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Head injury trauma

Study links ‘playful’ activities near ceiling fans to head injuries requiring emergency care

August 17, 2023

Ceiling fans may seem far out of reach for most children, but a sample of U.S. emergency department (ED) visits reveals how some fan-related injuries — including rare but severe head lacerations — can result from everyday play.

Injuries occur when children are thrown in the air, lifted too close to the fan or when they climb or jump on furniture, especially bunk beds, a new study showed.

International studies have shown that while most injuries are minor, metal ceiling fans can cause penetrating injuries to the skull, and severe injuries can require neurosurgery.

The overall incidence of injuries from ceiling fans in the U.S. is unknown. Researchers, therefore, analyzed a nationally representative sample of U.S. ED visits documented in the National Electronic Injury Surveillance System (NEISS).

They described their findings in Traumatic Head Injuries Caused by Ceiling Fans Among Children Treated in US Emergency Departments,” (Garza, HH, et al. Pediatrics. Aug. 17, 2023).

Authors queried the system for patients under 18 using the product code for fans, with injuries to the head, face, eyeball, mouth or ear. There were 640 NEISS records that met inclusion criteria, corresponding to about 20,523 injuries.

About 2,300 head injuries in children were reported every year in U.S. EDs from 2013 through 2021. Lacerations were the most common diagnosis (60%).

The median patient age was age 5 years, with two peaks in age distribution: younger than age 1 year and at 4 years. Most older children were injured while on top of furniture like bunk beds.

Researchers found one facial fracture and two skull fractures, and both injuries were in children younger than 1 year.

Compared to older children, children under age 3 had twice the risk of injury by being lifted or tossed up by a caregiver. Head injuries from those behaviors were seen in infants as young as 1 month.

In addition to 356 head injuries, there were 272 injuries to the face, five to an eyeball, five to an ear and two to the mouth. While the vast majority (89%) of injuries occurred when the child’s head made contact with the fan, 55 cases involved the fan or part of the fan falling on the child.

Most incidents occurred at home, and most patients were treated in the ED and released.

Researchers were unable to assess race, ethnicity, insurance type, geographic location or fan speed.

Age distribution and common mechanisms of head injuries were similar to what is reported in international literature. However, the U.S. analysis seems to show a smaller proportion of skull fractures, the researchers noted. This could be due to rarity of these severe injuries, sample design of the dataset, geographic differences in ceiling fan usage, differences in materials or construction of the ceiling fans, or a combination.

The study includes a handout with injury prevention ideas for families, doctors, industry/policymakers and the U.S. Consumer Product Safety Commission.

Families are advised to place furniture, especially bunk or loft beds, away from ceiling fans; consider using a different type of fan for cooling; avoid placing large industrial or metal fans in locations where they could cause injury; and to be aware of what’s above when lifting children.

Physicians can talk to families about injury prevention and offer solutions to those with barriers, including living in rental units, having low ceilings, space limitations and cost concerns.

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