"85","author":"Warrington","year":"2001","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2014-307119-10","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.ijdevneu.2011.10.007","article-title":"Influence of age and fall type on head injuries in infants and toddlers","volume":"30","author":"Ibrahim","year":"2012","journal-title":"Int J Dev Neurosci"},{"key":"key-10.1136\/archdischild-2014-307119-11","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.aap.2010.07.020","article-title":"Pediatric short-distance household falls: biomechanics and associated injury severity","volume":"43","author":"Thompson","year":"2011","journal-title":"Accid Anal Prev"},{"key":"key-10.1136\/archdischild-2014-307119-12","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/00000433-199309000-00005","article-title":"Fatal falls in childhood. How far must children fall to sustain fatal head injury? Report of cases and review of the literature","volume":"14","author":"Reiber","year":"1993","journal-title":"Am J Forensic Med Pathol"},{"key":"key-10.1136\/archdischild-2014-307119-13","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1542\/peds.2007-2281","article-title":"Annual risk of death resulting from short falls among young children: less than 1 in 1 million","volume":"121","author":"Chadwick","year":"2008","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2014-307119-14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00000433-200103000-00001","article-title":"Fatal pediatric head injuries caused by short-distance falls","volume":"22","author":"Plunkett","year":"2001","journal-title":"Am J Forensic Med Pathol"},{"key":"key-10.1136\/archdischild-2014-307119-15","volume-title":"Triage, assessment, investigation and early management of head injury in infants, children and adults","author":"NICE","year":"2007"},{"key":"key-10.1136\/archdischild-2014-307119-16","volume-title":"The Injury Database (IDB) coding manual: data dictionary","author":"European-Union","year":"2005"},{"key":"key-10.1136\/archdischild-2014-307119-17","volume-title":"Advanced life support manual","author":"Trauma ACoSCo","year":"1993"},{"key":"key-10.1136\/archdischild-2014-307119-18","first-page":"17","article-title":"Association between the assessment of conscious level using the AVPU system and the Glasgow Coma Scale","volume":"4","author":"Mackay","year":"2000","journal-title":"Pre-Hos Immediate Care"},{"key":"key-10.1136\/archdischild-2014-307119-19","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/S0196-0644(05)81254-5","article-title":"Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography?","volume":"22","author":"Dietrich","year":"1993","journal-title":"Ann Emerg Med"},{"key":"key-10.1136\/archdischild-2014-307119-20","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1136\/archdischild-2013-304267","article-title":"Patterns of accidental craniocerebral injury occurring in early childhood","volume":"98","author":"Thomas","year":"2013","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2014-307119-21","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/j.1440-1754.2005.00562.x","article-title":"Pre-ambulatory infants with head trauma: a three-year retrospective study","volume":"41","author":"Settle","year":"2005","journal-title":"J Paediatr Child Health"},{"key":"key-10.1136\/archdischild-2014-307119-22","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/00006565-199902000-00002","article-title":"Short vertical falls in infants","volume":"15","author":"Tarantino","year":"1999","journal-title":"Pediatr Emerg Care"},{"key":"key-10.1136\/archdischild-2014-307119-23","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1097\/00005373-199110000-00005","article-title":"Injuries in infants and small children resulting from witnessed and corroborated free falls","volume":"31","author":"Williams","year":"1991","journal-title":"J Trauma"},{"key":"key-10.1136\/archdischild-2014-307119-24","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1097\/00005373-199110000-00006","article-title":"Deaths from falls in children: how far is fatal?","volume":"31","author":"Chadwick","year":"1991","journal-title":"J Trauma"},{"issue":"(2 Pt 1)","key":"key-10.1136\/archdischild-2014-307119-25","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1542\/peds.90.2.179","article-title":"Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age","volume":"90","author":"Duhaime","year":"1992","journal-title":"Pediatrics"},{"issue":"(3 Pt 2)","key":"key-10.1136\/archdischild-2014-307119-26","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1542\/peds.82.3.457","article-title":"Stairway injuries in children","volume":"82","author":"Joffe","year":"1988","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2014-307119-27","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1542\/peds.2011-2314","article-title":"Stair-related injuries to young children treated in US emergency departments, 1999\u20132008","volume":"129","author":"Zielinski","year":"2012","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2014-307119-28","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1503\/cmaj.091421","article-title":"CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury","volume":"182","author":"Osmond","year":"2010","journal-title":"CMAJ"},{"key":"key-10.1136\/archdischild-2014-307119-29","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1136\/adc.2005.083980","article-title":"Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children","volume":"91","author":"Dunning","year":"2006","journal-title":"Arch Dis Child"}],"container-title":["Archives of Disease in Childhood"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2014-307119","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T20:06:26Z","timestamp":1653077186000},"score":1,"resource":{"primary":{"URL":"https:\/\/adc.bmj.com\/lookup\/doi\/10.1136\/archdischild-2014-307119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,8,21]]},"references-count":29,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2015,10,19]]},"published-print":{"date-parts":[[2015,11]]}},"alternative-id":["10.1136\/archdischild-2014-307119"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2014-307119","relation":{},"ISSN":["0003-9888","1468-2044"],"issn-type":[{"value":"0003-9888","type":"print"},{"value":"1468-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,8,21]]}}}