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PED-EM-L  June 2012

PED-EM-L June 2012

Subject:

Re: stair falls leveling criteria

From:

Ted Walkley <[log in to unmask]>

Reply-To:

Ted Walkley <[log in to unmask]>

Date:

Mon, 25 Jun 2012 08:14:30 -0700

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (1 lines)

Pediatrics Vol. 82 No. 3 September 1, 1988
pp. 457 -461

Stairway Injuries in Children

    Mark Joffe,
    Stephen Ludwig

+ Author Affiliations

    From the Section of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, and the Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia

Abstract

Children frequently injure themselves falling down stairways, but the characteristics of these injuries are not well described. A total of 363 consecutive patients seen in a pediatric emergency department were studied. The majority of patients had minor superficial injuries. Bony injuries occurred in 7% of patients. Head and neck injuries occurred in 73% of patients, extremity injuries, which were predominantly distal, in 28%, and truncal injuries in 2%. Children younger than 4 years of age were more likely to sustain head trauma than children older than 4 years of age (P < .005). Injury to more than one body part occurred in only 2.7% of patients. Children who fell down more than four steps had no greater number or severity of injury than those who fell down less than four steps (P = .67). Patients were admitted to hospitals in 3% of cases. No patient had life-threatening injuries and no patients required intensive care. When multiple, severe, truncal, or proximal extremity injuries are noted in a patient who reportedly fell down stairs, a different mechanism of injury should be suspected.

Sometimes being in the field for a long time helps
 Ted Walkley  MD
 Mary Bridge Children's Hospital
Tacoma WA


-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Marty Herman
Sent: Monday, June 25, 2012 6:34 AM
To: [log in to unmask]
Subject: Re: stair falls leveling criteria

I agree with the previous posters. However, I do not think the worst injury is bruises and fractures. I have read, possibly seen an epidural from a fall down stairs. I think trauma activation, shouldn't be automatic based on mechanism but rather assessments. I had a baby who supposedly fell down a flight of concrete steps with a metal edge, that presented comatose. Later determined to have been beaten. If you went on history only the trauma team wouldn't have been present on his arrival. SO wouldn't it be best to have fall down stairs as a low level indicator and activation occur if the child's clinical condition meets criteria for serious injury? AMS< post traumatic seizures, altered respirations, long bone fractures, open wounds, altered vs etc?

Marty
Martin Herman, M.D.

Pediatric Emergency Medicine
Sacred Heart Children's Hospital
FSU @ Sacred Heart, Division of Pediatrics
5153 N. 9th Ave, 6th Floor Nemours Bldg
Pensacola, FL 32504
Ph: 850 416 7658(office)
Ph: 901 219 9202 ( cell)
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 > Date: Sun, 24 Jun 2012 19:27:23 -0500
> From: [log in to unmask]
> Subject: Re: stair falls leveling criteria
> To: [log in to unmask]
>
> Well put.
> Todd Z
>
> Sent from my HTC smartphone on the Now Network from Sprint!
>
> ----- Reply message -----
> From: "Matt Wilkinson" <[log in to unmask]>
> To: <[log in to unmask]>
> Subject: stair falls leveling criteria
> Date: Sun, Jun 24, 2012 6:45 PM
>
>
> "Ten one-foot falls does not equal one ten-foot fall."
>
> -MW
>
> On Jun 24, 2012, at 6:00 PM, james reingold <[log in to unmask]> wrote:
>
> > I've never heard of that before despite having worked at a few Level 1 trauma centers.  I will tell you from experience that falling down the full flight of stairs seems a lot milder than falling out the window even if the total height is the same.  I feel like I've seen more skull fractures from falling off the kitchen counter.
> > James
> >> Date: Sun, 24 Jun 2012 03:08:08 +0000
> >> From: [log in to unmask]
> >> Subject: Re: stair falls leveling criteria
> >> To: [log in to unmask]
> >>
> >> We have never consider stairs fall as a vertical fall, and would treat the child based on the physical findings at triage, your trauma team view looks to me like an over response, and I wonder how often did those multi protocol generated tests result in change of care... How about using clinical judgement?
> >>
> >> Sent from my iPad
> >>
> >> On Jun 23, 2012, at 5:52 PM, "Joshua Ross" <[log in to unmask]> wrote:
> >>
> >>> Colleagues,
> >>>
> >>> I'm a PEM physician at an academic Level I trauma center.  One of our automatic activation criteria for a Level II trauma response is a "fall from 10 feet or 2-3x the child's height."  Our PEM group has always interpreted this as a vertical fall.
> >>>
> >>> The trauma team has expressed that this should include stair falls.  Meaning, a child falling 10 feet or 2-3 times his/her height down the steps would trigger a Level II response (entire trauma team evaluation, full immobilization,often cxr/pelvis, labs) regardless of the child's clinical appearance.
> >>>
> >>> Our PEM group feels this would overtriage patients and the injury severity and pattern of stair falls are not equivalent to vertical falls.
> >>> My question for other Level I trauma centers:  In your institution how is the mechanism of stair falls addressed in your leveling criteria?
> >>>
> >>> Thanks for your input,
> >>>
> >>> Josh Ross
> >>>
> >>> Pediatric Emergency Medicine
> >>> University of Wisconsin College of Medicine and Public Health
> >>> American Family Children's Hospital
> >>>
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