Determinants of severe fall-related injuries among children and youth: a systematic review and meta-analysis

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.