Craniofacial injuries from slip, trip, and fall accidents of children

BACKGROUND: Slips, trips (STs), and falls are frequent events in childhood. As a child is likely to impact headfirst in these events, craniofacial injuries are the most common trauma. We retrospectively surveyed our experience with pediatric craniofacial injuries and investigated the distributions of wound type and injury site, severity, and mechanism. METHODS: A total of 750 children sustaining craniofacial injuries resulting from STs and falls were enrolled in this study. Facial and cranial areas were delimited by an imaginary line extending between the ears and across the eyebrows. Soft-tissue injuries were classified into laceration, contusion, and abrasion. The Glasgow Coma Scale was used to assess the severity of brain injury. RESULTS: Peak incidence of ST-type childhood craniofacial injury occurred at toddler age, whereas falls tended to occur when the children were younger than 1 year old; most of the patients were preschool. The home was the scene for 73% of the STs and 86% of the falls. Lacerations occurred more often in STs (67% vs. 25%), whereas contusions more often resulted from falls (64% vs. 27%). Most of the injuries were to the anterior head with a T-shaped distribution; however, over one third (37%) of the contusions were to the posterior area. Brain injury was absent or only mild in 98% of craniofacial injuries. Falls resulted in a significantly higher incidence of moderate-severe brain injury relative to STs. CONCLUSIONS: Childhood craniofacial injuries resulting from STs are more prevalent than are those that were sustained in falls; however, the latter is associated with greater trauma morbidity. The incidence of childhood craniofacial injury appears to be associated with the level of development irrespective of event type. The home is a potentially dangerous environment for children, especially during the preschool years. Padding the hard, acutely angled surfaces of housing structures and furniture around children's activity zones is an effective method of reducing the risk of childhood craniofacial trauma. Serious or fatal head injuries will rarely occur as the result of a fall from furniture or stairs at home.