Results: The authors reviewed 90 cases; 55 were male. The median age was 2 years. Ninety eight percent of falls were reported to be from the third floor or lower. The median length of hospital stay was two days range 0—24 days. The most common injuries were head trauma and extremity fractures.
Three patients died, and an additional three patients were discharged to rehabilitation centers. Conclusions: Some window falls result in serious injury. Strategies to prevent window falls should be directed to the owners and occupants of this type of housing.
Falls are the leading cause of unintentional injury among children in the United States. Annually, 2. Community education and installation of window guards in several cities have successfully decreased the incidence of window falls among children. A critical component of the success of the programme was the active involvement of property managers. The managers of mid-sized, low and moderate income properties were encouraged to install guards purchased through a programme that matched the amount spent by property owners.
Each year there are an estimated 15 window falls per Chicago preschool children. The purpose of this study is to describe the demographic characteristics of children who fell from windows in Chicago, to perform site visits to determine the heights and types of buildings that children fell from, and to quantify the injuries resulting from window falls.
Children treated in a level I pediatric trauma center for injuries related to window falls between and were identified retrospectively using the ICD9 external cause of injury code E for fall from a building. Cases were included if they met the following criteria: 1 the fall occurred from a window and 2 the fall was unintentional.
Information collected from the records included patient demographics, circumstances floor of fall, landing surface , anatomic areas injured, Glasgow Coma Score GCS on arrival to the emergency department, number of inpatient hospital days, and inhospital death or patient disposition. Social worker notes that reconstructed, in text form, the circumstances leading to the fall were reviewed to gather specific information about the supervision of the child, if there was furniture near the window, and if it had a screen.
The second phase of the study included site visits to the location of the fall to describe the type of building, the total number of floors in the building, and the type of window the child fell through. Building types were designated as houses one or two family , townhouses, or multiple unit dwellings.
Building height was described as the number of floors. Window type was described as single hung, double hung, sliding, or casement.
Windows in garden units were considered first level; windows in the floor above were designated second level. We estimated the height of the fall by measuring the vertical height of a brick, or siding panel, and counting vertically to the reported window. Ninety children were treated for injuries resulting from window falls during the seven year study period. Fifty five were males. The age range was 9 months to 16 years with a median of 2 years mean age 3 years 2 months.
Ninety percent were 5 years old or younger. Five of the 12 children 6 years old or older were developmentally delayed. Presence or absence of a screen was documented in 56 cases. In five cases the window had some other type of covering mosquito netting, plastic, glass. None reported having a window safety guard.
More than half of window falls were during the summer, with 53 falls occurring between June and August. There were three falls from windows in high rise buildings: these buildings were 26, 10, and seven storeys and the falls occurred from the second, fifth, and third floors respectively. Figure 1 shows the reported floor of the fall and the distance of the fall estimated during the site visit. The estimated distances of falls reported as through first floor windows ranged from 2.
Falls reported as second floor falls ranged from 6. The median height of fall was 17 feet. Relation between floor of window fall and the measured height of window. Significant anatomic injuries are shown in table 2. Thirteen percent had injuries to the chest or pelvis. The GCS in the emergency department ranged from 3 to The length of hospital stay ranged from 0 to 24 days; the median length of stay was two days.
Eighty four children were discharged to home and three were discharged to rehabilitation facilities. Three children died, each from head trauma. Their reported height and estimated fall distances were first floor The ages of the children who died were 9 months, one and a half years, and 2 years. These data from Chicago indicate most children fell from first, second, or third floor windows in buildings that were four or fewer storeys high. Site visits suggest there is much overlap in the actual fall heights reported to be from first and second floor windows, and between second and third floor windows.
Although most children in Chicago fall from lower floors, our data show a significant degree of morbidity and mortality from these falls. Almost half of falls occurred between noon and 6pm and many children were reportedly supervised at the time of the fall. Others have reported demographic findings similar to those we observed, with males 5 years old or younger accounting for the majority of those injured in window falls.
Similar to studies in Los Angeles, London, and New York, the incidence of window falls increased during the hot summer months. Other environmental conditions and parent supervision behaviors associated with window falls are less clear. These data suggest that household furniture was a contributing factor in almost one fourth of falls.
Parents may be unaware that household furniture placed under windows could put a child at risk of a window fall by giving a child easy access to the window opening. Another possibility is that furniture may be placed near windows because alternative sites are limited in crowded households. Additional work is needed to better understand window fall circumstances.
In addition, in Dallas window falls were through windows that were within 2 feet of the floor, within the reach of a young child. In Chicago, the building code requires window guards if the height of the window sill is less than 2 feet above the floor.
We do not know how well this code is enforced and its potential effectiveness to prevent window falls. As the site visits were limited to the exterior of the building, we cannot report the distance between the sill and the floor inside. It may be that lower windows lacked guards, or that children fell from windows more than 2 feet from the floor. The data suggest that furniture placed near some of the windows was a contributing factor to the fall, allowing children access to the higher windows.
In Chicago, the reported floor of a fall is a poor indicator of the height of the fall. In these data, a fall reported from the second floor may represent a 6—25 foot fall.
These data are unique in that the performance of the site visits allowed us to estimate the actual distance of the fall and compare that to the reported floor of fall. Falls from windows in Chicago resulted in significant injuries. Less falls occurred during the summer in our study. The exceptionally hot weather in our setting discourages opening the windows because of the air-conditioned environment. Furthermore, many families travel overseas for summer holidays. More incidents occurred during the working days of the week and decreased during the weekends, possibly due to increased supervision by parents and older siblings.
The time of incidents differs in the literature. Some studies showed more falls in the afternoon [ 3 , 5 ], while others in the evening [ 9 ]. The information about supervision in newspapers was limited. Nevertheless, many of the children were not alone during the incident similar to a US study, in which more than half the falls occurred when a parent was at home [ 3 ].
In another study from Switzerland, the supervising person did not see the fall of the child. The child was left alone at home or left unattended for a short period of time [ 11 ].
Parents, maids, or siblings may have difficulty to watch children all the time. They may be distracted by other activities. Many parents undermine the importance of limiting access of children to balconies or windows. One alarming case study occurred when police saved a child sitting at the kitchen window by breaking into the apartment.
The police warned the parents. Nevertheless, the same child fell to death from the balcony later on [ 17 ]. Our data suggest that furniture placed near a window or at a balcony is a contributing risk factor for falls, because the child has an easier access to the window.
This was reported by others [ 3 , 11 , 16 ]. The government, municipalities, police, and building construction sectors in the UAE reacted to the fall incidents and have made active efforts to reduce the burden of falls over the last few years.
This included introduction of new building and construction laws, enforcement of window guards, requiring minimum heights for railing at balconies, and educational campaigns. The challenge remains with the high turn-over of working expatriate families having different educational, cultural and socio-economic background, and various languages. The broad base public education should not focus only on parents, but also on maids, building owners, and managers [ 15 ].
We have to acknowledge that there are certain limitations of our study. There is debate about the value of using newspaper clippings for injury prevention [ 18 , 19 , 20 ]. Despite that debate, we can observe the high precision of information on the floor level from which children fell and their associated mortality.
We could not previously reach that level of accuracy in our prospectively collected data of a trauma registry [ 21 ]. We have previously studied charts of pediatric injured patients who fell from height and found that detailed information on risk factors was missing [ 22 ].
Available data reports on mortality and morbidity is usually lacking details on personal and environmental risk factors which can affect appropriate local prevention strategies.
There is no unified health information system in the United Arab Emirates. Every health authority has its own injury data collection. Although newspaper clippings contained rich information, some cases could have been missed, including less serious cases which may be treated in emergency rooms or hospitals.
There is a possibility for selection bias by newspapers as they capture more serious conditions, while milder cases may have survived. Our study population represents only the tip of an iceberg. The exact time of incidents is lacking in our study. We could not also verify the reported information with official death reports.
Although death reports in our setting improved by introducing an electronic reporting system, the access to data is limited. Some of our unintentional falls could be cases of child abuse or may include suicide attempts, especially among older children. Newspaper clippings proved to be useful to study national pediatric falls from heights. It is necessary to improve window safety by installing window guards and raising awareness among parents, maids, and building owners and managers.
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Asia Pac J Public Health. Download references. All data generated and analyzed during the current study are available at websites of newsletters. Hanan M. Al-Marzouqi, Maryam R. You can also search for this author in PubMed Google Scholar.
MG did the newsletter search, analyzed data, drafted the manuscript, and approved the final version for submission. HMA, MRA, and NNA were working together on the newsletter search did partial data analysis, critically reviewed, and approved final version of manuscript for submissions. FMA helped in data analysis, drafted with MG the manuscript, and approved the final version for submission. Correspondence to Michal Grivna. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Reprints and Permissions. Grivna, M. Pediatric falls from windows and balconies: incidents and risk factors as reported by newspapers in the United Arab Emirates.
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