More than 5,000 children fall from windows annually

In the United States, pediatric injury rates from window falls steadily decreased during a 19-year period, but these declines could be more substantial if comprehensive prevention programs similar to those launched in New York City and Boston were adopted nationwide.

The average injury rate attributable to window falls among children and adolescents was 7.3 per 100,000 per year from 1990 to 2008, data from the first nationally representative sample to assess these trends indicate.

“These injuries are an important pediatric public health problem, and increased prevention efforts are needed, including development and evaluation of innovative prevention programs,” Gary A. Smith, MD, DrPH, of Nationwide Children's Hospital in Columbus, Ohio, and colleagues wrote in Pediatrics.

They found that window fall-related injury rates reached a high point of 11.4 per 100,000 in 1992 and a low of 5.8 per 100,000 in 1999.

Although overall annual injury rates fell modestly during the study period — a reduction entirely accounted for by an annual decrease of 0.426 cases per 100,000 among children younger than 4 years (P=0.001) — the decline was much less than the 96% decreases observed in New York City and Boston during the 10-year period after these cities adopted fall-prevention programs.

Parent education, increased access to window guards, and in New York a mandate requiring window guards in certain households, were the cornerstones of these initiatives.

To examine window-fall related injuries and determine how to best prevent them, Smith and colleagues analyzed emergency department data from the National Electronic Injury Surveillance System (NEISS), which included 98,415 children and teens who were treated for injuries related to window falls.

This accounted for an average rate of 5,1809 window fall-related injuries per year, the researchers determined, among a population with a mean patient age of 5.1 years.

The majority of injuries occurred among boys (58.1%) and children aged 4 years or younger (64.8%). Falls most frequently occurred from a height of two stories (62.7%), whereas 30.8% occurred from the first floor and even fewer, 6.5%, occurred from heights greater than two stories.

In 82.8% of the cases with such information available, there was a screen in the window. “Parents and other child caregivers should be counseled not to depend on screens to prevent children from falling out of windows,” the researchers wrote.

About three-quarters of the injured children and teens were treated and released, although one-quarter was admitted to the hospital and 0.2% died.

When the researchers compared injuries and mortality among the 0-to-4 year old age group and the 5-to-17 year old age group, they found that the younger group was more likely to sustain head injuries (injury proportion ratio= 3.33; 95% CI: 2.65-3.91), have worse outcomes, and be hospitalized or die (IPR=1.65; 95% CI: 1.38-1.97).

Children in both age groups who landed on hard surfaces, such as concrete and asphalt, were more likely to sustain a head injury and to be hospitalized or die, than those who landed on soft surfaces like mulch or flower beds.

“Prevention measures for young children should aim to prevent falls by reducing the child's opportunity to exit the window, through the use of devices such as window guards or window locks and through placement of furniture away from windows,” Smith and colleagues recommended.

”Prevention measures for all children should address softening the landing surfaces below windows, to help reduce the severity of injury when a fall does occur,” they added.

NEISS data likely underestimate mortality, as the study only captured data from children who were treated in hospital EDs and not those who died prior to ED admission, or after the patients were released from the ED to the hospital, the researchers noted.

Additionally, many of the NEISS case narratives lacked complete details about the circumstances under which injuries occurred. Future studies should aim to assess the role of fall height, furniture placement and window status in injury type and severity, the researchers concluded.

Other information, including patient age and whether the fall was intentional or unintentional, could also improve fall-prevention recommendations.

Harris VA et al. Pediatrics. 2011;doi:10.1542/peds.2010-2687.

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