Background Falls are a leading cause of injury-related morbidity among children worldwide, yet determinants of severe and fatal falls remain poorly characterised. Objective To systematically review and synthesise evidence on the determinants of severe and fatal unintentional fall injuries among children and youth ≤19 years, focusing on studies reporting quantitative measures of associations. Methods We searched MEDLINE, Embase, CINAHL and Web of Science from inception to April 2026. Eligible studies included observational cohort studies involving children and youth ≤19 years and examining factors associated with severe (requiring hospitalisation or Abbreviated Injury Scale ≥3) and fatal unintentional fall injuries. Two reviewers screened studies, extracted data and assessed quality using the Cochrane Risk Of Bias In Non-randomised Studies—of Exposure tool. Random-effects models were used for meta-analyses. Results 20 studies (n=4 12 330 severe unintentional fall injuries) were included. Area-based socioeconomic status (SES), ethnicity and residential setting were the only determinants assessed across multiple studies. Meta-analysis showed no significant association between area-based SES and severe fall injuries, with substantial heterogeneity. Two studies reported higher risks of severe fall injuries among Indigenous compared with non-Indigenous children, although estimates were imprecise. Compared with major urban centres, risks appeared higher in rural or non-metropolitan areas, although estimates were uncertain due to wide or unreported CIs. Conclusion Evidence on determinants of severe paediatric unintentional fall injuries is limited and heterogeneous. Future studies should use standardised, context-specific definitions of falls and assess a broader range of determinants using quantitative measures of associations to better identify high-risk populations and inform prevention strategies.
Gnanvi et al. (2026) studied this question.