eLetters to:

REVIEW ARTICLE: David L. Chadwick, Gina Bertocci, Edward Castillo, Lori Frasier, Elisabeth Guenther, Karen Hansen, Bruce Herman, and Henry F. Krous Annual Risk of Death Resulting From Short Falls Among Young Children: Less Than 1 in 1 Million Pediatrics 2008; 121: 1213-1224 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

eLetters published:

Short Falls Can Be Lethal

John R Hall, MD, FACS, FCCM   (13 August 2009)

Short Falls Can Be Lethal 13 August 2009
John R Hall, MD, FACS, FCCM, Professor of Surgery ETSU Send letter to journal: Re: Short Falls Can Be Lethal jrhmdtraum{at}aol.com John R Hall, MD, FACS, FCCM	To the Editor I would like to respond to a serious corrigendum in a paper by Dr. David Chawick and coauthors on short falls that was published in your journal (l) . The authors note in table 7 that in our study on falls in children (2), the fall histories were not validated. We did a review of the records of the Cook County Medial Examiner’s office of all pediatric deaths within the County of Cook from 1983 – 1986. In this 4-year review of 44 deaths due to falls, we found 18 children (mean age 1.8 years) who died from a fall of less than 3 feet. Two children were being carried by their parents who fell on ice, five fell while playing, eight fell off an object and the remaining three fell down steps. Fifteen had subdural hematomas (five with linear skull fractures), one an epidural hematoma, one diffuse edema and one a brain laceration. In contradiction to Dr. Chawick’s comment that the falls were not validated, all of these children had not only a complete investigation by the local police department but also by an investigator of the Medical Examiner’s office (3) . All children had a complete post mortem plus full body X-rays. One of the authors of our paper was the medical examiner for the County of Cook, Illinois and was involved in all investigations. It was the practice of his office to “rule out” (not “rule in”) abuse in all suspicious cases. Additionally, two of the cases occurred in a medical facility – one normal child fell off a chair in the waiting room and another, admitted for appendicitis, fell while running down the hall in a hospital. It is doubtful that a more complete validation could be performed. Our study remains the largest study of deaths from falls to date. Unlike hospital record based studies which use the small denominator of admitted falls, our used the 397342 children 5 years of age any younger who resided in the County of Cook, Illinois based on the 1988 census. Caretakers of children need to be aware that hospital based studies denying the risks of short falls are based on extremely small numbers. We do agree with Dr. Chawick and his coauthors that the risk of death from a short fall is extremely rare. However, it does occur! Thirty-eight percent of the deaths in our study had a delay in treatment due to the premise that it does not happen. While it is obvious that all short falls do not need medical attention, the parents should be made aware of signs and symptoms of developing severity. Two of our deaths occurred in medical facilities due to this erroneous belief of the benignity of short falls. 1 Chadwick DL, Bertocci G, Castillo E, Grasier L, Buenther E, Hansen K, Herman B, Krous HF. Annul risk of death resulting from short falls among young children: less than 1 in 1 million. Pediatrics 2009;121(6):1213- 1224. 2 Hall JR, Reyes, HM, Horvat M, Meller JL, Stein R. The mortality of childhood falls. J Trauma 29(9): 1273-1275 3 Hall JR, Reyes HM, Horvat M, Meller JL, Stein. Author’s reply, letter to the editor. J Trauma 1990; 30 (11): 1422-1423. Conflict of Interest: None declared