Toppling TVs Traumatize Toddlers

DALLAS, June 1 - Their risks to impressionable young minds aside, too many heavy TVs appear to be teetering on the brink of crashing down on little bodies, warn emergency specialists.

Giving new meaning to the term "fall season," pediatric emergency specialists reviewed cases of 26 children between the ages of one and seven years who were brought into the ED with head trauma, limb injuries, facial lacerations, and other injuries from toppling TVs.

Two children even ended up in the ICU, reported Floyd Ota, M.D., and colleagues, of the University of Texas Southwestern Medical Center here, in the June issue of Academic Emergency Medicine. "Our data indicated a lack of parental awareness and an absence of primary prevention as a root cause for this problem," said Dr. Ota.

Many of the injuries occurred when kids climbed on television stands, or when someone else accidentally knocked the set over. In 22 out of 26 cases (85%), the tumbling tubes were parked from two-to-five feet above the floor, the researchers found.

"The majority of the weight is placed toward the front of the unit," Dr. Ota said. "If the television is not placed on a stable display area, or if the display area is not secured, the imbalanced weight distribution increases the potential for toppling forward."

In the so-called "Golden Age" of television, kids settled in to catch the latest antics of Howdy Doody on rock-steady Philco or RCA floor consoles. But today's sleeker table models-most involved in the study measured between 20 and 30 inches, and none was bigger than 40 inches-pack most of their heft up front in the glass screen, particularly in traditional cathode-ray tube sets.

"In our study population, none of the televisions or the furniture that they were placed on was secured," the investigators wrote.

Earlier retrospective studies have found that falling TV sets can be a significant hazard to young children, but this study is the first to include data from parental interviews about the settings in which the injuries occurred, the authors said.

The children enrolled in the study were culled from among all those who visited the ED over a year. All adults who accompanied children younger than 13 years of age who were injured by falling TV sets were interviewed directly and the patients' medical records were reviewed.

The accompanying adults were asked about the location of the accident, the television screen size, how long the family had owned the set, the height of the set above the floor, what it was placed on, and whether it was secured in any fashion.

The interviewers also asked the adults whether they had witnessed the injury and to describe how they thought it had occurred, and whether they had ever been told that unsecured televisions could be a hazard.

The patients' charts were reviewed to determine the types of injuries and anatomic site, the elements of the clinical ED evaluation, presenting Glasgow Coma Scale (GCS) score, length of stay (if the child was admitted), and the timing of any surgical intervention.

All but one of the children were injured at home; one was hurt by a tumbling set at a church function.

In 65% of the cases the TVs measured between 20 and 30 inches diagonally, although sets smaller than 19 inches and in the 30- to 40-inch range were also involved.

In 73% of the accidents the parents said that the child was or may have been climbing on the furniture, while 27% of the injuries occurred when the set was pushed off of its perch by someone else, the parents said.

Of the 46% of parents who reported witnessing the injury 42% (five of 12) said it was caused by the child climbing on the furniture and 58% (7 of 12) reported that the television was pushed off its stand by another person.

"Most parents (85%) reported that they were unaware that injuries could occur by this mechanism," the investigators noted.

Most of the injuries were not serious, with only one child having a Glasgow Coma Scale score less than 15 (the highest and best possible score). The median Injury Severity Score was 2.5 (range 1-20).

"We found that orthopedic and closed-head injuries were common among our study population," the authors wrote. "However, some children may sustain serious injury that requires ICU monitoring. Similar to previous studies, closed-head injuries with intracranial bleeding were the main reason for ICU care. Thus, the potential for significant injury by this mechanism is an unfortunate reality and the reason to search for methods of prevention."

In all, 63% of the patients were discharged home from the emergency department, and 37% (9 of 26) were admitted. Of these, six went to a general hospital ward, two required care in the ICU, and one was taken to the operating room for repair of a large facial laceration.

The median length of stay for these children was one day (range one to four days).

The investigators noted that if more parents used a simple TV hold-down strap such as that developed by a California company to prevent injuries from tumbling televisions during earthquakes, many more injuries could be prevented.

"The electronic industry should display warning labels for such injury clearly in their packaging and instruction manuals. Perhaps with an increase in public awareness, and a simple securing device, consumers will display their televisions in a safe manner," they wrote.