Editorial: Television sets and traumatic brain injury

Truc M. Le Division of Pediatric Critical Care Medicine, Department of Pediatrics, and

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John C. Wellons III Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee

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In this modern society, it is hard to believe that car seats, seat belts, and airbags were once nonexistent. However, other safety initiatives such as motorcycle helmets have still not become law across all states. (Currently in our home state of Tennessee, there is a bill approaching the legislative table that would make them optional.) As with many safety devices and public health initiatives, injuries have led to litigation, which then led to legislation. Not every time, but often enough. Those of us involved in managing child brain and spine injuries have no doubt seen a rise in TV-toppling injuries. It has spurred many of us to wonder if there was some way to effect change, through better base design, material engineering, and/or education. In their accompanying article, Cusimano and Parker are to be commended for bringing these publications together for the common good and using public health methodology to suggest a path forward.1

The number of TVs in US households is continually increasing, with an estimated 115.6 million TV-containing households, representing 96.7% of all US households.2 Likewise, the US Consumer Product Safety Commission reports that TV-toppling injuries have been increasing in frequency since 2006. Serious TV-toppling injuries are most commonly seen in preschool-age children, and an estimated 44% of these injuries are related to the head. Given the vulnerability of this population as well as the potential for serious harm, TV-toppling injuries represent a growing public health concern in the area of preventable injuries.

In their article on head injuries related to TV sets, Cusimano and Parker report findings from a systematic review of the existing literature on TV-toppling injuries.1 Their findings demonstrate that injuries related to TVs occur frequently and that toddlers represent the population segment most at risk for serious injury. In addition, they report that the vast majority of these injuries occur during an unwitnessed event within the home and are due to improper placement of the TV, climbing, or collisions with the TV. As part of their report, the authors analyze their findings using Haddon’s Matrix to identify strategies that can modify host and environmental factors to decrease the rate of TV-toppling injuries.

Many of the strategies identified by the authors aim to increase public awareness regarding dangers related to falling TVs. The frequency and severity of TV-toppling injuries is underrecognized by the general populace. Therefore, public education campaigns, increased visibility of warnings and warning labels, and improved instructions regarding the safe mounting/installation of TVs should be used to bring the issue of TV-toppling injuries into the public consciousness. Increasing awareness of the frequency and severity of TV-toppling injuries is an integral first step in preventing these types of injuries.

Because end-user education has limited utility in behavior modification, the authors also suggest several strategies aimed at altering the design of TVs and their mounting systems. These engineering modifications focus on improving the weight distribution and stability of TV sets as well as improving the solidity of TV stands and mounting systems. Currently, postmanufacturing testing is performed according to government standards, but improved standards and safety regulations may be needed to decrease TV-toppling injuries. To encourage industry attention to these engineering changes, mandates from consumer regulatory agencies will be required.

As health care providers, it is incumbent on us to advocate on behalf of those without a voice. TV-toppling incidents are common enough and can result in life-threatening injuries. These injuries are easily preventable and represent an area in which advocacy on the part of individual health care providers as well as national medical organizations can impact the lives of hundreds of children annually. Leaders in our field and elected officials are encouraged to use a publication such as the one that Cusimano and Parker have provided us to motivate change for the common good. Perhaps after that, our attention could be turned to other issues that are holdouts from our past, like motorcycle helmets.

References

Michael D. Cusimano Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, and Dalla Lhana School of Public Health, University of Toronto; and
Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael’s Hospital, Toronto, Ontario, Canada

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Nadine Parker Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael’s Hospital, Toronto, Ontario, Canada

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Canadian Brain Injury and Violence Research Team
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