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LETTER TO EDITOR
Year : 2018  |  Volume : 13  |  Issue : 4  |  Page : 521-522
 

Television tip over: An avoidable cause of head injury in children


Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India

Date of Web Publication25-Feb-2019

Correspondence Address:
Dr. Prasad Krishnan
Department of Neurosurgery, National Neurosciences Centre, 2nd Floor, Peerless Hospital Campus, 360 Panchasayar, Garia, Kolkata, West Bengal 700094
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JPN.JPN_87_18

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How to cite this article:
Patel SM, Thamatapu E, Roychowdhury S, Krishnan P. Television tip over: An avoidable cause of head injury in children. J Pediatr Neurosci 2018;13:521-2

How to cite this URL:
Patel SM, Thamatapu E, Roychowdhury S, Krishnan P. Television tip over: An avoidable cause of head injury in children. J Pediatr Neurosci [serial online] 2018 [cited 2019 May 20];13:521-2. Available from: http://www.pediatricneurosciences.com/text.asp?2018/13/4/521/252772




Dear Editor

The seriousness of television tip-over accidents as a cause of head injury in children is not well appreciated. It is the 15th leading cause of childhood death in Canada following trauma[1] and has been cited third in the list of the “top five hidden household hazards” by the United States Consumer Product Safety Commission.[2] There have been two prior reports from India[3],[4]dealing with this topic but countrywide data on the same is lacking.

We encountered seven admitted cases of head injuries in children because of television toppling on them over a 13-year period (2004–2017). All the cases in our series were male. In two of the cases, the event leading to the tip over was unwitnessed, whereas in the remaining pushing mobile television stands and pulling at screens covering the television sets or cables attached to them have been involved in causation. In three cases, cathode-ray television sets were involved, whereas flat-screen televisions were involved in the remaining four. Five patients could be treated conservatively and surgery was required in only two. The most common radiological finding was skull fracture. No mortalities were reported and long-term outcome was good. The cases are summarized in [Table 1].
Table 1: Clinical characteristics, radiological findings, treatment, and outcomes of children admitted with head injury following television tip over

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Samson et al.[3] have elaborated on the factors that make children a specially vulnerable population to this mode of injury. This includes their tendency to hold on to and pull objects placed higher than them on stands or shelves and inability to assess risk that such activities incur. Dotchin and Gordon[5] have noted that in cathode-ray televisions, the majority of the weight is located in the panel anteriorly and this leads to their tendency of toppling forward. Flat-screen televisions (that are increasingly replacing the cathode-ray tube televisions) though lighter, have a higher center of gravity than older sets resulting in an increased momentum when they begin to fall.[2] Head injuries are more common than injuries to other body parts following television falls on children because of thin skulls and large head-to-body ratio in them.[3]

In most series,[1-4],[6] toddlers were the most common group involved—a finding that we too encountered. The most common injuries described in various series (including ours) are fractures of the skull.[3],[4],[6]We did not encounter any cases with basal skull fractures, though these have been described elsewhere[3],[6]as a common radiological finding. The majority of cases in several series have been managed conservatively with the presence of large intracranial hematomas being the most common indication for surgery. In our small series, only two cases required surgical intervention. We did not have any mortality but Cusimano and Parker[7] in a literature search of 29 papers describe mortality ranging up to 100%.

Doctors, parents and television manufacturers all need to be aware of the hazards televisions can pose for children. Weak stands that cannot support the sets, placement of objects on the sets that the children are attracted toward, covering the sets with screens that are prone to be pulled off, and insufficiently highly placed or inadequately secured televisions are all preventable risk factors,[3],[7]which the consumers must be educated about.


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There are no conflicts of interest.



 
   References Top

1.
Mills J, Grushka J, Butterworth S. Television-related injuries in children—the British Columbia experience. J Pediatr Surg 2012;47:991-5.  Back to cited text no. 1
    
2.
Befeler AR, Daniels DJ, Helms SA, Klimo P Jr., Boop F. Head injuries following television-related accidents in the pediatric population. J Neurosurg Pediatr 2014;14:414-7.  Back to cited text no. 2
    
3.
Samson SK, Nair PR, Baldia M, Joseph M. Television tip-over head injuries in children. Neurol India 2010;58:752-5.  Back to cited text no. 3
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4.
Suresh N, Harini G, Radhika R, Chidambaram B. Head injuries in children resulting from the fall of television. Indian J Pediatr 2010;77:459-60.  Back to cited text no. 4
    
5.
Dotchin SA, Gordon KE. The terrible truth about toppling televisions. Paediatr Child Health 2007;12:221-4.  Back to cited text no. 5
    
6.
Jea A, Ragheb J, Morrison G. Television tipovers as a significant source of pediatric head injury. Pediatr Neurosurg 2003;38:191-4.  Back to cited text no. 6
    
7.
Cusimano MD, Parker N. Toppled television sets and head injuries in the pediatric population: a framework for prevention. J Neurosurg Pediatr 2016;17:3-12.  Back to cited text no. 7
    



 
 
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