Severe head injury in infants more likely with fall above two feet

By Shannon Aymes

NEW YORK (Reuters Health) - Skull fractures or intracranial injury in infants are associated with a fall from above two feet or with parietal, temporal, or occipital impact, according to a new study.

"It is important to identify the critical fall-height above which young children have an increased likelihood of sustaining a skull fracture or brain injury. This information can inform interventions to prevent serious head injury and help clinicians assess the likelihood of brain injury when assessing a child who presents to emergency departments," Dr. Alison Kemp, of the Institute of Primary Care and Public Health at the Cardiff School of Medicine in Cardiff, UK, told Reuters Health by email.

Head injury in young children and infants is a source of significant morbidity and mortality. However, debate continues on the relationship of fall height and severity of injury.

Dr. Kemp and colleagues analyzed cases of children up to 4 years old who presented to the hospital after a fall less than 10 feet with minor head injuries versus children with intracranial injury or a skull fracture. The investigators analyzed site of impact, surface, and mechanism of fall.

A total of 416 children with minor head injury and 47 children with intracranial injury or skull fracture were included in the analysis. A simple skull fracture was found in 24 children with seven also having intracranial injury. Complex fractures were observed in 19 children, with seven also having depressed fractures, six having more than one fracture, four with bilateral fractures, and three with fractures that crossed suture lines.

Of the 21 children with intracranial injury, five had intracerebral injury or more than one extra-axial hemorrhage (23.8%) and 16 had a single extra-axial hemorrhage (76.2%).

A fall from sitting or standing was mostly associated with minor head injury and the mean fall height for minor head injuries was much lower than in children who developed skull fracture or intracranial injury (p<0.001). However, a fall while being carried, especially on stairs, was associated with a higher likelihood of intracranial injury or skull fracture (p<0.001).

Other factors associated with a higher likelihood of intracranial injury or skull fracture included falls in children 1 year old or younger (p<0.001) with head impact onto wood (p=0.004) and impact to the temporal, parietal, or occipital areas of the head (p<0.001).

There were no cases of intracranial injury or skull fracture in a fall occurring from a height of less than two feet, the investigators report online September 17 in Archives of Disease in Childhood.

Summing up, Dr. Kemp told Reuters Health, "Skull fractures or brain injury are more likely in head injury in 1) infants 12 months or younger, 2) from a fall from above 0.6 m /2 ft, 3) from impacts to the side or back of the head, 4) from falls from a carer's arms, particularly when dropped on stairs."

"This study blends biomechanical theory with clinical factors and gives greater understanding of the biomechanics of head injury and the clinical consequences," Dr. Kemp continued.

The authors pointed out that clinicians should record the surface of the impact, the height from fall, position prior to fall, and the anatomical sight of impact. Together these variables may help guide clinical decisions when children present with a head injury.

The study was supported by the Cardiff University Schools of Engineering and Medicine. The authors declared no competing interests.

SOURCE: http://bit.ly/1OyMVbT

Arch Dis Child 2015.

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