Pediatric Fall Injuries at an Urban Level 2 Pediatric Trauma Center: Epidemiology, Injury Patterns, and Implications for Community-Based Prevention

Gia Ramsey, MBA, ADN, LPN, CPST-I
Rubaiat Ahmed, MD
Tom Werber, MD
Lynn Model, MD, MS
Julia Czyzak, LPN, CSTR
Lisa Grippo, BSN
Rachel Caiafa, MD
Mikayla Mason, MD
M. Andrea Reinberg, MD
Abena Yeboah, MD
Nachammai Nachiappan, MD
Megan Banfield, MD
Gregoire Joseph, MD

Pediatric falls are the leading cause of unintentional injury in children under 14, with significant emergency department visits and healthcare costs nationwide. Despite prevention efforts, frequent and severe falls remain a challenge in densely populated urban areas with vulnerable populations. Locally derived data are essential for targeted interventions. This study characterizes pediatric fall trends and outcomes at an urban Level 2 Pediatric Trauma Center to support prevention strategies.

A single-center retrospective observational cohort study included all children aged 0–14 years presenting with fall-related injuries between January 2020 and December 2024. Data were extracted from the institutional trauma registry and electronic medical records. Descriptive statistics were computed for demographic, injury, and outcome variables, including frequencies, percentages, and measures of central tendency. Temporal trends were assessed across the five-year study period.

Among 1,552 pediatric patients, 940 (60.6%) were male with a mean age of 4.1 years (SD 4.0). Children under 5 comprised 1,022 (65.9%); 1,167 (75.2%) were Medicaid-insured. Falls occurred most commonly at home (n=1,000, 64.4%), with the bedroom identified as the most frequent specific location (n=299, 19.3% of all falls; 29.9% of home falls). Beds and other home furniture were the main sources of falls (n=474, 30.5%); three household fall mechanisms — bed/furniture/chair, stairs/steps/ladder, and slip/trip/stumble — together caused 1,020 falls (65.7%). Mean fall height was 3.5 feet (SD 4.4; range 0–50). The head and neck were the dominant injury region (n=1,117, 72.0%). ISS was mild (1-8) in 1,344 (86.6%); moderate (9-15) in 124 (8.0%); severe (16-24) in 13 (0.8%); and profound (ISS >25) in 15 (1.0%). ED disposition included Observation Unit (n=951, 61.3%), hospital admission (n=350, 22.6%), discharge home (n=244, 15.7%), and transfer (n=7, 0.5%). Admitted patients stayed a median of 3.0 days (mean 3.4, SD 3.3; range 1–39). Nearly half of all falls (n=767, 49.4%) occurred in the evening; home falls during evening hours numbered 553 (55.3%). Spring was the peak season (n=482, 31.1%). Pediatric fall cases rose 145% over five years, from 162 in 2020 to 397 in 2024.

Pediatric falls in this urban cohort primarily affect young children from socioeconomically vulnerable families in modifiable home settings. The increase in cases and consistent injury patterns highlight the urgent need for targeted, local prevention efforts to address household fall hazards in high-risk communities.

1. Identify the main causes of falls, injury patterns, and high-risk age groups in an urban pediatric population to guide prevention efforts.
2. Recognize how socioeconomic status shapes pediatric fall risk in urban populations.
3. Describe how data from an urban trauma center can guide targeted community pediatric fall prevention.