Nonfatal Emergency Department Visits Associated with Fall-related Fractured Skulls of Infants Aged 0–4 Months.

Background Children aged 0–4 years have the highest rate of emergency department (ED) visits for traumatic brain injury (TBI) with falls a leading cause. Infants under age 2 are more likely to sustain a fractured skull after a fall. Objective This study examines caregiver actions and products associated with ED visits for fall-related fractured skulls in infants aged 0–4 months. Methods Data were analyzed from the 2001–2017 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). Case narratives of infants aged 0–4 months who visited an ED for a fall-related skull fracture were examined to code caregiver actions preceding the fall. Product codes determined fall location and product type involved (e.g., flooring, bed, stairs, etc.). All national estimates were weighted. Results There were more than 27,000 (weighted estimate) ED visits of infants aged 0–4 months for a nonfatal fall-related fractured skull between 2001 and 2017. Most were under 2 months of age (46.7%) and were male (54.4%). Falls primarily occurred in the home (69.9%) and required hospitalization (76.4%). Primary caregiver actions coded involved placing (58.6%), dropping (22.7%), and carrying an infant (16.6%). Floor surfaces were the most common product (mentioned in 24.0% of the cases). Discussion Fall-related fractured skulls are a health and developmental concern for infants, highlighting the importance of a comprehensive assessment at the time of the injury to better understand adult actions. Findings indicate the need to develop prevention messages that include safe carrying and placement of infants.