Falling Televisions: The Hidden Danger for Children

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Falling Televisions The Hidden Danger for
Children

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Background/Purpose

• To date,little is known regarding the
  significance of this mechanism of injury in
  childhood trauma.
• The current investigation was designed to examine
  the risk factors,spectrum of injuries,and
  operative intervention required in children
  injured by falling televisions.

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MATERIALS AND METHODS

• Study Population
• Statistical Analysis

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Study Population

• Pennsylvania Trauma Outcome Study (PTOS).
• We queried the database from the PTOS for all
  patients, age 0 to 16 years injured by a fallen
  television for the period between 1989 and 1999.
• Demographic data, presenting Glascow Coma Scale
  (GCS),injury severity score (ISS),length of
  hospital stay (LOS),major injuries sustained, and
  operative procedures performed were analyzed.

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• 14 of the children entered into the PTOS database
  for TV-related injuries were evaluated at the
  Benedum Trauma Center of Children s Hospital of
  Pittsburgh (CHP).
• Supplementary information regarding the injury
  scenario was obtained by chart review o these 14
  children.

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Statistical Analysis

• SAS statistical software (SAS Institute, Cary, NC
• Frequency distributions were determined for
  categorical variables.
• Statistically significant differences in means
  for normally distributed data were determined
  using the Student s t test.
• The Mann-Whitney U test was performed to compare
  medians for skewed data.

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• The ?2 test of proportions was used for
  comparison of categorical data. If the expected
  value was less than 5,the Fisher s Exact test
  was used.
• Statistical analyses were conducted as 2-tail
  tests with a .05 level of significance.

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RESULTS

• 43 children 0 to 16 years of age entered into the
  PTOS between 1989 and 1999 who sustained
  television-related injuries.
• A trend toward a increased number of TV-related
  injuries during the study period was observed,
  especially after 1994

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• Over 80 of the children involved in
  television-related incidents were 6 years with
  the majority of injuries occurring in children 1
  to 3 years of age.
• Significantly, boys gt girls
• 5 deaths, mortality rate of 11.
• 80 of the deaths occurred in children 3 years

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(Table 1).
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• Both infants (lt 1 year) who were injured by TV
  died.
• The high mortality rate in young children ( 3
  years old) is reflected in a significantly higher
  injury severity score and decreased admission GCS
  compared with older children.
• Furthermore, children 1 to 3 years were observed
  to have the longest overall hospital stay.

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• In contrast, relatively few associated thoracic
  injuries or pelvic fractures were observed.
• Over 75 (30 of 38) of all injuries occurred in
  children 6 years. Although few operative
  procedures were required (n 15), 80were
  performed in these children.
• All neurosurgical (n 5) and abdominal (n 3)
  procedures were performed in children 6 years of
  age.

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• Orthopedic (n4) stabilization was required in
  children 4 to 6 years (n 3) and those greater
  than 7 years (n 1).
• Plastic procedures (n 3) occurred in children
  greater than 4 years (4 to 6 years,n 1
  gt7years,n 2).

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• Of the 43 children entered in the PTOS, the
  hospital records were available for the 14
  children who were evaluated at Children s
  Hospital of Pittsburgh, Benedum Trauma Program.
• All TV-related injuries were sustained in the
  child s own home except one, which occurred at a
  relative s house.
• However, 93 of the events were not witnessed by
  the care giver at the time of the incident.

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• The caregiver was either the mother (n 7),
  father (n 4),or a relative (n 3).
• In 36 of the case, there was at least one other
  child present.
• The most common size television involved in the
  accident was a 19-inch monitor (n 9) but ranged
  from 13 (n 1)to 27 (n 4) inches.
• The average height of the fall was 3.7 feet (1.12
  m) (range,2 to 6 feet).

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(Fig 2)
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DISCUSSION

• Trauma is responsible for a significant number of
  childhood deaths, with a high percentage of
  injuries occurring within the home environment.
• The home is an important area to target
  preventive strategies and where instituted
  measures can be enforced by the caregivers.
• Bernard et al ? United States Consumer Product
  Safety Commission (USCPSC)

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• The current study was undertaken to analyze the
  risk factors, spectrum of injuries, and operative
  intervention required in children injured by
  falling televisions to facilitate clinical
  management and formulate focused prevention plans

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• USCPSC 78 injuries and 28 deaths occurring
  within the United States by televisions falling
  on children over a 7-year period.
• As a result, 43 injuries and 5 deaths were found
  to occur in one state during a similar time
  frame.
• Thus, the current data illustrate that the
  magnitude of TV-related injury has been
  underestimated previously and, as a consequence,
  not fully appreciated

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• Our data show that the majority of children who
  sustained injuries from falling televisions were
  3 years of age.
• In the current study, toddlers sustained the
  majority of the injuries, required the longest
  hospitalization, and accrued the most number of
  deaths attributable to this mechanism.
• Children between the ages of 1 and 3 years
  presented with the most significant neurologic
  sequelae from their trauma

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• Consistent with previous literature, head
  injuries are the most common form of injury and
  cause of death in pediatric trauma patients.

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• Moreover, toddlers sustained a high number of
  concomitant abdomen injuries.
• All incidents,except one,occurred in the child s
  own home with the parent and additional children
  present.
• Caregivers, particularly those with multiple
  responsibilities, need to be educated and
  cognizant of the potential dangers associated
  with falling televisions.

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• Similar to Bernard et al, the current study found
  a predominance of dressers?? and standard
  television stands involved in many of the
  TV-related injuries.
• Although some dressers are well adapted to
  tolerate the heavy burden of televisions, the
  creativity of children disables the stability of
  the furniture complex.

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Fig 3
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• Eliminating TV stands and dressers as support for
  televisions in households with children is
  recommended.
• After review of current injury statistics, 2
  manufactures of television carts, the Bush
  Industries and Sauder Woodworking Company,
  recently have withdrawn TV carts from the market
  in cooperation with the US Consumer Product
  Safety Commission (US-CPS).

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• Injuries caused by falling televisions occur
  mainly in children between the ages of 1 and 3
  years ? significant mortality rate, mainly
  related to severe head injuries.
• To reduction injury? education and modified
  design of the standard support structures

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Table 3 recommendation

• TV should be set as low to the flow as possible
• Dresser and moveable stands should not be used
  for support in home with child lt 6 yr
• Weighted and permanently anchored structures are
  recommended
• TV should be properly secured to the supportive
  structure, which can be fasted to the floor or
  wall
• Remote controls and accessories for video and
  electronics should be arranged on a separate
  shelf below the TV

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• TV should be set away from the shelf edge
• Activity around the TV should be restricted
• Toddlers (1 to 3 yr) should not be left alone
  near the TV monitors