Principal Investigator: Dr. Brian Johnston, MD, MPH
Funding Source: Centers for Disease Control and Prevention
Scope of the Problem
In children under the age of five, falls are a common cause of emergency department visits. Emergency department and outpatient surveillance systems indicate that falls are the most common injury requiring medical care. In contrast, falls are an infrequent cause of childhood death, accounting for approximately 300 deaths per year in the U.S. The case fatality rate for children hospitalized for falls is seven-fold lower than that for other, non-fall related injuries. Hospitalizations for falls are intermediate in relative frequency compared to emergency department visits and fatalities, with one study finding that falls account for 29% of hospital admissions for trauma to children and adolescents 19 years of age and under. Another study from New Zealand found that falls were the leading cause of injury hospitalization in children under the age of 15, accounting for 36.7% of hospitalizations in the North Health region.
The most common type of fall leading to hospitalization is fall from one level to another, such as from playground equipment, beds, table, and chairs. Baby walkers are a common cause of injuries in young children, in which children in walkers fall down stairs or off porches. Falls resulting in severe or fatal injuries are usually due to falls from second story or higher windows. The mean height for a fatal injury is 5-6 stories. Window screens are made to pop out for fire safety reasons, and do not serve as a barrier to prevent children from falling out of windows.
When temperatures rise, pediatricians at Harborview Medical Center anticipate one of summer’s tragedies-children falling out of windows. On average, Harborview admits more than 25 children injured from falls each season. Even more surprising is that many cases involve children falling out of windows covered by screens.
In 2008 summer, Dr. Brian Johnston, chief of pediatrics at Harborview and a center investigator went on the offensive. With the help of regional media, he participated in a series of news stories aimed at warning families of the risk of window falls and what can be done to prevent them. In October, he took the message further by organizing a public conference to develop prevention strategies, including the formation of an expert coalition with advocates from public health and safety, manufacturing, and housing and construction. Dr. Johnston has secured funding for a research effort to test the effectiveness of a window safety device.
The goal of this project is to test procedures for case identification, subject enrollment, and environmental data collection needed to conduct a case-control study of risk factors for window falls among children 0-9 years old. This is a pilot project that will take place at a single study center.
The specific aims include:
- Develop detailed scripts, recruitment strategies, home inspection protocols and alternative data collection methods for use in a case-control study
- Pilot procedures to identify, contact and enroll eligible case households
- Pilot procedures to identify, contact and enroll eligible control households
- To estimate study refusal rates and, among participants, the prevalence of specific risk factors and potential confounding factors in case and control households
- To use the information above to plan a population-based case-control study to determine important risk factors for falls of children from windows