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.
Method Cross-sectional study of HIs from falls in children
(<6 years) 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.
Results Of 1775 cases ascertained (median age
18 months, 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 year)) 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 years) OR 6.84
(95% CI 2.65 to 17.6) and from an infant or child product
(mean age 21 months) OR 2.75 (95% CI 1.36 to 5.65).
Conclusions 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.