Fall Injury Interventions

Window Bars

Background

As discussed above, most of the severe and fatal injuries to children from falls are falls from heights of two or more stories, usually out of windows. One strategy which has been developed is the use of window bars to decrease the size of the opening and prevent a small child from falling through.

A program in New York City, first based on an educational program with free window guards, and later backed up by regulation requiring these guards on all multifamily housing above the first floor, has been evaluated.


Review of window bar intervention studies:

Author

Spiegel and Lindaman, 1977

Study design and target population

Before and after time series design.

Fatal and non-fatal window falls to children 15 years of age and under in NY city.

Intervention

Community education program and distribution of 16,000 free window guards to 4,200 families with pre-school age children, living in tenements in high risk areas.

Outcomes

Fatal falls to children 15 years and under

Non-fatal falls reported by police precincts and hospital emergency rooms

Results

Risk of falls in Bronx, the area with the most intensive intervention, decreased by 50% over 2 years

City wide, deaths decreased by 35% over 2 years.

No falls were reported from windows where guards had been installed.

Study quality and conclusions

Numerators only were reported, and only 3 years of data are given.

Nevertheless, the study provides strong suggestive evidence that the intervention is effective.



Author

Barlow et al., 1983

Study design and target population

Interrupted time series.

Children under 16 in NYC.

Follow-up to the Spiegel and Lindaman study

Intervention

Community education program in 1972; regulation in 1979 requiring window bars

Outcomes

Admissions to Pediatric Surgical Service at Harlem Hospital. 1970-1980

Results

96% reduction in fall admissions after the regulation took effect

Study quality and conclusions

No denominators and not population based.

The regulation was very effective in decreasing falls.

Summary of window bar studies:

Window bars to prevent falls from heights has only been evaluated in New York City. Both the educational program and the regulation appeared effective, although the regulations would be expected to have continued long term impact.

Unfortunately, these studies are flawed in that they have neither denominators nor other control groups in their designs.

Recommendations on window bars:

Window bars appear to be effective for preventing falls. Regulations requiring bars on rental housing appears to be most appropriate.

Recommendations for future research:

This study needs duplication in another setting, using a stronger study design with population based data. One case series from Chicago of 70 children falling from heights found that 36% fell from windows, despite a regulation requiring window guards if the height of the sill is less than 2 feet above the floor. 10 In addition, studies of the effectiveness of programs to increase window bar use for second story or higher windows in single or private family dwellings are also needed.