Date on Master's Thesis/Doctoral Dissertation

5-2011

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Mechanical Engineering

Committee Chair

Bertocci, Gina E.

Author's Keywords

Biomechanics; Pediatric falls; Child abuse; Pediatric injury

Subject

Falls (Accidents); Children's accidents; Children--Wounds and injuries; Child abuse--Investigation

Abstract

Pediatric short-distance falls, especially from beds or other furniture, are common false histories given by caretakers to cover up abusive trauma. However, short-distance falls are also a common occurrence in young children. Knowledge of the types and severity of injuries that can result from these short falls can aid clinicians in distinguishing between inflicted and non-inflicted injuries. Early detection of abuse may lead to prevention of further escalating injuries and, in some cases, prevent the death of the child. The purpose of this study was to describe relationships between biomechanical measures and injury potential in short-distance household falls. This study involved three components: case-based biomechanical fall assessments, fall simulations using an anthropomorphic test device (ATD), and development/validation of a computer simulation model used to investigate sensitivity of injury outcome measures to fall environment and child surrogate parameters. Overall, the risk of severe or life-threatening injury in short-distance household falls is low. Fractures of the skull and extremities commonly result from these falls (21.5% of falls resulting in Emergency Department visits). 2 of 79 fall cases involved small, contact-type subdural hematomas. These subjects both had unique fall dynamics that contributed to their injuries. Results of ATD experiments supported those from the clinical portion of the study with the exception of neck injury potential. Future studies are needed to both improve ATD neck biofidelity and determine more accurate pediatric neck injury thresholds. Fall environment parameters (fall height and impact surface type) have been shown previously to influence injury potential, but this is the first study to investigate the influence of child or surrogate parameters (body mass index, overall mass, head stiffness, and neck properties) on injury potential. Additionally, through a parametric sensitivity analysis, it was found that fall environment and surrogate parameters that altered fall dynamics had the greatest influence on injury potential. These results highlight the need for obtaining detailed case histories when making injury assessments that include not only environment and child factors, but descriptions of the fall dynamics and orientation of the child upon impact with the ground.

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