PEDIATRICS Vol. 121 No. 6 June 2008, pp. e1696-e1702 (doi:10.1542/peds.2007-2555)
ARTICLE |
Bunk Bed–Related Injuries Among Children and Adolescents Treated in Emergency Departments in the United States, 1990–2005
a Ohio State University, College of Medicine, Columbus, Ohio
b Department of Pediatrics, College of Medicine, Ohio State University, Columbus, Ohio
c Center for Injury Research and Policy, Research Institute at Nationwide Children's Hospital, Columbus, Ohio
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ABSTRACT |
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OBJECTIVE. Our goal was to comprehensively examine bunk bed–related injuries in the United States by using a nationally representative sample.
METHODS. Using the National Electronic Injury Surveillance System database, cases of nonfatal bunk bed–related injuries treated in US emergency departments from 1990 through 2005 were selected by using the National Electronic Injury Surveillance System bunk bed product code (0661). Cases concerning individuals 
21 years old were included.
RESULTS. An estimated 572 580 children and adolescents aged 21 years were treated in US emergency departments for bunk bed–related injuries during the 16-year study period, yielding an average of 35 790 cases annually. An average of 42 per 100 000 population were treated annually. Bunk bed–related injuries occurred more frequently among males (60.6%). Lacerations were the most common type of injury (29.7%), followed by contusions and abrasions (24.0%) and fractures (19.9%). The body parts most frequently injured were the head and neck (27.3%) in all age groups. Falls were the most common mechanism of injury (72.5%). Of the cases for which locale of injury was recorded, 93.5% occurred at home. Approximately half of the bunk bed–related injuries that occurred at schools involved individuals aged 18 to 21 years (50.9%). An estimated 2.9% of injuries resulted in hospitalization or transfer to another hospital or required additional observation. The number of bunk bed–related injuries showed no significant trend from 1990 to 2005.
CONCLUSIONS. Bunk beds are a common source of injury among children and adolescents, and these injuries mostly involve the head and face. Given the continuing large numbers of bunk bed–related injuries at homes and in schools, increased efforts are needed to prevent bunk bed–related injuries among children and adolescents.
Key Words: bunk bed • bed (MeSH) • accidental falls (MeSH) • wounds and injuries (MeSH) • child (MeSH) • adolescent (MeSH) • emergency department • National Electronic Injury Surveillance System
Abbreviations: CPSC—Consumer Product Safety Commission • NEISS—National Electronic Injury Surveillance System • ED—emergency department • RR—relative risk • CI—confidence interval
Bunk beds are common in homes across the United States and other industrialized countries.1 While playing or sleeping, children sustain bunk bed–related injuries that result from falls, jumps, bunk bed ladders, bed malfunctions, and striking the bed.1–5 Injuries associated with bunk beds are typically more severe than those associated with conventional beds.2 Lacerations and contusions are the most common injuries from beds of conventional height.1,2,5–8 Children younger than 6 years sustain the majority of bunk bed–related injuries.1,2,4,5,9 Because children younger than 6 years are at the highest risk for death resulting from head entrapment and collapsing mattresses, the US Consumer Product Safety Commission (CPSC) has promulgated mandatory standards for bunk beds to prevent injuries.10–12 College students are also at higher risk for bunk bed–related injuries.13 Although most studies of bunk bed–related injuries have focused on pediatric populations, only 1 assessed bunk bed–related injuries among college students.13 The majority of published studies of bunk bed–related injuries have examined populations of <300 patients.1,5–9 A recent study analyzed injuries associated with bunk beds by using data from the National Electronic Injury Surveillance System (NEISS) during a 4-year period among children aged 0 to 9 years.4 We extend the previous work by Mack et al4 by determining national patterns of bunk bed–related injuries for children, adolescents, and young adults aged 21 years treated in US emergency departments (EDs). To our knowledge, this is the first study to use nationally representative data to comprehensively examine patterns and trends of bunk bed–related injuries in this population.
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METHODS |
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Data Source
Data for patients treated from January 1, 1990, through December 31, 2005, were obtained through the NEISS, which is operated by the CPSC. The NEISS provides data on consumer product–related and sports activity–related injuries treated in US EDs. The NEISS receives data from a network of
100 hospitals, representing a stratified probability sample of 6100 hospitals with at least 6 beds and a 24-hour ED.14 The network includes urban, suburban, rural, and children's hospitals.14 Data collected by the NEISS are weighted to produce national estimates for consumer product–related and activity-related injuries.14 The NEISS was established in 1972 and has had revisions made in its sampling frame in the years 1978, 1990, and 1997. At all sampled hospitals, ED medical charts are viewed by professional NEISS coders, and data regarding patients' age, gender, race, injury diagnosis, body part injured, product(s) involved, and disposition from the ED and a brief narrative describing the incident are recorded. Data from the US Census Bureau was used to calculate injury rates per 100 000 individuals aged 21 years. This study was approved by the institutional review board of the Research Institute at Nationwide Children's Hospital.
Variables
All NEISS data narratives identified by the bunk bed code (product code 0661) were reviewed. The NEISS product code for alcohol (1903) was also identified. For the current study, a new variable was created to record mechanism of injury. Mechanism of injury was coded into 1 of 6 categories: (1) falls (from top or bottom bunk); (2) strikes/hits; (3) jumps; (4) ladder-related; (5) bed malfunction; or (6) entrapment (eg, when any part of the body was injured by getting trapped in parts of the bunk bed). Ms D'Souza reviewed each NEISS narrative to assign the mechanism of injury. Patients were divided into 6 age groups for analyses: <3, 3 to 5, 6 to 9, 10 to 13, 14 to 17, and 18 to 21 years. These categories approximate younger-than-school-age children (aged <3 years), preschool- and kindergarten-aged children (aged 3–5 years), elementary school–aged children (aged 6–13 years), high school–aged children (aged 14–17 years), and college-aged individuals (aged 18–21 years). The CPSC recommends that children younger than 6 years sleep in the lower bunk because of the increased risk of fatality resulting from entrapment in the upper bed rails (which can lead to suffocation) and dangerous falls caused by mattress collapse while in the upper bunk10–12,15; therefore, children younger than 6 years were kept in age categories separate from older children. The body part injured was grouped into categories of "upper extremity," "lower extremity," "face," "shoulder and trunk," and "head and neck." The category "upper extremity" included the upper arm, lower arm, elbow, wrist, hand, and finger; "lower extremity" included the upper leg, lower leg, knee, ankle, foot, and toe; "face" included the face, eyeball, ear, and mouth; and "shoulder and trunk" included the upper trunk, shoulder, and lower trunk. Case disposition was categorized as either "treated/released" (patients were treated and released) or "treated/transferred, admitted, or observation" (patients were treated and admitted, treated and transferred, or held for further observation). We excluded fatalities because of very few actual cases (n = 4) and because the NEISS does not capture fatal injuries well (people with life-threatening injuries are more likely to go directly to trauma/surgery, and injuries that result in fatalities before arrival to the ED are not recorded in the NEISS) and is generally not regarded as useful for studying fatal injuries and their characteristics.
Data were analyzed using SPSS 14.0 (SPSS Inc, Chicago IL).16 The sample weight assigned to each case was based on the inverse probability of selection. Computation of relative risks (RRs) with 95% confidence intervals (CIs) was performed. All data reported are national estimates unless specified as unweighted cases. The estimates for this study were based on weighted data for 16 845 patients aged 21 years treated for injuries in EDs between January 1, 1990, and December 31, 2005.
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RESULTS |
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From 1990 through 2005, an estimated 572 580 patients (95% CI: 489 920–655 240) were treated in EDs for bunk bed–related injuries, yielding an average of 35 790 patients annually (Table 1). An average of 42 patients per 100 000 population (ages
21 years) in the US population were treated for bunk bed–related injuries annually (Fig 1). Male patients accounted for 346 870 cases (60.6% [95% CI: 59.2%–62.0%]). The patients ranged in age from 1 month to 21 years with a mean age of 6.8 years and a median age of 6.0 years. Numbers of injuries sustained were highest for the 3- to 5-year-old age group (190 200 cases [95% CI: 161 390–219 010]; Fig 2). Of the 480 040 cases (83.8% of the total) for which location was recorded, 93.5% of bunk bed–related injuries occurred at home (449 040 cases [95% CI: 373 450–524 630]) and 5.4% occurred at school, recreational sports facilities, or other public property (25 730 cases [95% CI: 19 590–31 870]). Approximately half (50.9%) of the bunk bed–related injuries that occurred at schools involved young adults aged 18 to 21 years. There was no overall increasing or decreasing trend in injury rates from 1990 to 2005; however, rates per 100 000 children fluctuated by 44% between 1990 and 2005.
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Location
The risk for injury at school, recreational sports facilities, or other public property was dramatically higher for older children. For example, individuals aged 10 to 21 years were 17.3 times more likely to be injured at school, recreational sports facilities, or other public property than younger children (95% CI: 12.3–24.3). In addition, each age group had a higher risk of injury at school, recreational sports facilities, or other public property compared with younger children, with 18- to 21-year-olds having had the highest risk of injury for any single age group (RR: 14.0 [95% CI: 9.5–20.7]).
Type of Injury
Lacerations were the most common injury type overall (29.7% [168 851 of 572 580]) and also for children younger than 10 years (Table 1). Contusions and abrasions were the second most common injury type overall (24.0% [137 234 of 572 580]) and the most common for children between the ages of 10 and 21 years (Fig 3). The most commonly injured body parts for all children were the head and neck (27.3% [156 527 cases (95% CI: 131 660–181 394)]). Children aged 5 years were more likely to sustain head and neck injuries than older children (RR: 1.3 [95% CI: 1.2–1.4]). Concussions were responsible for 37.9% (59 395 of 156 528) of head and neck injuries, followed by lacerations, which accounted for 34.1% (53 387 of 156 528) of head and neck injuries. Lacerations were the most common injuries to the face (66.9% [99 457 of 148 619 cases]) and the head and neck (34.1% [53 387 of 156 527 cases]). The face was 4 times (95% CI: 3.6–4.3) more likely to sustain lacerations than other parts of the body, and the head and neck and face regions combined were 6.8 times (95% CI: 5.8–7.8) more likely to sustain lacerations compared with other parts of the body.
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Body Region
The upper extremities sustained the majority of fractures (67.8% [77 070 of 113 699]) (Fig 4). Upper extremities were 7.8 times (95% CI: 7.1–8.4) more likely to experience a fracture than other body parts. Children aged 6 to 13 years were at increased risk for upper-extremity injuries compared with children in all other age groups combined (RR: 1.7 [95% CI: 1.6–1.9]). The lower extremities sustained the greatest number of strains and sprains (46.5% [23 306 of 50 086]). Strains and sprains were 5.5 times (95% CI: 4.9–6.3) more likely to occur to the lower extremity than to other body parts. Children aged 14 to 17 years were 1.9 times (95% CI: 1.6–2.4) more likely to sustain injuries to the lower extremity than children in all other age groups. The shoulder and trunk (upper and lower) were 2.2 times (95% CI: 2.0–2.4) more likely to experience contusions and abrasions than all other body parts.
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Disposition From ED
Most injuries (96.7%) resulted in treatment and release from the ED (553 600 cases [95% CI: 473 070–634 130]). Patients who were hospitalized, transferred to another hospital, or held for observation accounted for 2.9% of the cases (95% CI: 2.4%–3.4%). Injuries to the upper extremity were 2.7 times (95% CI: 2.1–3.5) more likely to result in admission, transfer to another hospital, or further observation than injuries to other body parts. Fractures were 6.3 times (95% CI: 5.0–8.0) more likely to require admission, transfer to another hospital, or further observation than other types of injuries.
Mechanism of Injury
Falls were the most common mechanism of injury (72.5% [415 220 cases (95% CI: 353 590–476 860)]). Alcohol was involved in 0.06% of all cases (360 estimated cases); however, it was involved in 0.7% of cases in the 18- to 21-year-old age group (282 cases) and 0.4% of cases in the 14- to 17-year-old age group (77 cases). All alcohol-related injuries resulted from falls. Compared with other mechanisms of injury, concussions were 2.1 times (95% CI: 1.7–2.5) more likely to result from falls. Compared with other mechanisms of injury, fractures were 1.8 times (95% CI: 1.6–2.1) more likely to result from falls. Compared with other mechanisms of injury, entrapment was 2.5 times (95% CI: 2.1–3.1) more likely to result in an upper-extremity injury and 1.9 times (95% CI: 1.4–2.6) more likely to result in a lower-extremity injury. Entrapment injuries were 2.8 times (95% CI: 1.6–5.0) more likely to occur among children aged 10 to 13 years compared with those in all other age groups. Injuries caused by bed malfunction occurred more frequently among children aged 10 to 21 years (RR: 6.1 [95% CI: 4.0–9.2]) compared with children younger than 10 years. Lacerations were 2.2 times (95% CI: 2.1–2.4) more likely to result from strikes/hits compared with other mechanisms of injury. Strikes/hits were more likely to occur among 14- to 21-year-olds (RR: 2.2 [95% CI: 1.9–2.6]) than among younger children. Compared with other mechanisms of injuries, ladders were 1.9 times (95% CI: 1.6–2.2) more likely and jumps from the bunk bed were 4.2 times (95% CI: 3.7–4.7) more likely to result in injuries to a lower extremity.
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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With this study we offer a more comprehensive analysis of bunk bed–related injuries treated in US hospital EDs on a national level than that of previous studies. We examined patterns and trends in these injuries over a 16-year period and included the important college-aged group in addition to younger children and adolescents. The average rate of bunk bed–related injury annually was 42 patients per 100 000 individuals aged
21 years in the US population. Almost half of the children injured were younger than 6 years (49.6%). Compared with children aged 14 to 17 years, college-aged individuals (18–21 years) experienced more than double the number of injuries. The reason for this is unknown; however, individuals 18 to 21 years of age may use bunk beds more often as a result of increased residence in institutional settings (ie, college dormitories, prisons, and military). Males sustained the majority of injuries in all age groups. Previous studies have found that males are at higher risk for pediatric injuries in general, including injuries from bunk beds.1,2,4,5,7,8,13,17–24 In our study, falls were the most common mechanism of injury, and the head and neck was the body region most commonly injured. Previous studies have demonstrated that most bunk bed–related injuries are associated with objects around the bed, by children playing in and around the bed, or by children jumping on and off the bed.2,4,5,9
In March 1976, the CPSC reported that an estimated 13500 bunk bed–related injuries were treated in EDs and that the majority (87%) of those injured were children younger than 15 years.25 In 1987, 25 000 children younger than 15 years required treatment in hospital EDs for bunk bed–related injuries.5 Bunk bed–related injuries have increased since 1987; an average of 35 790 cases occurred annually from 1990 through 2005 according to our study. Although voluntary safety standards for bunk beds were instituted by the American Society for Testing and Materials in 1992, bunk bed–related injuries continued to increase until 1999 (when rates began to decrease). In fact, as a result of entrapment-related deaths among children younger than 15 years numbering 10 deaths per year,26 the CPSC issued a mandatory standard for bunk beds in 1999. The mandatory standard, however, does not apply to institutional beds (military, college dormitories, prisons), because the cost of compliance would be higher while the benefits would be significantly lower compared with residential bunk beds.27 However, our results show that children have a significantly increased risk of injury from bunk beds in schools, recreational sports facilities, and other public properties. This suggests that bunk bed safety in institutional settings requires major improvements and, at minimum, deserves additional study.
The CPSC recalled >630 000 bunk beds from 1994 to 2004 that presented potential risks for fatal head entrapment among children.15 According to the CPSC and other published studies, parents should verify that guardrail gaps are 3.5 in (to prevent hanging and strangulation); that side rails are present on both sides of the bed; that the mattress foundation is sturdy and secure; and that a mattress of correct size is used.1,2,5,9,11,29 The CPSC also recommends that children younger than 6 years not sleep in the upper bunk, that children be discouraged from playing on bunk beds, and that night lights be used to prevent falls at night.29 Bunk beds, including bunk bed ladders, should not be used if any part is damaged or defective. Hazardous objects should be removed from around the bed,5 and bunk beds should not be placed too close to ceiling fans or other ceiling fixtures.17 Consistent with previous research on this topic, our study found that injuries associated with bunk beds occur most often to males1,2,5,7,8 and to children younger than 6 years.5,8,9,18 The high rate of injury to the head is similar to findings in other studies that assessed childhood falls, including falls from bunk beds.3,5,18 Small children tend to fall head first because of a higher center of gravity and can experience serious injuries such as concussions and skull fractures.8,18,20,23 In our study, children younger than 3 years were 40% more likely to sustain head injuries than older children.
Consistent with other published studies, lacerations, contusions/abrasions, fractures, lacerations, and concussions were the most common types of bunk bed–related injuries.1,2,5,13,24 Although fractures were the third most common injury in our study, they were almost 6 times more likely to require hospital admission, transfer to another hospital, or being held for observation compared with other types of injuries. In addition, fractures were more likely to occur in the upper extremities. One possible explanation could be that some of the upper-extremity fractures involved the elbow (supracondylar fractures) and these injuries are more serious because of the rich nerve and vascular supply in the elbow area. A fracture to this area requires that the patient go to the operating room, which would result in hospitalization.
Jumps from the bunk bed were more than 4 times more likely to result in lower-extremity injuries compared with injuries to other body parts. When children jump or fall from heights with their feet/legs out-stretched, they may sustain a fracture of the proximal first metatarsal, sometimes called the "bunk bed fracture," which can often be initially missed on diagnosis.24 Two previous studies revealed that the risk of "major" injury (ie, fracture) was reduced when children fell on a carpeted surface rather than an uncarpeted surface.1,5 Attempts to break a fall with out-stretched arms most likely account for the increased risk of fractures to the upper extremity compared with other types of injury. According to a study by Sawyer et al,23 who assessed fracture patterns associated with falls from heights, infants fall head first, children fall feet first and/or hands first, and adolescents and adults fall feet first.23 The results of our study generally agree with those of the Sawyer et al study except that head and neck injuries were most common in the 18- to 21-year age group (28.4%) in our study.
Our results indicate that 18- to 21-year-olds experienced twice as many injuries as adolescents in the 14- to 17-year-old age group. Factors, such as alcohol use, might be associated with the increased number of bunk bed–related injury in college-aged individuals.13 A survey performed by Dedrick et al13 indicated that 72% of college students slept in elevated beds during college, but only 17% of those students had used bunk beds before college. In addition, 37% of the survey respondents admitted that they had consumed alcohol before the bunk bed–related fall.13 Alcohol use was documented in 360 cases among adolescents and young adults (ages 14–21), all of which resulted in falls from the bunk bed.
There was also a significant association between age of patients and bed malfunction, with older children more likely to be involved in an injury caused by bed malfunction than younger children. This increased risk, perhaps, could be a result of the larger size/increased weight of older children, adolescents, and young adults. We do not have data about the weight of children or the weight tolerances of bunk beds involved in injury; however, this deserves additional study as a potential risk factor for bunk bed injuries.
Our study has several limitations. This study underestimates the total number of bunk bed–related injuries, because only injuries in patients treated in EDs were included.31 The findings of this study may not be representative of bunk bed–related injuries treated in other health care facilities or of those that did not receive medical treatment at all. Data reported to the NEISS are limited by the detail provided in the ED medical chart. Missing data and inconsistent documentation in the medical chart also occur, which affects NEISS data quality. The narrative portion of the NEISS database frequently lacks detail about the height of the fall, the surface on which the patient landed, the type of activity taking place at the time of the injury event, the type of bunk bed being used, other factors that may have contributed to the injury event, and injury severity. In addition, data regarding exposure to bunk beds are unavailable; therefore, calculation of true injury rates was not possible. Despite these limitations, the strength of this study is that it uses a large, nationally representative sample of data regarding bunk bed–related injury that span 16 years.
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CONCLUSIONS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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Although bunk bed–related injuries affect children of all ages, approximately half of these injuries occur to children younger than 6 years. The head and neck and facial areas are the most frequently injured body parts. Falls are the most common mechanism of injury and are associated with hospitalization, transfer to another hospital, and being held for observation. Although lacerations are the most common type of bunk bed–related injury, fractures, which are the third most common type of injury, are much more likely to result in hospitalization, transfer to another hospital, and holding for observation. Currently, the CPSC makes available a number of publications concerning bunk bed safety.10–12,15,28,29,30,32 The CPSC promulgated mandatory standards for bunk beds in 1999 following the voluntary standards published by the American Society for Testing and Materials in 1992; both sets of standards were intended to reduce the risk of bunk bed–related injuries. CPSC regulations specifically target prevention of entrapment hazards of bunk beds, because entrapment may result in fatality.31 Given the continuing large numbers of bunk bed–related injuries at home and in schools, increased efforts are needed to prevent bunk bed–related injuries among children, adolescents, and young adults.
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ACKNOWLEDGMENTS |
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We thank Brenda Shields, MS, and Uwe Stolz, PhD, MPH, of the Center for Injury Research and Policy (Columbus, OH) for helpful comments and suggestions on this article.
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FOOTNOTES |
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Accepted Dec 18, 2007.
Address correspondence to Lara B. McKenzie, PhD, Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Department of Pediatrics, Ohio State University, College of Medicine, 700 Children's Dr, Columbus, OH 43205. E-mail: lara.mckenzie{at}nationwidechildrens.org
The authors have indicated they have no financial relationships relevant to this article to disclose.
| What's Known on This Subject Bunk beds are common in homes across the United States. Children sustain bunk bed–related injuries from falls, jumps, bunk bed ladders, bed malfunctions, and striking the bed. Injuries associated with bunk beds are typically more severe than those associated with conventional beds.
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| What This Study Adds Bunk bed–related injuries are common among pediatric patients of all ages, they can be severe (eg, fractures) and require hospital admission. This topic is relevant and important to practicing pediatricians, who are asked about bunk bed safety by parents.
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REFERENCES |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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- Mayr JM, Seebacher U, Lawrenz K, Pesendorfer P, Berghold A, Baradaran S. Bunk beds: a still underestimated risk for accidents in childhood? Eur J Pediatr. 2000;159 (6):440 –443[CrossRef][Web of Science][Medline]
- Belechri M, Petridou E, Trichopoulos D. Bunk versus conventional beds: a comparative assessment of fall injury risk.
J Epidemiol Community Health. 2002;56
(6):413
–417
[Abstract/Free Full Text] - Macgregor DM. Accident and emergency attendances by children under the age of 1 year as a result of injury.
Emerg Med J. 2003;20
(1):21
–24
[Abstract/Free Full Text] - Mack KA, Gilchrist J, Ballesteros MF. Bunk bed-related injuries sustained by young children treated in emergency departments in the United States, 2001–2004, National Electronic Injury Surveillance System-All Injury Program.
Inj Prev. 2007;13
(2):137
–140
[Abstract/Free Full Text] - Selbst SM, Baker MD, Shames M. Bunk bed injuries.
Am J Dis Child. 1990;144
(6):721
–723
[Abstract/Free Full Text] - Helfer RE, Slovis TL, Black M. Injuries resulting when small children fall out of bed.
Pediatrics. 1977;60
(4):533
–535
[Abstract/Free Full Text] - Lyons TJ, Oates RK. Falling out of bed: a relatively benign occurrence.
Pediatrics. 1993;92
(1):125
–127
[Abstract/Free Full Text] - Nimityongskul P, Anderson LD. The likelihood of injuries when children fall out of bed. J Pediatr Orthop. 1987;7 (2):184 –186[Web of Science][Medline]
- Macgregor DM. Injuries associated with falls from beds.
Inj Prev. 2000;6
(4):291
–292
[Abstract/Free Full Text] - Consumer Product Safety Commission. New mandatory requirements for bunk beds. Available at: www.cpsc.gov/BUSINFO/bbletter.html. Accessed April 2, 2007
- Consumer Product Safety Commission, Office of Compliance. Requirements for bunk beds. Available at: www.cpsc.gov/BUSINFO/regsumbunkbed.PDF. Accessed April 2, 2007
- Consumer Product Safety Commission. CPSC warns that tubular metal bunk beds may collapse. Available at: www.cpsc.gov/CPSCPUB/PUBS/tubular.pdf. Accessed April 2, 2007
- Dedrick DK, Burney RE, Hensinger RN, Mackenzie JR. Bunk bed injuries in college students. J Am Coll Health. 1988;36 (5):279 –282[Medline]
- Consumer Product Safety Commission. National Electronic Injury Surveillance System: A tool for researchers. Division of Hazard and Injury Data Systems, March 2000. Available at: www.cpsc.gov/library/neiss/2000d015.pdf. Accessed April 9, 2008
- Consumer Product Safety Commission. CPSC warns consumers of bunk bed entrapment hazard and mattress support collapse. Available at: www.cpsc.gov/CPSCPUB/PUBS/bunkbed.pdf. Accessed April 2, 2007
- SPSS for Windows [computer program]. Version 14.0. SPSS, Inc: Chicago, IL; 2003
- Alias A, Krishnapillai R, Teng HW, Abd Latif AZ, Adnan JS. Head injury from fan blades among children. Asian J Surg. 2005;28 (3):168 –170[Medline]
- Bulut M, Koksal O, Korkmaz A, Turan M, Ozguc H. Childhood falls: characteristics, outcome, and comparison of the Injury Severity Score and New Injury Severity Score.
Emerg Med J. 2006;23
(7):540
–545
[Abstract/Free Full Text] - Chadwick DL, Chin S, Salerno C, Landsverk J, Kitchen L. Deaths from falls in children: how far is fatal? J Trauma. 1991;31 (10):1353 –1355[Web of Science][Medline]
- Hall JR, Reyes HM, Horvat M, Meller JL, Stein R. The mortality of childhood falls. J Trauma. 1989;29 (9):1273 –1275[Web of Science][Medline]
- Pillai SB, Bethel CA, Besner GE, Caniano DA, Cooney DR. Fall injuries in the pediatric population: safer and most cost-effective management. J Trauma. 2000;48 (6):1048 –1051[Web of Science][Medline]
- Pitone ML, Attia MW. Patterns of injury associated with routine childhood falls. Pediatr Emerg Care. 2006;22 (7):470 –474[CrossRef][Web of Science][Medline]
- Sawyer JR, Flynn JM, Dormans JP, Catalano J, Drummond DS. Fracture patterns in children and young adults who fall from significant heights. J Pediatr Orthop. 2000;20 (2):197 –202[CrossRef][Web of Science][Medline]
- Johnson GF. Pediatric Lisfranc injury: "bunk bed" fracture.
AJR Am J Roentgenol. 1981;137
(5):1041
–1044
[Abstract/Free Full Text] - Editorial: bunk bed injuries? Am Fam Physician. 1976;14 (2):55[Medline]
- Consumer Product Safety Commission. CPSC issues federal safety standard for bunk beds. News From CPSC. 1999:1 –7. Available at: www.cpsc.gov/cpscpub/prerel/prhtml00/00024.html. Accessed March 24, 2008
- Consumer Product Safety Commission. 16 CFR Parts 1213, 1500, and 1513: safety standard for bunk beds—final rule. Fed Regist. 1999;64 (245):71890 –71915
- Consumer Product Safety Commission. CPSC, manufacturers, importers announce recall of wooden and metal bunk beds. 2001. Available at: www.cpsc.gov/cpscpub/prerel/prhtml97/97193.html. Accessed April 2, 2007
- Consumer Product Safety Commission. Just the facts. Available at: www.cpsc.gov/CPSCPUB/PUBS/071.html. Accessed April 2, 2007
- Consumer Product Safety Commission. Petition CP 03-1/HP 03-1 Requesting a standard for bunk bed corner post extensions and finials. Available at: www.cpsc.gov/LIBRARY/FOIA/FOIA98/BRIEF/34C8EB.PDF. Accessed April 2, 2007
- Quinlan KP, Thompson MP, Annest JL, et al. Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in US hospital emergency departments [published correction appears in Ann Emerg Med. 2000;35(1):101]. Ann Emerg Med. 1999;34 (5):637 –645[CrossRef][Web of Science][Medline]
- Consumer Product Safety Commission. Voluntary standards. 2004. Available at: www.cpsc.gov/volstd/bunkbed/bunkbed.html. Accessed April 2, 2007
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
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