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PubMed2004

Preventing injuries on horizontal ladders and track rides.

OBJECTIVES: This study examined the type of injury, fall heights and measures of impact attenuation of surfaces on which children fell from horizontal ladders and track rides. METHOD: All injured children who presented to two children's hospitals and received medical attention following a fall from a horizontal ladder or track ride in a public school or park during 1996--1997 were interviewed and the playground visited. RESULTS: The number of children who fell from horizontal ladders and track rides and presented to hospitals with injury was 118. Of those children, 105 were injured when they hit the ground and data were available on 102 of those playground undersurfaces. Fractures to the arm or wrist were the most common injury. The median height fallen by children was 1930 mm, 73% of injuries were from falls greater than 1800mm. In 41% of sites, the surface was deficient in impact absorbing properties for the height of the equipment. Fractures were no more likely on loose surfaces than other surfaces, such as rubber matting (p = 0.556) but more prevalent on compliant than non-compliant surfaces. Relative to falls occurring on noncompliant surfaces, the odds of a fracture occurring on a compliant surface was 2.67 (95% CI 0.88-8.14). CONCLUSIONS: Modification of the height of horizontal ladders and track rides to 1800mm is preferable to removal of such equipment. The prevalence of fractures on compliant surfaces suggests that the threshold of 200g or 1000 head injury criteria (HIC) needs to be revisited, or additional test criteria added to take account of change in momentum that is not presently accounted for with either g-max on HIC calculations.

Accidental Falls↗

PubMed1989

[Quasi-static and dynamic bending stress of the pediatric femur for producing a femoral fracture].

At the Institute of Forensic Medicine of the University of Heidelberg, in the years 1986-1988 thigh loading tests were conducted in order to produce fractures in a total of 28 cadavers of babies and children who had died at ages ranging from 1 day to 6 years. In 18 tests a universal strength testing machine was used and each thigh was loaded quasi-statically from the outside with a blunt edge applied to the middle of the femur, bending it to the point of fracture. The loading velocity amounted 50 mm/min with a defined support distance. The breakage load amounted to 470 N in a 6-day-old baby and increased about evenly up to 2920 N in a 6-year-old child; however, in a newborn 2720 N was needed and in a 15-month-old child, 5700 N. The total deformation way ranged from 16 to 60 mm. The main types of fracture that occurred were: complete and incomplete transverse fractures, oblique fractures, Messerer fractures, and spongiosa fractures. Ten children ranging in age from 2 months up to 27 months were submitted to dynamical thigh loading by means of a failing weight impactor and a horizontal impactor. Only in one case did a transverse fracture occur, when the lateral thigh impacted on an edge at a falling height of 70-93 cm. The forces set up amounted to 320-600 N with the falling weight impactor and to 2370 N with the horizontal impactor. These results suggest that fracture of the femur does not occur if a baby or small child falls from a changing table or from an adult's arm.

Biomechanical Phenomena↗

PubMed2003

[Polytrauma is more severe after a free fall from a height than after a motor vehicle accident].

AIMS: To compare specific features and prognosis of polytrauma victims requiring urgent laparotomy, after a free fall from a height (FFH) or a motor vehicle accident (MVA). PATIENTS AND METHODS: Urgent laparotomy was performed only in case of massive hemoperitoneum associated with hemodynamic instability. Injury severity score (ISS) and hospital mortality rate were used to determine the severity of trauma. RESULTS: Two hundred and four patients underwent urgent laparotomy for blunt abdominal trauma: 79 after FFH (intentional defenestration: 65, accident: 14), and 125 after a MVA. Mean ISS was higher after FFH (39 +/- 11) than MVA (35 +/- 12) (P< 0.05). Spine injury and pelvic fractures were more frequent and more severe in FFH patients, with a high incidence of retroperitoneal hemorrhage. Juxta-hepatic veins and inferior vena cava tears usually occurred after FFH. Hospital mortality was 48% (38/79) after FFH and 30% (37/125) after MVA (P< 0.01). Predominant cause of death was associated injuries. The height of the fall was not a prognostic factor, unlike the quality of the landing surface: the mortality dropped from 59% (34/58) when patient fell onto a hard ground, to 19% (4/21) in case of soft landing surface (P< 0.05). CONCLUSION: Blunt abdominal trauma requiring urgent laparotomy is more severe after FFH than after MVA. The usual cause of death is associated injuries in both groups. Quality of the landing surface is a discriminating factor for mortality after FFH.

Accidental Falls↗

PubMed2004

Stochastic-rheological simulation of free-fall arm impact in children: application to playground injuries.

The aim of this study was to develop and pilot a stochastic-rheological biomechanical model to investigate the mechanics of impact fractures in the upper limbs of children who fall in everyday situations, such as when playing on playground equipment. The rheological aspect of the model characterises musculo-skeletal tissues in terms of inertial, elastic and viscous parameters. The stochastic aspect of the model allows natural variation of children's musculo-skeletal mechanical properties to be accounted for in the analysis. The relationship of risk factors, such as fall height, impact surface, child mass and bone density, to the probability of sustaining an injury in playground equipment falls were examined and found to closely match findings in epidemiological, clinical and biomechanical literature. These results suggest that the stochastic-rheological model is a useful tool for the evaluation of arm fracture risk in children. Once fully developed, information from this model will provide the basis for recommendations for modifications to playground equipment and surface standards.

Accidental Falls↗

PubMed2005

Stature prediction equations for elderly Hispanics in Latin American countries by sex and ethnic background.

BACKGROUND: We estimate prediction equations of stature from knee height for elderly Hispanic Blacks, Mulattos, Mestizos, Mexicans, and Whites. We test the predictive power of estimated equations, assess the magnitude of relative errors in measures of body mass index (BMI), quantify errors committed when using predicted rather that observed height, and evaluate the differences in the strength of the relation between BMI and diabetes. METHODS: Using data collected in 1999-2000, we split each sex and/or ethnic group into validation and cross-validation groups, estimate equations from the validation groups, then test them on the cross-validation groups. We use robust linear regression to assess the sex- and/or ethnic-specific relation between knee height and stature. We evaluate the accuracy of classifications by obesity and of estimates of risk of diabetes when using estimated versus observed height. RESULTS: Our equations are slightly less accurate than those obtained from U.S. data ( 4), although ethnic-specific parameters are comparable. Classification of subpopulations by obesity has high sensitivity and specificity. The estimated measure of BMI strongly attenuates estimated effects of obesity on diabetes. Thus, although the predicted heights fall within acceptable error bounds, their utilization in modeling relations to other health outcomes may give misleading inferences. CONCLUSIONS: Knee height is a good surrogate for current height for elderly populations. It is always preferable to use ethnic-specific predictions, because the relation differs by ethnicity. Great care has to be exercised when classifying populations using surrogate measures of height, or in estimating relations between measures that are functions of surrogate height and health outcomes.

Aged↗

PubMedDate not supplied

[Nature and outcomes of craniocerebral injury in a fall from a height].

The case records of 1,137 patients with trauma suffered as the result of a fall from a height were studied, 399 of them (35.1%) had a craniocerebral trauma. Isolated traumas with injury to the cranial bones and brain accounted for 74.4% of cases, multiple injuries (injuries to the cranial bones, brain, and facial skeleton) for 0.8%, and combined injuries (injuries (injuries to the skull, brain, weight-bearing and motor apparatus, and internal organs) for 24.8%. Severe craniocerebral trauma was encountered in 34.9% of the injured, trauma of moderate severity in 24.3%, and mild craniocerebral trauma in 40.8% of the injured. Death from a craniocerebral trauma suffered in a fall from a height occurred at the site of the accident in 17.2% of cases and in later periods at the hospital in 12.7% of cases.

Accidents↗

PubMed2006

Fatal falls from a height: two case studies.

Two case studies are presented involving fatal falls of adult females from a height. One involved a launch at low speed from a balcony, and one involved a launch at high speed from the top of a cliff. Crime scene evidence obtained on the balcony itself provided a strong indication of homicide, but subsequent investigation showed that the fall was accidental. No crime scene evidence was obtained for the cliff fall since the fall initially appeared to be just another suicide from a popular suicide spot. Subsequent investigations indicated homicide based on measurements of cliff height, horizontal distance to the impact, and available runup distance, plus measurements of possible run, jump, and throw speeds. It was found that a female weighing 61 kg (134 lb) can be thrown at speeds up to 4.85 m/s by a strong male, more than enough to account for the estimated launch speed (4.5 m/s). Given the available 4.0 m runup distance, it was found that women of better than average rather than elite athletic ability can dive at speeds of about 3.5 m/s or jump feet first at speeds of about 4.0 m/s, both being less than the estimated launch speed. The decedent had no athletic ability and landed head first after falling through a height of 29 m.

Accidental Falls↗

PubMed2006

Childhood falls: characteristics, outcome, and comparison of the Injury Severity Score and New Injury Severity Score.

OBJECTIVES: The aim of this study was to determine the general characteristics of childhood falls, factors affecting on mortality, and to compare the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) as predictors of mortality and length of hospital stay in childhood falls. METHODS: We retrospectively analysed over a period of 8 years children aged younger than14 years who had sustained falls and who were admitted to our emergency department. Data on the patients' age, sex, type of fall, height fallen, arrival type, type of injuries, scoring systems, and outcome were investigated retrospectively. The ISS and NISS were calculated for each patient. Comparisons between ISS and NISS for prediction of mortality were made by receiver operating characteristic (ROC) curve and Hosmer-Lemeshow (HL) goodness of fit statistics. RESULTS: In total, there were 2061 paediatric trauma patients. Falls comprised 36 (n = 749) of these admissions. There were 479 male and 270 female patients. The mean (SD) age was 5.01 (3.48) years, and height fallen was 3.8 (3) metres. Over half (56.6%) of patients were referred by other centres. The most common type of fall was from balconies (38.5%), and head trauma was the most common injury (50%). The overall mortality rate was 3.6%. The cut off value for both the ISS and NISS in predicting mortality was 22 (sensitivity 90.5%, specificity 95.4% for ISS; sensitivity 100%, specificity 88.7% for NISS) (p>0.05). Significant factors affecting mortality in logistic regression analysis were Glasgow Coma Scale (GCS) <9, ISS >22, and NISS >22. There were no significant differences in ROC between three scoring systems. The HL statistic showed poorer calibration (p = 0.02 v p = 0.37, respectively) of the NISS compared with the ISS. CONCLUSIONS: In our series, the head was the most frequent site of injury, and the most common type of fall was from balconies. Scores on the GCS, NISS, and ISS are significantly associated with mortality. The performance of the NISS and ISS in predicting mortality in childhood falls was similar.

Accidental Falls↗

PubMed2006

Effect of compliant flooring on impact force during falls on the hip.

Compliant flooring represents a promising but understudied strategy for reducing impact force and hip fracture risk due to falls in high-risk environments such as nursing homes, hospitals, gymnasiums, and senior centers. We conducted "pelvis release experiments" with young women (n=15) to determine whether floor stiffness influences peak hip impact force during safe, low-height falls. During the trials, we used a pelvic sling and electromagnet to lift and instantly release the participant from a height of 5 cm above a force plate, which measured the force applied to the hip region during impact. Trials were conducted for rigid floor conditions and with layers of ethylene vinyl acetate foam rubber overlying the floor that we regarded as firm (1.5-cm thick; stiffness=263 kN/m), semifirm (4.5-cm thick; stiffness=95 kN/m), semisoft (7.5-cm thick; stiffness=67 kN/m), and soft (10.5-cm thick; stiffness=59 kN/m). When compared to the rigid condition, peak hip impact force averaged 8% lower in the firm condition and 15% lower in the semifirm condition. Peak forces were not significantly different between the semifirm, semisoft, and soft floor conditions, indicating that a 4.5 cm-thick foam mat provides nearly the same force attenuation as a 10.5 cm-thick mat. These results support the need for laboratory experiments to measure the effect of floor stiffness on postural stability and for clinical trials to determine the effect of compliant flooring on hip fracture incidence in high-risk environments.

Accidental Falls↗

PubMed1996

Children falling from a height in London.

OBJECTIVES: To determine the frequency and geographical distribution of children falling from a height in London and to suggest possible causes and preventative measures. METHODS: All relevant cases attended by the Helicopter Emergency Medical Service (HEMS) in a three and a half year period were reviewed and the locations related to the boroughs. The rates, per 1,000 resident children, were compared with socioeconomic indices for the boroughs concerned. In addition, a survey was undertaken of window fittings and maintenance in high rise flats close to one particular incident. RESULTS: A total of 90 incidents were attended involving 91 patients (64 male, 27 female) of whom five died. HEMS attends approximately one third of incidents involving serious trauma. In the study period the maximum frequency was 0.2 fallers per 1,000 resident children, occurring in three boroughs. In three boroughs there were no fallers. There was no overlap in socioeconomic indices between the five boroughs with the highest fall rates and the five with the lowest. The building survey found a high incidence of faulty window catches, a slow response rate for repair, and a lack of safety advice for residents. CONCLUSIONS: The frequency of falling is related to urban deprivation, poor maintenance, and lack of safety information. A combination of regulation and targeted education could substantially decrease deaths and injuries in children from this cause.

Accidental Falls↗

PubMed2006

Prediction of distal radius fracture in children, using a biomechanical impact model and case-control data on playground free falls.

OBJECTIVES: To assess the ability of a biomechanical impact model to predict the likelihood of distal radius fracture in children using data gathered for a previous epidemiological case-control study of falls from playground equipment. METHODOLOGY: Factor of Risk (FR) values were generated for each of selected subjects from the case-control study using a biomechanical model. Logistic regression curves were fitted to examine the relationship between the FR values and the probability of radius fracture. RESULTS: Forty-five cases and thirty-one controls were selected. The logistic regression analyses showed a significant association between the probability of fracture and FR. CONCLUSIONS: The biomechanical model distinguished between children who fractured their distal radius and those who did not. The model can be used to test how risk factors, such as fall height and ground surface type, affect physical stresses transmitted through the arm and their relation to the fracture tolerance of the distal radius.

Accidental Falls↗

PubMed1996

Growth hormone treatment in children before and after renal transplantation.

Growth failure is a major problem for many children with chronic renal disease. For approximately 75% of pediatric renal allograft recipients final height falls below the third percentile. In the intermediate term, recombinant human growth hormone (GH) therapy at a dose of 28-30/m2/week accelerates growth significantly in patients with growth retardation secondary to chronic renal failure and after renal transplantation, without evidence of adverse effects or acceleration of bone maturation. Therefore, GH therapy may well improve final height of these patients.

Adolescent↗

PubMedDate not supplied

[The use of a method of sequential mathematical analysis for the differential diagnosis of trauma from a fall from a height and of trauma due to the collision of a moving automobile with a pedestrian by the chest injuries].

Fifty cadavers of subjects dead after falling from height and 50 cadavers of subjects dead as a result of collisions between moving cars and pedestrians were examined. Under study were injuries to soft tissues of the chest, thoracic bones and viscera, and combinations thereof. Mathematical probability successive analysis after Gubler (1978) helped distinguish 64 highly informative injuries-signs which permit determining the type of injury. Diagnostic coefficients and informative value of these signs are presented in the differential diagnostic table.

Accidental Falls↗

PubMed2006

Development of a simulation system for performing in situ surface tests to assess the potential severity of head impacts from alleged childhood short falls.

There is considerable debate in the medical literature surrounding the issue of fatal child head injuries being caused by short falls. When reviewing a case history a medical expert will form an opinion of the likely cause of an injury based on his/her knowledge of the literature, training and experience of similar cases. The severity of an injury is determined by the age of the victim, fall height, body impact site and the impact surface. A medical expert, when forming an opinion, is invariably assisted by a description of the scene or scene photographs and assumes the mechanical response of the floor conforms in the same way to "similar" surfaces. The impact response characteristics of the entire surface mixture is critically important when considering the potential for head injury to a child due to a short fall. However, at present during an investigation, the response of a surface to a head impact remains an unknown, since a simple description of, or cursory glance at, a floor surface is insufficient in determining its potential to cause injury. This paper documents the development of a simulation system for assessing the impact response, and potential to cause injury, of domestic floor surfaces during short falls. The method utilises a headform and drop tower adapted from techniques and current standards used to assess the potential for childhood head injuries of playground surfaces and pedestrian-bonnet impacts. The results suggest that the potential of a surface to cause head injury is dependent on the entire surface mixture, including the top surface layer (e.g. carpet and underlay), the underlying surface (wood, chipboard or concrete) and the support material (joists, supports. etc.). The results illustrate a wide range of injury potential between surface mixtures. The simulation system shows the potential to discriminate between differences in surface mixture. In conclusion, the authors suggest that in future investigations, the response of the entire surface mixture be taken into account when forming an opinion on the injury potential of short falls.

Accidental Falls↗

PubMed2000

Fall injuries in the pediatric population: safer and most cost-effective management.

BACKGROUND: At our children's hospital, 30% of all trauma admissions are from falls. The aim of this study was to outline inefficiencies and unnecessary costs incurred in the care of these patients. METHODS: The charts of 127 children admitted for falls (height > or = 9 feet) from 1993 to 1996 were reviewed. Patient demographics, injuries, and treatment costs were recorded and analyzed. RESULTS: Fifty-seven children (45%) were evaluated at an outside facility before transfer. Of these, 73% had injuries requiring treatment at the pediatric center. Local hospital work-up resulted in an average treatment delay of 4.5 hours. Additionally, significant cost was incurred by duplication of radiographic studies, the majority of which were normal. CONCLUSION: Improved and more cost-effective care in pediatric falls can be ensured by immediate transfer of patients with significant injuries, omission of radiographs before transfer, and avoidance of multiple routine x-ray films, the majority of which are normal.

Accidental Falls↗

PubMed1990

The influence of altered head, thorax and pelvis mass on the postnatal development of the air-righting reaction in albino rats.

The experiments were performed on 18 albino newborn rats of both sexes. The postnatal development of the air-righting-reaction (ARR) of the rats was tested for 4 different falling heights (30, 40, 50 and 60 cm) with 3 different loading conditions: artificial alteration of the head, thorax and pelvis mass, respectively. The reaction was analyzed in terms of a three-segment model of the rat (three rotatable parts: head-thorax-pelvis with only one degree of freedom between successive segments). Loading of the head resulted in a delayed development of the first phase of the ARR, whereas loading of the trunk or pelvis slowed the second phase of development. In general, it appears that loading of a body segment results in a delayed development of the rotation of that segment during free fall. Furthermore, loading of a caudal region was associated with an earlier rotation of cranial segments. The completion of the ARR maturation process showed no dependency on either the location or the size of the load, suggesting that the postnatal development of the ARR is pre-programmed.

Animals↗

PubMed1991

Interventricular septum rupture due to falling from a height.

Non-penetrating traumatic interventricular septal rupture of the heart is rare. This lesion can result from blunt injuries, either immediate or delayed, but has never been reported from blunt chest trauma secondary to falling from height. Surgical repair can usually be done as an elective procedure with good results. However, with some patients early repair is necessary as a lifesaving measure. We report on a 15-year-old patient admitted after falling from the fourth floor with multiple bone fractures and blood pressure of 80/0. He soon required mechanical ventilation, but a heart murmur was only detected after some hours. On the fifth day a non-penetrating traumatic interventricular septal rupture became apparent, which was proved by echocardiography and Swan-Ganz catheterization. The patient underwent successful repair of the interventricular septal defect on the 13th day following injury. Two weeks later surgery for his bone fractures was carried out, after which the patient could be discharged uneventfully.

Accidental Falls↗

PubMed1989

Factors influencing rain splash dispersal of infective larvae of Ostertagia ostertagi (Trichostrongylidae) from cow pats to the surroundings.

Laboratory experiments were conducted to investigate rain splash dispersal of infective Ostertagia ostertagi larvae (L3) from cow pats to the surroundings during simulated rainfall. Simulated rainfall on dry cow pats resulted in dispersal of only very few L3. When cow pats were watered prior to the experiments, many infective larvae were stimulated to migrate up onto the surface of the pats, where they might be hit by water drops. When pre-watered pats were hit by falling drops, a considerable proportion of L3 was translocated. More than 90% of the translocated larvae were transported passively by splash droplets and only a minor part of the larvae migrated actively in water films or were transported passively by water run-off to the soil surrounding the pats. A reduction of the fall height of the simulated raindrops resulted in a significant reduction of the number of translocated L3. When cow pats were hit by drops of diameters between 2 and 5 mm, it was found that small raindrops were just as effective as large drops in splash dispersal of L3, provided the amount of rain was the same; but individual small drops were less effective in this respect than individual large drops. When splash droplets could travel freely, most of the splash-dispersed L3 were found within a horizontal distance of 90 cm from the pats; this applied for all sizes of drops. Most splash droplets carrying L3 were travelling within a vertical distance of 30 cm from the ground.

Animals↗