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Tödliche Stürze von Kindern und Jugendlichen aus großer Höhe im Zeitraum 1997–2012. Retrospektive Fallstudie aus Berlin. [Fatal falls of children and adolescents from a height in the period 1997-2012. Retrospective case study from Berlin]

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Abstract

Autopsies conducted at the university Institutes of Legal Medicine in Berlin, Germany in the time period from 1997 to 2012 were retrospectively analyzed for the frequency and phenomenology of fatal infant and juvenile cases of falls from low and great heights and compared with previous studies. The 16,211 autopsy protocols analyzed included 22 cases of fatal infant and juvenile (age between 0 and 17 years) falls from a great height. The average age of the deceased was 4.9 years with a median age of 25.5 months and 68 % of the victims were male. In 77 % of cases death was caused by accidental falls while 3 cases were due to suicide, 1 case was due to neonaticide and 1 other case was due to a psychiatric disorder. The main cause of death was traumatic brain and cranial injuries (59 %) followed by multiple trauma (32 %). The most common injuries involved the skull. The distance of fall varied between 7 and 34 m with an average height of 13 m. In cases of multiple trauma the average height of fall was 18 m. In small children skeletal injuries of the extremities were less common. Climbing or stepping aids used to overcome vertical barriers played a significant role in 75 % of accidental falls of infants aged between 2 and 4 years. The accidental falls occurred mainly around noon or the early evening during the spring and summer months.

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Introduction Injury patterns after falls from a height > 3 m represent a significant mechanism of multiple trauma and are frequently subjected to forensic autopsy to establish the cause of death. Aim The aim of this study was to determine whether there is a relationship between the height of a fall and the resulting injury pattern and to determine whether certain injury patterns can be related back to the height of the fall and the circumstances of death (e.g. suicide, homicide or accidental). Material and methods The study included 326 cases (median age 40 years, interquartile range IQR 25.3 years) of fatal falls from a height in Berlin from 1988–2004. A retrospective analysis of police investigation files and autopsy reports in this 17-year period was conducted. A floor height of 3 m was assumed. Results A total of 206 men (63 %, median age 38 years, IQR 23.3 years) and 120 women (37 %, median age 44.5 years, IQR 30.5 years) were included in the study. The analysis showed that suicides predominated (68.7 %) followed by household accidents (10.4 %) and accidents at work (8 %). Homicides were not identified. The median height of falling was from the fifth floor (15 m, IQR 2 m) and suicide victims fell from greater heights significantly more often which resulted in more severe injury patterns. Primary head impact predominated (22.7 %) and was mostly present in falls from the third floor and higher (first floor 50 %, second floor 40 %). The frequency of head injuries decreased between the fifth and eighth floors. The most frequent bony injuries were rib fractures (87.1 %), pelvic fractures (60.7 %), skull base fractures (51.5 %) and skull fractures (50 %). The most frequently injured chest organ was the lungs (72 %) and the most frequently injured abdominal organ was the liver (69 %). Almost all investigated injury patterns were already detected in falls from above the first floor. The number and severity of injuries increased significantly with increasing height of falling, except for injuries of the cervical spine, sternal fractures, fractures of the hands and feet and vascular injuries of the neck. Specific injury patterns attributable to a defined falling height or specific circumstances of death were not detected. Conclusion Assignment of a defined floor to a specific injury pattern or circumstances of death (e.g. suicide, homicide or accidental) is not possible in individual cases. For future studies, all variables should be collected in a more detailed and standardized way to ensure more comparability.
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Context Interest in the discarding or killing of newborns by parents has increased due to wide news coverage and efforts by states to provide Safe Haven legislation to combat the problem. Objective To describe the characteristics of these cases in North Carolina. Design, Setting, and Population Case series derived from data on all deaths among liveborn infants 0 to 4 days of age reported to the North Carolina medical examiner from 1985 through 2000. Main Outcome Measures incidence of newborns known to have been killed or discarded by a parent; epidemiological characteristics of newborns and parents. Results There were 34 newborns known to have been killed or discarded by a parent, comprising 0.002% of all liveborn infants during the 16-year study period, giving a rate of 2.1 per 100000 per year. A total of 58.8% were male, 41.1% were white, and 52.9% were black. For 29 cases, the perpetrator was determined to be the mother. Among mothers, 50% were single and 20.6% were married (marital status of the remainder was unknown). Thirty-five percent had had other children. Eight mothers (23.5%) were known to have received some prenatal care. The mean age of the mothers, was 19.1 years (range, 14-35 years) and more than half were aged 18 years or older. The most common causes of death were asphyxiation/strangulation (41.1%) and drowning (26.5%). Conclusions In North Carolina, at least 2.1 per 100000 newborns are known to be killed or left to die per year, usually by their mothers. It is unknown how many of these deaths might be prevented by Safe Haven laws. Efforts to educate the public about these laws need to target the general public. Where resources are limited, the focus should be on on adolescent pregnancy prevention programs, young adults, prenatal care clinics, and married women.
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BackgroundUnintentional injuries are the leading cause of death in children, and falls are the most common type of unintentional injury in the US. The incidence of falls from windows, a common cause of death in urban areas, has not been described outside major cities such as New York and Chicago, and rates in urban and suburban areas have not been compared. ObjectiveTo estimate the incidence and identify the population at risk for falls from windows among children in Hamilton County, Ohio. DesignRetrospective case series identified using Cincinnati Children's Hospital Medical Center (CHMC) Trauma Registry. SettingHamilton County, Ohio, which has urban and nonurban areas. ParticipantsChildren less than 15 years old residing in Hamilton County, Ohio, presenting to CHMC in Cincinnati, Ohio, after a fall from a window between January 1, 1991, and December 31, 1997. Outcome MeasureAnnual incidence by age, race, gender, and residence of those who fell from windows. ResultsOver the 7-year study period, 86 (6.3%) of 1,363 falls were from windows. The mortality rate for falls from windows was 4.7%, compared to 0.07% for all other falls presenting to CHMC (P<.0001). Children 0–4 years old had a higher rate of falls than children aged 5–14 (14.6/100,000 vs. 2.0/100,000) (P<.0001). Males were twice as likely to fall as females (P<.016), and black children were three times more likely to fall than non-black children (P<.002). The incidence of falls in the city of Cincinnati was four times that of the non-urban area (P<.0002). ConclusionsInjuries from falls from windows are a public health problem in Hamilton County, Ohio, especially for young, urban children.
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The objective of the study is to evaluate temporal trends, gender effects and methods of completed suicide amongst children and adolescent (aged 10-17) when compared with temporal trends of deaths from other causes. Data were extracted from the Italian Mortality Database, which is collected by the Italian National Census Bureau (ISTAT) and processed by the Statistics Unit of National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS) at the National Institute of Health (Istituto Superiore di Sanità). A total of 1,871 children and adolescents, age 10-17 years, committed suicide in Italy from 1971 to 2003 and 109 died by suicide during the last 3-year period of observation (2006-2008). The average suicide rate over the entire period of observation was 0.91 per 100,000; the rate was 1.21 for males and 0.59 for females. During the study period, the general mortality of children and adolescents, age 10-17 years, decreased dramatically, the average annual percentage change decrease was of -3.3% (95% CI -4.4 to -1.9) for males and -2.9% (95% IC -4.4 to -2.5) for females. The decrease was observed, for both genders, for all causes of deaths except suicide. For males, the most frequent method was hanging (54.5%), followed by shooting/fire arms (19.6%), falls/jumping from high places (12.7%); for females, the most frequent method, jumping from high places/falls, accounted for 35.7% of suicides during the whole study period. In conclusion, this study highlights that over the course of several decades suicide is a far less preventable cause of death as compared to other causes of death amongst children and adolescents. Our study demonstrated that suicide rates in adolescents are not a stable phenomenon over the 40 years period of study. It suggested that rates for males and females differed and varied in different ways during specific time periods of this study. National suicide prevention actions should parallel prevention measures implemented to reduce other causes of death.
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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. 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. 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. 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.
Article
Falls of all kinds represent an important cause of child injury and death. In the United States, approximately 140 deaths from falls occur annually in children younger than 15 years. Three million children require emergency department care for fall-related injuries. This policy statement examines the epidemiology of falls from heights and recommends preventive strategies for pediatricians and other child health care professionals. Such strategies involve parent counseling, community programs, building code changes, legislation, and environmental modification, such as the installation of window guards and balcony railings.
Article
The question of whether fatal head injuries may occur from short-distance falls is one that continues to cause controversy. The records of the Sacramento County Coroner's Office from 1983 to 1991 were reviewed for cases of fatal head injury in children aged <=5 years, where a history of a fall was initially given. During this 9-year period, three cases of witnessed falls from heights of > 10 ft (3 m) were found. At autopsy, all children had multiple complex calvarial skull fractures, basal fractures, or both; subdural and subarachnoid hemorrhage was found in all cases, and two showed severe cerebral contusion. None had retinal hemorrhage or axonal injury. These are compared with 19 fatalities initially alleged to have occurred from short falls of <=5-6 ft (1.5-1.8 m). As others have found, most of these "minor fall" fatalities occurred under circumstances where there were no unrelated witnesses to corroborate the initial history. Autopsy findings in these cases tended to be of unexpected severity for the initially proposed mechanism of injury, and a number of cases showed evidence of accelerative injury (retinal hemorrhage and/or diffuse axonal injury) where no such mechanism was accounted for by initial history. After sufficient investigation, most of these cases (74%) have ultimately been proven to represent inflicted trauma. A thorough literature review on the subject identifies two major viewpoints. One is that short falls have a significant potential for fatality. The other, more widely espoused view is that short falls rarely, if ever, cause serious injury or death. These two views, and the data upon which they rest, are compared and contrasted.
Article
Falls from height are one of the leading causes of death from unintentional injuries. We reviewed cases of musculoskeletal trauma due to fall from height, who were treated at a tertiary care hospital in Delhi over a one-year period, with respect to demographic data, site of accident, circumstances and location of fall, approximate height of fall, season, landing surface, details of skeletal and other injuries, and duration of hospital stay. Of 1451 admissions during the period, 138 were injured due to fall from height. Thirty-seven cases were excluded. The mean age of the patients was 31.3 years. The mean height of the fall was 4.54 meters (range: 0.6-12 meters). A total of 126 fractures occurred in 101 patients: 55 in the upper limbs, 50 in the lower limbs, 14 in the spine, and 7 in the pelvis. Associated injuries included head (n = 17), chest (n = 9) and abdominal injuries (n = 6). Ninety patients (89%) needed surgical intervention for fracture management. Eleven (10.8%) of these 101 injuries were fatal. Fall from height is a potentially preventable cause of skeletal injuries, as most of the injuries sustained due to fall from height were domestic injuries and occurred due to poor dwelling units.
Article
The aim of this study was to compare the outcome and clinical course of multiple trauma patients with accidental or intentional (suicide related) fall from heights > 4 m. 211 patients with an injury severity score (ISS) > 17 were assigned to the following groups: I: intentional fall, n = 94; A: accidental fall, n = 117) and ISS (1: 28 +/- 1; A: 30 +/- 1), ventilation time (1: 16 +/- 2; A: 15 +/- 1) were not different. Significant differences were found in sex (m/f: I: 56/44; A: 73/27 %), fractures of lumbarspine (I: 34; A: 15 %), pelvis (I: 51; A: 38 %), lower leg (I: 47; A: 20 %), pilon (I: 15; A: 5 %), and os calcis (I: 17; A: 9%). Liver lacerations occured more often after intentional fall (I: 16; A: 6 %). Single or multiple organ failure (MOF) was diagnosed significantly more often in group A (I: 1; A: 8 %). Main cause of death in both groups was single or multiple organ failure (MOF: 1: 47; A: 69 %) or related to brain-injuries (I: 35; A: 19%). Prognosis and rehabilitation of multiple trauma patients after intentional fall is related to brain-injuries, spine-fractures and the functional outcome of the injured lower leg. Prognosis of patients after accidental fall is related to the development of MOF during the ICU-course.
Article
In a 7-year period (April 1, 2003-March 31, 2010), all medico-legal childhood deaths aged 0-18 years investigated by the Lancaster County Coroner's Office under the auspices of Nebraska Institute of Forensic Sciences, Inc. (NIFS), were retrospectively reviewed (n = 140). This number of cases represents 10.9% of the 1287 forensic autopsies performed during the same period. Age, race, gender, cause and manner of deaths were analyzed for all victims categorized into five age groups: 0-1 year, 1-4 years, 5-9 years, 10-14 years, and 15-18 years. Male victims predominated with 98 cases (70%) versus 42 cases (30%) for females giving a male to female ratio of 2.3: 1. The mean age of the children was 7.6 years. The racial composition was 86.4% white, 10.7% Hispanic, 0.7% American Indian, 1.4% African American, and 0.7% Asian American. The majority of deaths occurred in the 0-1 age group (50 cases), followed in rank order by the 15-18 age group (40 cases), the 1-4 age group (23 cases), the 10-14 age group (17 cases), and the 5-9 age group (10 cases). The most common manner of death was accident, followed by natural, suicide, homicide, and undetermined. Accidents accounted for 71 cases (50.7%) of all the deaths and are amenable to prevention. Accidental blunt force trauma accounted for 41 cases or 58% of all the accident cases. The share of motor vehicle crashes in total blunt force trauma deaths was 33 cases. Natural deaths comprised 42 cases or 30% of all the deaths. Suicide (19 cases or 13.6% of all the deaths) was only encountered in the older age groups, the 10-14 age group (6 cases) and the 15-18 age group (13 cases). However, homicide which was observed as the least common manner of death (7 cases) was more predominant among the younger age groups (0-1 and 1-4 age groups). This review may provide useful information for the forensic pathologist, death investigators, law enforcement officers, policy makers, healthcare providers and Nebraska Child Death Review Team in predicting, preventing and investigating childhood medico-legal deaths.
Article
Falls from heights are a major preventable cause of morbidity and mortality in children. The aims of this study are to describe the evolution and long-term prognosis of such patients, to identify the pediatric population at greatest risk of falling from heights in our setting, and to define the variables at admission capable of predicting mortality. A retrospective patient cohort review was carried out. Pediatric patients. Pediatric patients admitted to the pediatric intensive care unit following a fall from a height of over two meters, in the last 10 years. Ninety-two percent of the patients fell from buildings. Out of a total of 54 patients suffering falls, 51% were preschoolers. Fifty percent of the adolescents cases corresponded to attempted suicide. Fifty-two percent of the children were immigrants. Head injuries were the most common type of traumatism. The mortality rate was 12%. Eighty-two percent of the patients with a follow-up period of two years were leading an independent life. The independent predictors of mortality were the height of the fall, the Glasgow coma score and pediatric trauma index score upon admission, the presence of anemia, acidosis and hypotension upon admission, the need for vasoactive drugs, and the presence of severe head injury with the development of intracranial hypertension. Falls from heights occur mainly in unsupervised preschool children and teenagers attempting suicide. These patients have a high number of injuries, a high mortality rate, and important care needs. Most survivors are able to lead an independent life over the long term. Preventive measures should be implemented in risk populations.
Article
In the analyzed period from 1998 to 2008, the autopsies performed at the Hamburg Institute of Legal Medicine included 13 cases in which an investigation for neonaticide had been initiated by the public prosecutor. The killed neonates showed a nearly equal distribution between both sexes. The most common method of neonaticide was suffocation. Most of the perpetrators were young, unmarried primipara with an average educational background. Almost all of them were suffering under psychological stress and had negated their pregnancy. In most cases, birth and neonaticide happened alone in their flat, and there was no medical attendance in any case. In the cases brought to court the women were charged with manslaughter (Section 212 German Criminal Code) and those found guilty were always granted a mitigated sentence pursuant to Section 213 Criminal Code.
Article
Specific information about the supervision of young children with injuries related to falls is limited. In this study, we describe the supervision and physical environment of falls resulting in medical care in the emergency department. We enrolled a convenience sample of 108 children younger than 7 years with fall injuries. The average age was 3 years, and 56% were male. Seventy-six (70%) were a fall from a height including 16 that involved stairs. Among caretakers in a nongroup setting (n = 95), most (61%) were supervising more than one child. The attention to the child was holding or playing with the child (13%), observing (45%), usually constantly, or listening for the child (19%); 9% reported no supervision at the time of the fall. Thirty-two percent stated they were touching or within reach of the child. Of falls indoors (n = 56), the supervisor was in the same room as the child for more than half of cases. There was no association between the number of children supervised and fall type (height vs. same level). When compared with those with same level falls, children with falls from a height were more often supervised with listening or no supervision (vs. observation, holding, or playing with the child) χ², p = 0.004. Many children were supervised at the time of their fall. Most caretakers had visual contact, and up to a third were touching or within reach of the child. The strategies used in these apparently low-risk situations were insufficient to prevent the falls we report.
Article
Falls from heights are common in urban areas in the United States. This study describes the epidemiology of balcony fall-related injuries requiring emergency department (ED) treatment among children and adults in the United States from 1990 through 2006. In 2009, a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission was conducted to describe the epidemiology of balcony fall-related injuries. An estimated 86,500 (95% confidence interval [CI], 68,400-104,600) balcony fall-related injuries were treated in US hospital EDs from 1990 through 2006; 70% of cases were male; 63% were adults (≥18 years old); 94% of injury events occurred at home; 24% of patients were hospitalized; and 8 patients died. The rate of balcony fall-related injuries among children decreased significantly during 1990 to 2006 and was similar to that of adults by the end of the study period. Fall heights ranged from 5 to 87.5 ft. Structural failure of the balcony was involved in an estimated 5600 cases. Patients younger than 18 years were more likely to sustain a concussion/closed head injury (relative risk, 2.42; 95% CI, 1.84-3.18) or skull fracture (relative risk, 5.86; 95% CI, 2.58-13.30) than adults. This is the first study of balcony fall-related injuries requiring emergency treatment using a nationally representative sample. Balcony falls are an important cause of injury in the United States. Age, male sex, and warm months of the year were associated with balcony fall-related injuries in our study population.
Article
The goal was to use a national database to determine the incidence of abusive traumatic brain injuries (TBIs) and/or fractures and the frequency of abuse versus accidents among children <36 months of age. We used the 2006 Kids' Inpatient Database and classified cases into 3 types of injuries, that is, (1) TBI only, (2) TBI and fracture, or (3) fracture only. Groups 2 and 3 were divided into 3 patterns, that is, (1) skull fractures, (2) skull and nonskull fractures, or (3) nonskull fractures. For each type and pattern, we compared abuse, accidental falls, other accidents, and motor vehicle accidents. The incidence of TBIs and/or fractures attributable to abuse was 21.9 cases per 100,000 children <36 months of age and 50.0 cases per 100,000 children <12 months of age. In the abuse group, 29.9% of children had TBIs only, 28.3% TBIs and fractures, and 41.8% fractures only. Abused children were younger and were more likely to be enrolled in Medicaid. For TBI only, falls were more common than abuse in the first 2 months of life but abuse was more common from 2 to 7 months. For TBI and skull fracture, falls were more common during the first year of life. For skull fracture only, almost all injuries were attributable to falls. There was overlap in TBIs and fractures attributable to abuse. Among <12-month-old children, TBIs and/or fractures attributable to abuse occurred in 1 of 2000. Falls occurred more commonly than abuse, even among very young children.
Article
One hundred and seventy-four deaths of infants and children due to accidental fall from height received from South Delhi for autopsy were studied during the 10-year period from January 1998 to December 2007 at the All India Institute of Medical Sciences, New Delhi. Data were analysed with regard to age, sex, location of fall, height of fall, pattern of injury, cause of death and seasonal variation. These cases represented approximately 22.56% of all deaths due to a fall from height and 1.31% of all medicolegal autopsies conducted during the period. There were 106 male (60.9%) and 68 female (39.1%) victims. Age-specific rate of fall showed that the highest rate was in toddlers (39.65%), followed by 26.43% each in preschool children and school-going children and the least in infants (7.47%). The head and face was the most frequently injured body region (93.67%) and the skull was the commonest bone fractured (59.19%). The most common cause of death was head injury (84.48%). Major fall sites in decreasing order of frequency were rooftop (38.50%), balcony (24.13%), household furniture (21.26%), staircase (6.89%), window (4.59%), wall (1.72%), rickshaw/bicycle (1.15%) and tree (0.57%). Most fatalities due to a fall from height were reported in the rainy season.
Article
Berlin, Freie Univ., Habil.-Schr., 1976 (Nicht für den Austausch).
Article
Falls remain a major cause of childhood morbidity and mortality. To improve effectiveness of our prevention program, we used our electronic injury surveillance database to analyze patient variables and the incidence of fall-related brain injury. The database was queried for all injuries treated in the pediatric emergency department for which the word "fall" was listed as part of the chief complaint. Age, sex, and mechanism variables were cross tabulated for analysis with traumatic brain injury (TBI) codes. Between June 2005 and June 2008, the electronic surveillance system reported 39,718 injury-related visits to the pediatric emergency department. Falls were reported in 3,436 patients (2,107 males, 1,329 females). TBI occurred from falls in 171 patients. Although black children had a higher fall rate (69.24%) than white children (23.75%) and non-black, non-white children (7.01%), white children had the highest TBI rate from falls (9.47%). TBI from falls occurred at a lower mean age for females (5.40 +/- 4.45) than males (6.6 +/- 5.15) and for non-whites (5.98 +/- 4.88) than whites (6.21 +/- 4.93). Multiple logistic regression demonstrated a significant influence of age, race, and sex on the likelihood that a fall results in TBI. Females have a higher risk of TBI from falls than males from ages 0 to 11.5. This runs contrary to previous studies suggesting that toddler males are at highest risk for TBI. A disproportionate number of infants, toddlers, and adolescents sustain brain injury from falls. Race and sex group differences mandate enhanced focus on environmental safety and risk-taking behaviors.
Article
"Children Can't Fly" is a health education program developed by the New York City Department of Health to combat the high incidence of child mortality and morbidity due to falls from windows. The success of the program, begun in 1972, in drastically reducing death and injury persuaded the New York City Board of Health to amend the Health Code in 1976 to require that landlords provide window guards in apartments where children ten years old and younger reside. The law is the first and only one of its kind in the nation. The program has four major components: 1) reporting of falls by hospital emergency rooms and police precincts, followed up by counseling, referral, and data collecting by public health nurses; 2) a media campaign to inform the public and elevate their awareness of the hazards; 3) community education for prevention through door-to-door hazard identification, counseling by outreach workers, community organization efforts with schools, tenant groups, clinics, churches, health care providers, etc; 4) provision of free, easily installed window guards to families with young children living in high-risk areas. Significant reduction in falls resulted, particularly in the Bronx, where reported falls declined 50 percent from 1973 to 1975. The program is one solution to an urgent urban problem which other cities might consider to avert the loss of life and limb, and the corollary financial burden for hospitalization, rehabilitation, and maintenance of the injured and permanently disabled.
Article
Sixty-six children who fell distances up to 96 feet were studied to determine the frequency and patterns of injuries sustained. Upper extremity, skull, and femoral fractures were most common; there was only one pelvic fracture and one os calcis fracture. Two of the children died, and 64 children returned to normal activities.
Article
Head injury in the youngest age group is distinct from that occurring in older children or adults because of differences in mechanisms, injury thresholds, and the frequency with which the question of child abuse is encountered. To analyze some of these characteristics in very young children, the authors prospectively studied 100 consecutively admitted head-injured patients 24 months of age or younger who were drawn from three institutions. Mechanism of injury, injury type, and associated injuries were recorded. All patients underwent ophthalmologic examination to document the presence of retinal hemorrhages. An algorithm incorporating injury type, best history, and associated findings was used to classify each injury as inflicted or accidental. The results confirmed that most head injuries in children younger than 2 years of age occurred from falls, and while different fall heights were associated with different injury types, most household falls were neurologically benign. Using strict criteria, 24% of injuries were presumed inflicted, and an additional 32% were suspicious for abuse, neglect, or social or family problems. Intradural hemorrhage was much more likely to occur from motor vehicle accidents and inflicted injury than from any other mechanism, with the latter being the most common cause of mortality. Retinal hemorrhages were seen in serious accidental head injury but were most commonly encountered in inflicted injury. The presence of more serious injuries associated with particular mechanisms may be related to a predominance of rotational rather than translational forces acting on the head.
Article
The injury pattern in the child who falls from a height is markedly different from that in the adult, so a different imaging protocol is needed. To help establish such a protocol, the authors reviewed the charts and imaging records of 45 children and infants 12 years of age and younger who had fallen one to six stories. Extremity fractures were the most common injury, occurring in 20 patients. Head injuries (including skull fractures) occurred in 19 patients. Abdominal injuries were present in only one patient. Pneumothoraces were seen in four patients and lung contusions in two patients. Fractures of the pelvis, spine, and os calcis were uncommon. The height of the fall did not enable prediction of either the severity or type of injury. The authors recommend radiography of the cervical spine and chest alone in the initial evaluation of the injured child and greater willingness to obtain computed tomographic (CT) scans of the head in children than in adults. Radiographs of the pelvis, thoracolumbar spine, and lower extremities, as well as CT scans of the head and abdomen, should be obtained on a case-by-case basis, and not according to protocol, as is often the situation in adults.
Article
Falls accounted for 5.9% of the childhood deaths due to trauma in a review of the medical examiner's files in a large urban county. Falls represented the seventh leading cause of traumatic death in all children 15 years of age or younger, but the third leading cause of death in children 1 to 4 years old. The mean age of those with accidental falls was 2.3 years, which is markedly younger than that seen in hospital admission series, suggesting that infants are much more likely to die from a fall than older children. Forty-one per cent of the deaths occurred from "minor" falls such as falls from furniture or while playing; 50% were falls from a height of one story or greater; the remainder were falls down stairs. Of children falling from less than five stories, death was due to a lethal head injury in 86%. Additionally, 61.3% of the children with head injuries had mass lesions which would have required acute neurosurgical intervention. The need for an organized pediatric trauma system is demonstrated as more than one third of the children were transferred to another hospital, with more than half of these deteriorating during the delay. Of the patients with "minor" falls, 38% had parental delay in seeking medical attention, with deterioration of all. The trauma system must also incorporate the education of parents and medical personnel to the potential lethality of "minor" falls in infants and must legislate injury prevention programs.
Article
Falls from a height are a major cause of accidental death in urban children. The medical and social data on 61 children admitted over the last decade for falls of one or more stories were reviewed. Seventy-seven percent of the children survived. Of the children who fell three stories or less, all survived (100%). Fifty percent mortality occurred between the fifth and sixth floors. Seventy-seven percent of the falls were accidental and 23% of the children jumped or were pushed. The 96% decrease in accidental falls from windows since 1979 demonstrates that the "Children Can't Fly" program in New York City has almost eliminated accidental falls from windows in our hospital population.
Article
The question of whether fatal head injuries may occur from short-distance falls is one that continues to cause controversy. The records of the Sacramento County Coroner's Office from 1983 to 1991 were reviewed for cases of fatal head injury in children aged < or = 5 years, where a history of a fall was initially given. During this 9-year period, three cases of witnessed falls from heights of > 10 ft (3 m) were found. At autopsy, all children had multiple complex calvarial skull fractures, basal fractures, or both; subdural and subarachnoid hemorrhage was found in all cases, and two showed severe cerebral contusion. None had retinal hemorrhage or axonal injury. These are compared with 19 fatalities initially alleged to have occurred from short falls of < or = 5-6 ft (1.5-1.8 m). As others have found, most of these "minor fall" fatalities occurred under circumstances where there were no unrelated witnesses to corroborate the initial history. Autopsy findings in these cases tended to be of unexpected severity for the initially proposed mechanism of injury, and a number of cases showed evidence of accelerative injury (retinal hemorrhage and/or diffuse axonal injury) where no such mechanism was accounted for by initial history. After sufficient investigation, most of these cases (74%) have ultimately been proven to represent inflicted trauma. A thorough literature review on the subject identifies two major viewpoints. One is that short falls have a significant potential for fatality. The other, more widely espoused view is that short falls rarely, if ever, cause serious injury or death.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Falls are a major cause of emergency room visits and admissions in pediatric hospitals. To better understand the epidemiology of falls from height and develop prevention strategies, the authors reviewed all admissions after a fall at a single institution from 1994 to 1997. Inclusion criteria are falls from a minimum height of 10 feet. Of 1,410 patients admitted after a fall, 64 patients including 45 boys and 19 girls with a mean age of 7.4 years (range, 1 to 18) are included in this study. Fifty (78%) children fell from 20 feet or less (two stories) and 14 (22%) from height greater than 20 feet. Patients mainly fell from balconies (n = 15), windows (n = 13), trees (n = 9), roofs (n = 6), stairs (n = 6), diving board (n = 3) and miscellaneous (n = 12). Over 60% of falls occurred in private houses and during the summer months. Fifty-five patients (86%) sustained only one system injury, two patients had no significant injury, and seven patients had multisystem injury. Major injuries included head trauma (39%), musculoskeletal (34%), abdominal (12%), maxillofacial (8%), and spine (6%). A surgical intervention was required for 43% of intracranial trauma, 39% of musculoskeletal injuries, 60% of facial trauma, and 50% of spine fractures. Mean length of stay in hospital varied according to the injured system. The overall survival rate is 98% with only one death after a fall greater than 50 feet. Although rarely mortal, falls from height carry a significant morbidity and are costly to the health care system. To decrease the occurrence of injuries caused by falls, strategies should include awareness campaigns, parent's education about the mechanisms of falls, increase parenteral supervision during playing activities, and legislative measures to ensure the safety of windows and balconies before the onset of summer.
Article
Trauma is a leading cause of morbidity and mortality for children and young adults. When all causes of trauma are considered, falls are the most common mechanism of injury. To address specifically age-related fracture patterns in children who fall, we identified 125 consecutive patients, 21 years old or younger, who fell from a height of 10 feet or greater. The medical records and radiographs for 110 of these patients were available for review. Patients were divided into three groups based on age: there were 25 infant/toddlers (0-2 years), 55 children (3-10 years), and 30 adolescent/young adults (11-21 years). We found statistically significant differences in fracture distribution between the groups. The adolescent/young adult group sustained a greater number of vertebral fractures (p<0.003) and total fractures per fall (p<0.015). The children, in contrast, had a greater number of long bone fractures (p<0.05). Knowledge of age-related fracture patterns could result in improved diagnosis and treatment of these injuries.
Article
Interest in the discarding or killing of newborns by parents has increased due to wide news coverage and efforts by states to provide Safe Haven legislation to combat the problem. To describe the characteristics of these cases in North Carolina. Case series derived from data on all deaths among liveborn infants 0 to 4 days of age reported to the North Carolina medical examiner from 1985 through 2000. Incidence of newborns known to have been killed or discarded by a parent; epidemiological characteristics of newborns and parents. There were 34 newborns known to have been killed or discarded by a parent, comprising 0.002% of all liveborn infants during the 16-year study period, giving a rate of 2.1 per 100 000 per year. A total of 58.8% were male, 41.1% were white, and 52.9% were black. For 29 cases, the perpetrator was determined to be the mother. Among mothers, 50% were single and 20.6% were married (marital status of the remainder was unknown). Thirty-five percent had had other children. Eight mothers (23.5%) were known to have received some prenatal care. The mean age of the mothers was 19.1 years (range, 14-35 years) and more than half were aged 18 years or older. The most common causes of death were asphyxiation/strangulation (41.1%) and drowning (26.5%). In North Carolina, at least 2.1 per 100 000 newborns are known to be killed or left to die per year, usually by their mothers. It is unknown how many of these deaths might be prevented by Safe Haven laws. Efforts to educate the public about these laws need to target the general public. Where resources are limited, the focus should be on on adolescent pregnancy prevention programs, young adults, prenatal care clinics, and married women.
Article
To evaluate the type and nature of head injuries sustained by children under the age of 5 years who present to a busy accident and emergency (A&E) department following an accidental fall. This study included all children under the age of 5 years, who over an 8-month period were referred to our A&E Department with head injury following an accidental fall. Data were collected regarding the height of the fall, whether or not stairs were involved, the type of surface that the child landed on and the height of the child. This was correlated with any soft-tissue injury or skull fracture. A total of 72 children (aged 4 months to 4.75 years) fulfilled all the criteria for an accidental fall. The heights of the falls ranged from less than 50 cm to over 3 m, with the majority below 1 m. Of the falls, 49 were onto a hard surface and 23 were onto a soft surface. Of the 72 children, 52 had visible evidence of head injury, 35 (71%) of 49 being the result of falls onto hard surfaces and 17 (74%) of 23 onto soft (carpeted) surfaces. There was no significant difference in the type of surface that resulted in a visible head injury. A visible head injury was seen in all children who fell from a height of over 1.5 m and in 95% of children who fell over 1 m. Of the 72 children, 32 (44%) had skull radiographs performed in accordance with established guidelines and 4 (12.5%) were identified as having a fracture. Of the 3 linear parietal fractures 2 were inflicted by falls of just over 1 m (from a work surface) and 1 by a fall of 80 to 90 cm onto the hard-edged surface of a stone fire surround. The 4th was a fracture of the base of skull following a fall from more than 3 m (from a first-storey window). In the vast majority of domestic accidents children do not suffer significant harm. Skull fractures are rare and probably occur in less than 5% of cases. To cause a skull fracture the fall needs to be from over 1 m or, if from a lesser height, then a small-area impact point should be considered an integral component of the injury.
Article
Evaluation of fatal jumps and falls from height in children, adolescents and young adults needs careful medico-legal investigation. The aim of this study was to examine the distribution of undetermined falling from height, accidental falling, and suicidal jumping cases between 1990-2003. Copies of death certificates relating to falling from height and jumping deaths in Hungarian youths from the ages of 0-24 years of those resident in Hungary were obtained. 215 (34.1%) accidental falls, 394 (62.6%) suicidal jumping, and 21 (3.3%) undetermined intent were investigated. A significant increase was detected in suicidal jumping death in the age group of 15-19 years (OR=0.7, CI=0.49-0.98, p=0.039), and in the age group of 20-24 years (OR=0.72, CI=0.54-0.96, p=0.025) in the most recent 5 year study period. Data concerning the scene investigation, detailed forensic autopsy, and family history have important role in the differentiation of fatal jumping or falling cases. Further investigation about the characteristics injuries may help the final determination of violent death causes at youth, and more effort should be directed to an effective prevention strategy for jumping or falling death cases.
Article
This study wanted to search for potential risk factors associated with falls from windows and balconies in order to eventually improve prevention. All children under the age of 16 years suffering from head injuries/multiple trauma due to falls from windows or balconies treated over the last 7 years at the intensive care unit (ICU) of the University Children's Hospital Zürich were analysed retrospectively (group A). Fifty patients out of all children suffering from head injuries/multiple trauma due to other types of accidents in the same period were selected at random as controls (group B). Out of a total of 241 children with head injury and/or multiple trauma, 31 (13%) fell out of a building. Twenty-seven of these victims (87%) fell from the third floor or lower. Twenty-one of the falls (68%) occurred at home. Fifteen children (49%) climbed on a piece of furniture before falling. In almost 20% of the accidents dangerous balcony or house constructions led to the fall. Parents did not witness the fall, except for three cases (10%) with direct parental involvement (one mother jumped out with her child, two mothers threw their child out of the window). Two children (6%) attempted suicide. Children aged 0-5 years were predominantly represented (84%), and all six children who died were in this age group. There were significantly more patients with foreign nationalities and lower socio-professional categories in group A than in group B. In both groups, the accidents concerned the youngest child of the family in approximately 50% and happened mostly during summer evenings. There were no significant differences in injured systems and in injury severity between the two groups. This study identified young age, an immigrant family setting, low socio-professional category of the parents, dangerous house constructions, inappropriate furniture placement, and summertime evenings as risk factors for serious building falls in children. This information may foster focused prevention.
Article
This nationwide study examined legal outcomes and possible psychiatric diagnoses of suspected cases of neonaticide. Neonaticide is commonly defined as the killing of a newborn on the day of its birth, and is considered to have not only a low prevalence but also a high level of concealed criminality. This hidden nature guided us to find out what the final legal outcomes of suspected neonaticide were. It was a comprehensive, retrospective, register-based study of all 44 cases of suspected neonaticide that occurred 1980-2000 as recorded by Statistics Finland. The 44 cases were ascribed to 40 suspects, three of whom died themselves during the offence. Twelve cases (27%) were eventually prosecuted and the accused convicted of neonaticide. Their mean sentence was 617 days (SD 216, range 300-1095 days). Fourteen offenders (35% of offenders) underwent a forensic psychiatric examination, out of which four (29%) were diagnosed with a psychotic disorder and 10 (71%) with a personality disorder. Six of the 14 women were not sentenced as criminally irresponsible and three of them were committed to involuntary hospital care. Nine cases (20% of cases) were still unsolved, and in eight (18%) cases the offence title had changed into something other than neonaticide. We concluded that since only 41% of suspected neonaticides completed the court process as neonaticides, the previous results from studies on neonaticide may present a subgroup of offenders, not the whole picture. Therefore, further discussion and research is needed to elucidate this perplexing, sad, and utterly redundant offence in modern society, to prevent it, and develop treatment programs for the offenders.
Verletzungen nach Fall aus großer Höhe
  • M Aufmkolk
  • G Voggenreiter
  • M Majetschak
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Expertise für die Bundesarbeitsgemeinschaft (BAG) Mehr
  • G Ellsäßer
Ellsäßer G (2004) Expertise für die Bundesarbeitsgemeinschaft (BAG) Mehr Sicherheit für Kinder e. V. – Epidemiologie von Kinderunfällen in Deutschland
Neonatizide in Hamburg
  • J Krohn
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  • K Püschel
  • Schröder
Neudeck F (1999) Verletzungen nach Fall aus großer Höhe
  • M Aufmkolk
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  • M Majetschak
Aufmkolk M, Voggenreiter G, Majetschak M, Neudeck F (1999) Verletzungen nach Fall aus großer Höhe. Unfallchirurg 102:525-530
Fatal falls of children: Victoria 1989-2002 Melbourne: State Coroner's Office & Department of Human Services
  • L Bugeja
Bugeja L (2004) Fatal falls of children: Victoria 1989-2002 Melbourne: State Coroner's Office & Department of Human Services. Government report, Australia
  • J Krohn
  • S Anders
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Krohn J, Anders S, Püschel K, Schröder AS (2011) Neonatizide in Hamburg, Deutschland, von 1998-2008. Arch Kriminol 227:174-180
Todesursachenstatistik Deutschland
  • Statistisches Bundesamt
Statistisches Bundesamt, Wiesbaden 2012, Todesursachenstatistik Deutschland 2010. Genesis Onlinedatenbank