Traumatic Head Injuries Caused by Ceiling Fans Among Children Treated in US Emergency Departments

International research shows ceiling fans cause head injuries in children, often when children are playfully thrown in the air or accidentally lifted too close to the fan; or they climb or jump on furniture, especially bunk beds.^1–6  Although most injuries are minor, skull fractures were reported in 5% to 18% of cases treated in emergency departments in Australia.^1,2  Metal ceiling fans can cause dramatic penetrating injuries to the skull⁵ ; one child died of such an injury in Iraq and severe injuries may require neurosurgery.^1–6  The incidence of injuries from ceiling fans in the United States is unknown. This study describes pediatric traumatic head injuries from ceiling fans seen in emergency departments in the United States.

A publicly available, nationally representative sample of emergency department visits reported to the National Electronic Injury Surveillance System (NEISS)⁷  was queried for patients <18 years of age, from 2013 to 2021, using the product code for fans (380), with injuries to the head (75), face (76), eyeball (77), mouth (88), or ear (94). The resulting 878 case narratives were reviewed independently by 2 authors. Cases were excluded if they involved a fan that was not a ceiling fan (n = 165), if the fan type could not be determined (n = 50), or if they did not involve direct contact with a fan (n = 23). Mechanisms of injury and contributing factors were derived from reading the case narratives. Discrepancies in case exclusion or narrative interpretation were resolved through discussion with a third author.

Statistical weights based on the sampling strategy⁷  were used to generate nationwide estimates. The reliability of estimates was determined using criteria recommended by the NEISS.⁶  Unadjusted relative risk was assessed using log-binomial regression. Data were analyzed using Stata/SE Release 17 (StataCorp, College Station, TX).

Approximately 2300 pediatric head injuries from contact with ceiling fans were seen in US emergency departments per year, from 2013 through 2021. There were 640 NEISS records that met inclusion criteria, corresponding to an estimated 20 523 injuries (95% confidence interval [CI] 13 613–27 433; Table 1), with no clear trend over time. The median child age was 5 years (interquartile range 3–8). Two peaks in the age distribution were observed, at less than 1 year of age and at 4 years of age (Table 1). Children under 3 had twice the risk of injury by being lifted or tossed up by a caregiver compared with older children (risk ratio 2.2; 95% CI 1.85–2.55); head injuries with this mechanism were seen in infants as young as 1 month old. Older children most often were injured while on furniture, especially bunk beds.

The most common primary diagnosis was laceration (60%). One facial fracture and 2 skull fractures were reported in children, with both of these under 1 year of age and 1 caused by a metal ceiling fan. Most injuries (80%) occurred in a home setting, and most patients (98%) were treated in the emergency department and released. The small number of cases documented in public settings involved children being lifted up or carried on someone’s shoulders.

This study demonstrated similarities in the age distribution and common mechanisms of head injuries to what is reported in the international literature.^1–6  However, our analysis seems to indicate a smaller proportion of skull fractures. This finding may be because of the rarity of these severe injuries and the sample design of the dataset, geographic differences in ceiling fan usage, differences in building construction or materials used in residential ceiling fans, or a combination of these factors. Of note, our single pediatric Level I trauma center, which is not part of the NEISS and is in a hot, humid climate, has seen at least 2 skull fractures requiring neurosurgery, 1 from a metal ceiling fan.

This study is subject to several limitations. The generalizability of this study’s results is limited to cases seen in emergency departments throughout the United States. Some misclassification is likely, given the multiple steps involved with documenting these injuries in the medical record, then by NEISS abstractors, and finally by study staff. We were also unable to assess race, ethnicity, insurance type, geographic location, or fan speed.

Numerous opportunities exist to prevent childhood head injuries from ceiling fans (Fig 1); families and clinicians should be aware of the dangers.

We thank Dr. Molly Johnson for her review of this research brief; and Karen Piper and Catherine Crocker for their research support.

NEISS

National Electronic Injury Surveillance System