Child defenestration: An unexpected collateral effect of the first COVID-19 lockdown!

In March 2020, several countries, including France, implemented a total lockdown policy to combat the spread of the COVID-19 pandemic, involving the closure of schools with travel restrictions and stay-at-home measures expect for necessary matters close to home. These measures forced children to stay at home for an extended period. Several studies have shown an increase in the number or proportion and in the severity of domestic accidents and defenestrations among children during this period [1], [2], [3], [4]. The French National Public Health Agency and the Toulouse University Hospital Pediatric Emergency Department conducted a study on the effects of the first lockdown (March 17 to May 11, 2020) on admissions for defenestration in children in France.

The study was conducted using data from nine French emergency departments participating in the French Home and Leisure Injury Permanent Survey (EPAC), which is based on the exhaustive daily collection of data on admissions for home and leisure injuries (HLI). All patients gave their consent to participate in this study.

All non-intentional falls from a window, balcony, or terrace of children under 15 years of age (for whom admissions for HLI are more frequent) were included. The data analyzed included the demographic characteristics of the victims, the circumstances of the accident, and medical details. Additional data on the accident were collected by questionnaire from the emergency departments. The Pediatric Trauma Score and the simplified Injury Severity Score were used to assess injury severity. The frequencies and characteristics of emergency admissions for defenestration were analyzed over the period from March 17 to May 11, 2020, and compared with those over the same period during 2016–2019.

During the lockdown period, 4309 HLI in children under 15 years of age were recorded in the EPAC survey, 3410 of which were domestic accidents (79%). Over the same period during 2016–2019, this proportion was 41% (16,593 domestic accidents / 40,899 HLI). Among the total number of domestic accidents for the two periods, 28 defenestrations were identified: 17 in 2016–2019 and 11 in 2020 (Figs. 1 and 2 ). A significant rise in defenestration cases was observed during this lockdown with a 3.2-fold increase in risk (OR=3.16 [95% CI: 1.48–6.74], p = 0.002). Among hospitalizations (seven out of 11 cases), more than half of the defenestration victims (four out of seven cases) were admitted to the pediatric intensive care unit (Table 1 ).

Fig. 1.

Flowchart HLI: home and leisure injuries.

Fig. 2.

COVID-19 lockdown (March 17 to May 11, 2020)-related emergency admissions for defenestration among children compared with the same period in the past 4 years.

Table 1.

Emergency department admissions for defenestration in children <15 years of age during lockdown in France (March 17 to May 11, 2020) compared with the same period in the previous 4 years.

Characteristics	2020 (n = 11)	2016–2019 (n = 17)	p*	OR [95% CI]
Emergency department, n (%) Hospital no. 1 (pediatrics) Hospital no. 2 (pediatrics) Hospital no. 3 (general) Hospital no. 4 (pediatrics) Hospital no. 5 (general) Hospital no. 6 (general) Hospital no. 7 (general) Hospital no. 8 (general) Hospital no. 9 (general)	6 (55) 2 (18) 1 (9) 1 (9) 1 (9) 0 (0) 0 (0) 0 (0) 0 (0)	7 (41) 2 (12) 1 (6) 2 (12) 4 (24) 1 (6) 0 (0) 0 (0) 0 (0)	0.96
Gender, n (%) Boys Girls	8 (73) 3 (27)	11 (65) 6 (35)	1.00 1.00 1.00	1.45 [0.28–7.61] 0.69 [0.13–3.62]
Mean age, years (SD) [median]	4.8 ± 4.2 [2.5]	5.4 ± 4.6 [2.7]	0.78
Boys [median]	3.6 ± 2.8 [2.5]	4.1 ± 3.2 [2.3]	0.80
Girls [median]	7.8 ± 6.4 [7.5]	7.8 ± 6.2 [7.6]	1.00
Age group (years), n (%) 0–2 2–5 5–10 10–15	4 (36) 3 (27) 3 (27) 1 (9)	7 (41) 3 (18) 3 (18) 4 (24)	0.76 1.00 0.65 0.65 0.62	0.82 [0.17–3.90] 1.75 [0.28–10.81] 1.75 [0.28–10.81] 0.33 [0.03–3.38]
Supplementary health insurance, n (%) Mutual society, provident institution or insurance Supplementary statutory health insurance No supplementary health insurance Unknown	1 (9) 1 (9) 8 (73) 1 (9)	7 (41) 2 (12) 5 (29) 3 (18)	0.14 0.10 1.00 0.03 1.00	0.14 [0.01–1.38] 0.75 [0.06–9.42] 6.40 [1.18–34.61] 0.47 [0.04–5.17]
Day of accident, n (%) Weekday Weekend	7 (64) 4 (36)	13 (76) 4 (24)	0.67 0.67 0.67	0.54 [0.10–2.84] 1.86 [0.35–9.80]
Time of accident, n (%) 8 a.m.–12 a.m. 12 a.m.–6 p.pm. 6 p.m.–12 p.m. 12 p.m.–8 a.m. Missing data	3 (27) 4 (36) 3 (27) 0 (0) 1 (9)	2 (12) 4 (24) 6 (35) 0 (0) 5 (29)	0.65 0.62 1.00 0.41	2.14 [0.28–16.37] 1.33 [0.23–7.63] 0.43 [0.07–2.50]
Type of housing, n (%) House Apartment Not specified	6 (55) 5 (45) 0 (0)	6 (35) 9 (53) 2 (12)	0.60 0.44 1.00	2.20 [0.47–10.35] 0.74 [0.16–3.39]
Height of fall, n (%) 1 floor 2 floors >2 floors	10 (91) 0 (0) 1 (9)	15 (88) 1 (6) 1 (6)	1.00 1.00 1.00	1.33 [0.11–16.74] 1.60 [0.09–28.57]
Emergency department treatment and follow-up, n (%) Hospitalized -Admission to pediatric intensive care unita Discharged home Other Deaths	7 (64) 4 (57) 4 (36) 0 (0) 0 (0)	12 (70) 2 (17) 4 (24) 1 (6) 0 (0)	0.80 1.00 0.13 0.67	0.73 [0.15–3.65] 6.67 [0.79–56.25] 1.86 [0.35–9.80]
Total length of stay, n (%) >24 h ≤24 h Missing data	6 (55) 3 (27) 2 (18)	5 (29) 9 (53) 3 (18)	0.21 0.21 0.21	3.60 [0.62–21.03] 0.28 [0.05–1.62]
Injury site, n (%) Head Torso Thorax Upper limbs Lower limbs	5 (45) 3 (27) 2 (18) 1 (9) 0 (0)	6 (35) 2 (12) 0 (0) 2 (12) 7 (41)	0.05 0.70 0.35 1.00	1.53 [0.32–7.19] 2.81 [0.39–20.46] 0.75 [0.06–9.42]
Type of main injury, n (%) Head trauma Contusion, bruising Fracture Wound Cerebral extradural hemorrhage Sprain, luxation	3 (27) 3 (27) 2 (18) 2 (18) 1 (9) 0 (0)	6 (35) 2 (12) 7 (41) 0 (0) 0 (0) 2 (12)	0.17 1.00 0.35 0.25	0.69 [0.13–3.61] 2.81 [0.39–20.46] 0.32 [0.05–1.94]
Pediatric Trauma Scoreb, median [range]	10 [7–12]	11 [8–12]	0.20
Simplified Injury Severity Score, median [range]	5 [1–22]	5 [1–18]	0.91
Known sequelaec, n (%) No symptoms No disability apart from symptoms (activities and independence retained) Low disability (unable to perform usual activities but still independent) Moderate disability (needs assistance but can walk without assistance) Moderately severe disability (unable to walk and perform daily activities without assistance) Major disability (permanent confinement to bed, incontinence, and permanent nursing care)	9 (82) 7 (64) 2 (18) 0 (0) 0 (0) 0 (0) 0 (0)	10 (59) 9 (90) 0 (0) 0 (0) 1 (10) 0 (0) 0 (0)	0.25 0.58	3.15 [0.51–19.27] 0.39 [0.03–5.23]

SD: standard deviation; CI: confidence interval.

^⁎Fischer's exact test (qualitative variables), Wilcoxon–Mann–Whitney test (quantitative variables), p value associated with the odds ratio (OR).

^aDeath within 12 h of admission (during 2016–2019).

^bPediatric Trauma Score was calculated from the complete medical records, based on the following criteria: weight, systolic blood pressure, penetrating wound, state of consciousness, airway status, and bone injuries (NA=10).

^cThe consequences (n = 19) were assessed using the modified Rankin score, which ranges from 0 (no symptoms) to 5 (major disability: permanent confinement to bed, incontinence, and permanent nursing care).

These results show that health policies should consider the collateral effects induced by certain measures implemented to manage the pandemic (ventilating homes, closing schools, etc.), and that prevention messages should not focus solely on biomedical aspects.

Declaration of Competing Interest

All authors have no conflicts of interest to disclose.