Issue 60, March 2013 - Safekids

STARSHIP TRAUMA UPDATE/NEW RESOURCES
Major sponsor:
Television tip-over admissions, June 2006 to January 2013
Background
Child television tip-over injuries are increasing globally, in part due
to a lack of public awareness and preventive measures. 1 The vast
majority of TV-tip-over injuries occur in the home when a child
is unsupervised, 2 the use of a dresser as a TV stand appears to
convey the greatest risk of injury. 3 Blunt head trauma secondary
to a TV falling on a child is the most common injury, followed by
chest and abdominal trauma. 4 United States consensus population
surveys reveal that 95% of households have at least one TV, 5 the
trend in New Zealand households is likely to be similar. 6 TV design
and size has changed in recent years, and the impact of this change
on TV-tip-over risk and injury is unknown. 7, 8
Demographics
During the study period:
• 28 children were admitted to Starship as a result of a TV tip-over
injury
• 57 percent (n=16) were male and 43 percent (n=12) were female
• Half of the children (n=14) were aged two to four years old and
29 percent (n=8) were under two years of age.
• 57 percent (n=16) were coded as Māori, 21 percent (n=6) as
Pacific, 13 percent (n=4) as European and nine percent as
Chinese or Other.
TV tip-over injuries by ethnicity and age
0 to 1
year
2 to 4
years
5+ years Total
Māori 5 9 ≤3 16
Pacific ≤3 ≤3 0 6
European 0 ≤3 ≤3 4
Chinese 0 0 ≤3 ≤3
Other 0 ≤3 0 ≤3
Total 8 14 6 28
Yearly trend
Cell counts of one, two and three have been suppressed
The median number of admissions per year was 4, with a maximum
of 6 cases occurring in 2010.
Seasonal trend
TV tip-over admissions did not demonstrate a clear seasonal trend.
Mechanism of injury
Common mechanisms of injury involved the child climbing up on
the TV stand/ furniture (n=6) and pulling the TV down (n=6). TVs
also toppled as a result of the TV stand/ furniture being rocked or
knocked. The mechanism of injury was unclear in the majority of
cases.
Injury location and type
Head injuries were the most common form of injury. Eight children
incurred multiple skull fractures (fractures to the base of the skull
were most common), eight incurred single skull fractures and
nine children incurred intracranial haemorrhages within various
parts of the skull (including subarachnoid, subdural and extradural
haemorrhages). Other injuries such as limb fractures and injuries
(8), tracheal tears, neck strain and facial lacerations were also
reported.
Injury severity
The Injury Severity Score
(ISS) is an internationally
recognised method for
calculating the combined
severity of injuries
sustained. An ISS greater
than ten indicates moderate
or severe injury. Seven of the
28 children admitted (25%)
had an ISS greater than ten.
The median ISS was seven.
One child died.
Key Messages 9
Injuries from TV tip-overs are
preventable. The use of TV
mounts and furniture straps
can help to keep children
safe.
• TV Safety Check
° ° Assess the stability of the TVs in your home.
° ° Flat screen TVs: mount it to the wall to reduce the risk of it
toppling off stands. Follow the manufacturer’s instructions to
ensure you protect your wall and have a secure fit.
° ° Large, heavy, old-style cathode ray tube (CRT) TVs: place it on
a low, stable piece of furniture.
• Secure Furniture
° ° Use brackets, braces or wall straps to secure unstable or topheavy
furniture to the wall.
° ° Install stops on dresser drawers to prevent them from being
pulled all the way out. Multiple open drawers can cause the
weight to shift, making it easier for a dresser to fall.
• Rearrange Household Items
° ° Keep heavier items on lower shelves or in lower drawers.
° ° Avoid placing remote controls, food, toys or other items in
places where kids might be tempted to climb up or reach for
them.
For more information on TV tip-overs and how to safely secure
televisions, furniture and other heavy household objects visit
the following websites:
www.eqc.govt.nz/be-prepared/multimedia/quake-safe-your-home
www.safekids.org/safety-basics/safety-spotlight/TV-andfurniture-tip-overs/
www.consumerreports.org
1
C. DiScala, et al., “Outcomes from television sets toppling onto toddlers,” Archives of
pediatrics & adolescent medicine, vol. 155, pp. 145-148, 2001.
2
Consumer Product Safety Commission, “CPSC Warns about TV, Large Furniture Tip-Over
Dangers. More than 100 Deaths Reported Since 2000, Most Involve Young Children,”
Consumer Product Safety Commission, Washington, USA, 2006.
3
J. D. Rutkoski, et al., “Traumatic television tip-overs in the pediatric patient population,”
Journal of Surgical Research, vol. 166, pp. 199-204, 2011.
4
J. Marnewick, et al., “Television tip-overs: The Starship Children’s Hospital experience
and literature review,” Injury, vol. 42, pp. 534-538, 2011.
5
P. A. Bernard, et al., “Toppled television sets cause significant pediatric morbidity and
mortality,” Pediatrics, vol. 102, p. e32, 1998.
6
J. Marnewick, et al., “Television tip-overs: The Starship Children’s Hospital experience
and literature review,” Injury, vol. 42, pp. 534-538, 2011.
7
P. A. Bernard, et al., “Toppled television sets cause significant pediatric morbidity and
mortality,” Pediatrics, vol. 102, pp. p. e32, 1998.
8
J. Deisch, et al., “Craniocerebral Trauma Inflicted by Television Falls*,” Journal of Forensic
Sciences, vol. 56, pp. 1049-1053, 2011.
9
Tip Sheet TV and Furniture Tip-Overs. Washington, USA, Safe Kids Worldwide: 2012.
8
Safekids News: March 2013 Issue No 60