More than one-fourth of the nearly 30,000 elevator-related injuries to children identified from surveillance data occurred in those under the age of three, found Joseph O'Neil, M.D., M.P.H., of Indiana University, and colleagues.
The most frequent type of injury was to soft tissue and the majority were caused by doors closing on body parts, especially the upper extremities, the authors wrote in an early online release from Clinical Pediatrics.
Slips, trips, and falls were also common causes of injuries, followed in order by contact with the closed doors or the elevator wall.
"What really surprised us was the number of infants with head injuries in our study. As the elevator doors close mothers may not realize the vulnerability of babies in strollers or in their arms," said Dr. O'Neil.
Nearly all of the injuries involved neglect or inattention, the authors said. Elevator malfunctions accounted for only 5.4% of injuries requiring a trip to the emergency department, they determined.
The authors conducted a retrospective cohort analysis looking at data from an electronic injury surveillance database maintained by the U.S. Consumer Product Safety Commission, using reported cases of elevator-related injuries to estimate national rates.
They estimated that 29,030 elevator-related injuries occurred among children from 1990 through 2004. The mean age of the children was 8.1 (+ 6.1 years), and slightly more than half of those injured (53.3%) were boys.
The overall injury rate among children was 2.5 per 100,000 population. But among infants and younger children (neonates through age four), the injury rate was 4.2 per 100,000. In contrast, among children ages five to 19 years the injury rate was 1.9 per 100,000.
Toddlers (children from one to two years of age) accounted for the greatest number of estimated injuries, at 7,610 of 29,030 (26.2%) or 6.5 per 100,000.
Nearly all of the injured patients (98%) were treated and released from the emergency department; of those who were admitted, most were for closed head injuries or injury to fingers and/or hands.
In a logistic regression analysis, the authors found that infants had a 93.4-fold risk for closed-head injury compared with children older than one year (95% confidence interval, 76.4-114.1), and infants with closed-head injuries had 12.2-fold risk for being injured by doors closing on their heads. (95% CI, 9.1-16.4). The authors noted, however, that the number of cases was relatively small, which could affect the stability of the regression analysis.
The authors said that many of the injuries appear to have been caused when children either didn't exit the elevator in time and the doors closed on their arms or legs, or when they put limbs in the doors to prevent them from closing, possibly in emulation of grownups.
"We have to stop thinking of unexpected injuries as accidents, which implies that they are unpreventable," said Dr. O'Neil. "Elevator injuries, like alcohol related car crashes and many other so-called accidents can be prevented. You can look at the environment and events before the incident and make changes to affect outcome."
The authors recommend closer supervision of young children on or near elevators, and adjustment of sensors on elevator doors.
The authors noted that the database records only those injuries reported by emergency departments, which could mean that the actual number of injuries is underreported.