Paediatric bed fall computer simulation model development and validation

Abstract

Falls from beds and other household furniture are common scenarios stated to conceal child abuse. Knowledge of the biomechanics associated with short-distance falls may aid clinicians in distinguishing between abusive and accidental injuries. Computer simulation is a useful tool to investigate injury-producing events and to study the effect of altering event parameters on injury risk. In this study, a paediatric bed fall computer simulation model was developed and validated. The simulation was created using Mathematical Dynamic Modeling(®) software with a child restraint air bag interaction (CRABI) 12-month-old anthropomorphic test device (ATD) representing the fall victim. The model was validated using data from physical fall experiments of the same scenario with an instrumented CRABI ATD. Validation was conducted using both observational and statistical comparisons. Future parametric sensitivity studies using this model will lead to an improved understanding of relationships between child (fall victim) parameters, fall environment parameters and injury potential.

Impact sites representing potential bruising locations associated with rearward falls in children

“…Prior studies [15][16][17] have shown that differences in initial position, fall dynamics and impact surfaces in fall experiments using the CRABI 12 ATD have a notable effect on recorded outcome measures. For this reason we chose to explore two initial positions and two impact surfaces in our fall experiments.…”

Head biomechanics of video recorded falls involving children in a childcare setting

“…Differences across studies are likely due to varying surrogate biofidelity and design, along with differences in child age represented by surrogates, initial position, fall dynamics 16 and anatomic location of impact 15 . Computational modeling has been used to investigate the effects of fall characteristics, initial conditions, and child characteristics on head injury risk in bed falls 17 , 18 , as well as to evaluate the sufficiency of playground standards in protecting against head injury in children and assessing the influence of playground surface stiffness and region of impact on head injury risk in falls 19 , 20 . Additional computational modeling studies using finite element models of the infant skull and brain have also been conducted to predict skull fracture risk associated with head impact and falls 21 – 26 .…”

Pediatric skull fractures and intracranial injuries

“…Original research conducted by Helfer et al ( 7 ) investigated children <5 years old who had fallen from a bed or sofa and used a cut-off of <0.91 m. Since then it has variably been defined, with authors using cut-off heights from 0.91 to 1.52 m ( 8 ). Previously, authors have also documented mean heights for moderate/serious head injury when comparing head injury severity groupings ( 9 , 10 ). Mean heights have been reported between 0.91 and 1.32 m ( 11 ).…”