Common Consumer Products Play a Major Role in Pediatric TBI

Damian McNamara

August 07, 2019

Nearly 3 of 4 nonfatal traumatic brain injuries (TBIs) in children and youth that require a visit to the emergency department (ED) involve common consumer products registered with the US Consumer Product Safety Commission, new research shows.

Investigators found that of more than 4 million pediatric TBIs that led to ED visits, 72% were linked to consumer products. These included home furnishings, fixtures, car seats, and sports equipment.

The data, said lead author Bina Ali, PhD, MPH, a research scientist at the Pacific Institute for Research and Evaluation in Beltsville, Maryland, provide clinicians and parents with valuable information about how to prevent TBIs in children.

"Doctors can play a role in TBI prevention. When doctors see patients, they ask how the head injury happened and discuss the symptoms. Doctors can take this opportunity to talk with parents and youth about safety to prevent injuries in the future," Ali told Medscape Medical News.

Physicians can educate parents on making homes and play areas safer for children and promoting greater safety in sports, she added.

"Even when seeing a patient for a reason other than a head injury, such as a wellness visit, doctors can still have this discussion with their patients," said Bina.

The study was published online July 29 in Brain Injury.

Beds, Chairs, Tables

According to data from the Centers for Disease Control and Prevention (CDC), every year, 700,000 TBIs occur in American children and youth aged <1 year to 19 years.

Prior studies on TBI in this population focused on mechanisms, treatments, and costs, the researchers note. However, "there is limited research on TBI in children that looks at both the child's age group and the involvement of products and activities that are associated with TBI," Ali said.

To identify the leading products and activities associated with TBI in this population, the investigators evaluated data from the National Electronic Injury Surveillance System–All Injury Program, augmented with product information from the National Electronic Injury Surveillance System. The Consumer Product Safety Commission oversees both datasets, which address both intentional and unintentional injuries.

They examined TBI data for the years 2010 through 2013 and found that the vast majority of TBIs — 94% — were unintentional. The remaining 6% were attributed to assault.

"Adolescents ages 15–19 years have the highest rate of assault-related TBIs. In this age group, struck by/against, sexual assault, and cut/pierce are the most common injury mechanisms of assault," the investigators write.

TBIs were associated most with sports/recreation, followed by home furnishings and fixtures, and home structures and construction materials. Football, bicycles, and basketball were the biggest contributors in the sports/recreation category.

Beds, chairs, and tables accounted for the majority of TBIs in the home furnishing and fixtures category. With regard to the home structures and construct materials group, floors, stairs, and ceilings led the list of causes of TBIs.

"We found that TBIs related to floors and stairs are common in children and adolescents of all ages. Slipping, tripping, and falling are very common. Uneven flooring and prefabricated stairs often contribute to falls," Ali said.

Products linked with 3% or fewer injuries included child nursery equipment, toys, personal use items, and home electronics.

The majority (92%) of the study participants were treated by ED staff and were released.

Variation by Age

Among the 4,091,376 nonfatal TBI cases seen in EDs during the study period, 27% occurred in adolescents aged 15 to 19 years. Another 27% occurred in the 1-year to 4-year-old group; 20% occurred in children and teens aged 10 to 14 years; 17% occurred in persons aged 5 years to 9 years; and 9% occurred in infants younger than 1 year.

The sports/recreation category "substantially contributed to TBIs in children and adolescents," the researchers note. For example, more than half — 54% — of children aged 10 to 14 years experienced a TBI related to this category. Football was the primary activity linked to these injuries.

In children aged 5 to 9 years, bicycles led the list of products linked to TBIs.

Injuries associated with home furnishings and fixtures largely affected younger children — specifically, 43% of infants younger than 1 year and 32% of children aged 1 to 4 years. Beds were the leading products associated with TBI in these two age cohorts.

"Another interesting finding was that car seats are the fifth leading cause of TBIs in infants," Ali said. She noted that although car seats can prevent injuries when used appropriately in vehicles, some parents use them as baby carriers in a risky way.

"Let's say a car seat is placed on a high surface, such as a table or countertop. There is a risk of the car seat falling off the surface and injuring the infant," she said.

"Our findings address an important gap in the literature by identifying leading products and activities associated with TBIs across the developmental ages of children and adolescents," the researchers note. Their findings, they add, could help set priorities for TBI prevention.

Recommended risk reduction strategies include removal of tripping hazards in the home, such as area rugs, and increasing use of stair gates, guardrails, and other safety devices.

One of the study's limitations was that it only included ED visits for TBIs. In addition, the investigators were unable to examine how TBI severity or the patients' socioeconomic status may have altered the study findings.

"Future research can look at injuries that did not go through the ED but treated at urgent care clinics, doctors' offices, and school health clinics," Ali said.

"Surprising" Finding

Commenting on the study for Medscape Medical News, Jimmy W. Huh, MD, director of neurosurgical neurocritical care at Children's Hospital of Philadelphia and associate professor of anesthesiology, critical care, and pediatrics at the University of Pennsylvania Perelman School of Medicine, said the study adds to previous research and "continues to show how common pediatric TBI is."

Huh pointed out several interesting points about the findings:

  • The youngest population, persons aged 4 years or younger, seem to be the most vulnerable and have the highest rate of product-related TBIs.

  • The same group also seems to have the highest rate of product-related TBIs that are associated with injuries to internal organs.

  • In contrast, the rate of assault-related TBIs seems to be lowest for children aged 4 years or younger.

"What is surprising in the current study is the relatively lower rate of assault in the youngest population," he said. In previous studies, abusive head trauma has been one of the most common causes of TBI in the youngest population.

"It would've been interesting if this study gave more specific details on what type of internal organ injuries they observed, such as the presence of retinal hemorrhages or unexplained healing fractures, which would be highly suspicious for assault or abusive trauma," said Huh.

Previous studies also suggest that the youngest patients with moderate to severe TBIs have the worst outcomes, Huh noted.

"The fact that the youngest TBI population are also the most vulnerable to internal organ injuries in the current study may suggest that additional injuries on top of sustaining a TBI may contribute to poorer outcome, although outcome was not assessed. Future studies should look at long-term outcomes," he added.

The study was supported by the Health Resources and Services Administration. The authors and Huh have disclosed no relevant financial relationships.

Brain Inj. Published online July 29, 2019. Full text

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