Television-Related Injuries to Children in the United States, 1990–2011

Discussion

More than 17 000 children receive emergency treatment of a TV-related injury in the US annually, which equals 1 child every 30 minutes. Although the overall rate of TV-related injury stayed fairly constant, the rate of injury associated with a falling TV almost doubled during the study period.

The number of US households with multiple TVs has more than doubled since 1990; now more than half of US households own ≥3 TVs. The escalating rate of injury from falling TVs may be due to the rising number of TVs in the home; however, if this were the only reason, then injury associated with striking the TV should also have increased due to increased exposure, but we found the opposite to be true.

The disparity between injury rates associated with falling TVs and striking a TV is provocative, especially given the more serious outcomes associated with falling TVs, and we speculate that changes in the location of TV placement in the home may be responsible for these observed trends. Sales of cathode ray tube (CRT) TVs have dropped steadily during recent years, with sales volume declining 84% in Europe from 2000 to 2010. In the United States, there have been negligible CRT TV sales in recent years, and based on an Internet search, many major electronics stores no longer carry CRT TVs.^31,32 As consumers purchase newer flat-panel display TVs, the fate of older CRT TVs is relevant. Older TVs may be relegated to less safe locations in the home, such as on dressers or other unsuitable furniture. Although furniture companies have recalled unstable TV stands,³³ dressers are often implicated in TV tip-overs.^11,15 Despite the relatively low documentation in NEISS narratives of the type of furniture on which falling TVs were placed, the frequency of dressers/bureaus/chests of drawers/armoires being used to support TVs (almost half of the cases in this study) is alarming. Moreover, the number of documented injuries associated with a TV falling from a dresser/bureau/chest of drawers/armoire increased almost 3.5-fold in 1995–2011, while there was no significant change in the number of documented injuries resulting from a TV falling off TV stands and entertainment centers during 1996–2011. As noted in previous studies, children may pull dresser drawers open to use as stairs to help them reach the TV, potentially pulling both the dresser and TV over onto themselves.¹¹ Small TVs do not preclude injury; approximately two-thirds of TVs with the screen size documented had a screen that was ≤26 inches. Safely positioning all TVs on appropriate furniture and securely anchoring both the TV and furniture, usually to the wall, is critical for the prevention of TV tip-over injuries.

The conversion to flat-screen TVs may also be contributing to the observed injury trends. CRT TVs carry their weight toward the screen, predisposing them to tip forward, and in 1 study, the weight of an anthropomorphic model of a 4-year-old child tipped 90% of TVs, emphasizing the potential for injury.²⁴ Flat panel displays are 82% lighter than CRTs with a similar screen size. For example, 13- to 36-inch screen size CRTs weigh, on average, 80.9 pounds compared with an average of 14.8 pounds for flat panel displays of 16 to 37 inches.³⁴ Lighter weights coupled with a less bulky design may make flat panels more easily tipped than CRTs and may be contributing to the observed increase in the rate of injuries associated with falling TVs. Additional studies are needed to delineate the relative tip-over risks associated with CRT and flat panel display TVs.

Children <5 years of age have immature motor skills and judgment, and they are at higher risk for TV tip-over injury and suffer worse outcomes than older children. A 2006 study found that 85% of adults accompanying young children receiving emergency treatment of a TV tip-over injury were unaware that a child could be injured by a falling TV.¹⁷ Increased efforts to educate parents and child caregivers about the importance and prevention of injuries associated with TV tip-overs are clearly needed.³⁵ Educational materials should be included with each new TV sale. Parents should appropriately place and anchor all TVs and should not place TV remote controls, toys, or other attractive items on top of a TV because this may encourage young children to climb and cause a TV tip-over.

In 2009, the voluntary safety standard for chests, door chests, and dressers was revised to require an antitip device or anchor be provided with the furniture at the point of sale.⁹ TVs are not covered by this voluntary standard, and even though they are implicated in approximately half of furniture-related tip-over injuries, no similar requirement applies to them.³⁶ Extending this type of requirement to TVs as part of the Underwriters Laboratories standard that addresses TV stability would be an important step in decreasing the number of injuries resulting from falling TVs.⁸ Unanchored TVs in the home are unsafe. Cars are not sold without safety belts, and similarly, TVs should not be sold without the necessary safety anchors. Initiatives to distribute TV anchoring devices, especially to households with young children, should also be undertaken.

TVs currently must meet the stability performance tests outlined in the UL 60065 safety standard for audio, video, and similar electronic equipment, which was most recently revised in late 2012.⁸ These stability tests include a tilt test, vertical force test, and horizontal force test, with test conditions varying according to TV parameters, such as weight, height, and screen size. Further strengthening of these stability performance requirements, and redesign of TVs to meet these more stringent requirements, is another important strategy for prevention of injuries from falling TVs.

This study had a number of limitations. The NEISS likely underestimates the true number of TV-related injuries because it only captures injuries treated in hospital EDs and not those treated in other medical settings or those for which medical treatment is not sought. Fatalities are also not captured well by the NEISS. Another limitation is the inconsistent amount of detail contained in NEISS narratives, which is limited by the information documented in ED medical records by health care professionals and also by the details extracted by NEISS coders. Bias may exist in the descriptive data reported; for example, parents may be more likely to report, and ED personnel and NEISS coders may be more likely to document, furniture that is unsuitable to support TVs and neglect to report appropriate furniture. An additional limitation was the lack of sufficient information in NEISS narratives to determine whether the TVs were CRT or flat-screen designs. More complete and consistent documentation in NEISS narratives about the type and size of TV involved in the injury would help inform and evaluate future prevention efforts. Another limitation of this study was the lack of data quantifying exposure of children to TVs; however, the use of US Census data to calculate population-based injury rates is an acceptable method.