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Taylor SV, Patel T, Welsh C. Low- and High-Energy Falls With Associated Traumatic Brain Injury: Epidemiology and Outcomes. Cureus 2025; 17:e80115. [PMID: 40051693 PMCID: PMC11882994 DOI: 10.7759/cureus.80115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2025] [Indexed: 03/09/2025] Open
Abstract
INTRODUCTION Falls are among the most common causes of injuries treated in emergency departments (ED), accounting for approximately 30% of all injury-related ED visits. Falls are also a significant cause of traumatic brain injury (TBI), a fact for individuals across the aging spectrum. Despite an abundance of information on the association between falls and TBI, limited investigation has occurred into the differences in population characteristics and outcomes based on fall energy (low-energy vs. high-energy falls) for individuals with TBI due to unintentional falls. METHODS We conducted a retrospective analysis of patients with diagnosed TBI at an urban trauma center. Hospital data were obtained from the Department of Surgery's trauma registry, a subset of the National Trauma Registry of the American College of Surgeons, for the years 2017-2022. Low-energy falls were defined as a fall from ground level to three feet in height, and high-energy falls were defined as falls from greater than three feet. Individuals with TBI due to low and high-energy falls were compared using descriptive, univariate, and multivariate methods. Fall height was also used as a continuous variable to examine bivariate relationships with clinical characteristics in this cohort. RESULTS This study identified 760 low-energy falls and 93 high-energy falls with associated TBI. Approximately 60% of the cohort was male, 14.5% identified as Black race, 20.1% utilized Medicaid, 12.2% had moderate-severe TBI, 15.6% had orthopedic injuries, and 7.3% died during hospitalization. Older age and Medicare insurance were associated with low energy falls. Younger age, orthopedic injuries, and alcohol use at the time of injury were associated with high-energy falls. No association was found between energy level and sex, length of stay, injury severity score (ISS), Glasgow coma scale (GCS) score on arrival, Medicaid usage, complication burden, TBI severity, disposition type, and death. Increasing fall height was associated with age, lower GCS score, greater ISS, and ventilator days. Multivariate analysis found that age and alcohol use were predictive of fall energy. CONCLUSION Overall, patients with high-energy falls with associated TBI were younger and were more likely to develop fractures and utilize alcohol at the time of injury. High-energy falls did not lead to more severe injuries as demonstrated by nonsignificant differences in ISS, GCS, TBI severity, and death. Targeted prevention programs should be designed to reduce traumatic injury. Further study is needed to evaluate long-term patient outcomes in this population.
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Affiliation(s)
- Shameeke V Taylor
- Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
- Emergency Medicine, Mount Sinai Morningside, New York City, USA
| | - Tirth Patel
- Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Connor Welsh
- Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
- Emergency Medicine, Mount Sinai Morningside, New York City, USA
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Terayama T, Toda H, Nagamine M, Tanaka Y, Saitoh D, Yoshino A. Association between length of hospital stay and fractures in the spine, pelvis, and lower extremity among patients after intentional fall from a height: an analysis of the Japan Trauma Databank. Trauma Surg Acute Care Open 2023; 8:e000988. [PMID: 37303981 PMCID: PMC10254599 DOI: 10.1136/tsaco-2022-000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
Abstract
Objective This study investigated the association between the number of regions with fractures in the spine, pelvis, and lower extremity (NRF) and the proportion of patients with a length of hospital stay (LOS) ≥30 days among those who attempted suicide by falling from a height. Methods Data recorded between January 1, 2004 and May 31, 2019 in the Japan Trauma Databank of patients aged ≥18 years injured by suicidal falls from a height and with ≥72 hours of LOS (period from admission to discharge home or to another hospital) were analyzed. Patients with an Abbreviated Injury Scale score ≥5 in the head region or those who died after admission were excluded. Multivariate analyses including clinically relevant variables as covariates were performed to determine the association, expressed as risk ratio with 95% CI, between NRF and LOS. Results Among 4724 participants, the multivariate analysis revealed significant factors related to LOS ≥30 days, including NRF=1 (1.64, 95% CI 1.41 to 1.91), NRF=2 (2.00, 95% CI 1.72 to 2.33), NRF=3 (2.01, 95% CI 1.70 to 2.38), systolic blood pressure in the emergency department (ED; 0.999, 95% CI 0.998 to 0.9997), heart rate in the ED (1.002, 95% CI 1.00 to 1.004), Injury Severity Score (1.007, 95% CI 1.00 to 1.01), and intubation in the ED (1.21, 95% CI 1.10 to 1.34). However, history of psychiatric diseases was not a significant factor. Conclusion An increase in NRF was associated with an increase in LOS of patients injured by intentional falls from a height. This finding can help both emergency physicians and psychiatrists in acute care hospitals to develop better treatment strategies with attention to time constraints. Further investigation of the association between LOS and both trauma and psychiatric treatment is required to evaluate the effect of NRF on treatment in acute care hospitals. Level of evidence Level III, retrospective study with up to two negative criteria.
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Affiliation(s)
- Takero Terayama
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan
| | - Hiroyuki Toda
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan
| | - Masanobu Nagamine
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Yoshihiro Tanaka
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Daizoh Saitoh
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Aihide Yoshino
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan
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Kort I, Hmandi O, Grayaa M, Bellali M, Kouada R, Gharbaoui M, Zhioua M, Allouche M. A comparative study of the injury pattern between suicidal and accidental falls from height in Northern Tunisia. J Forensic Leg Med 2023; 97:102531. [PMID: 37210812 DOI: 10.1016/j.jflm.2023.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/24/2023] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Falls from height are a common cause of marbidity and mortality. The aim of this study is to examine the characteristics of the victims, the circumstances of the fall and distribution of the injuries of accidental and suicidal falls from height. MATERIALS AND METHODS It was a retrospective cross-sectional study, based on autopsies performed over 16 years (January 2005 to December 2020). The recorded variables included demographic data of the victim, height of fall, death scene findings, length of hospital stay, autopsy findings, and toxicological results. RESULTS Of the 753 victims of fall from height, 607 were fallers and 146 were jumpers. We found that male victims were predominant in the accidental group (86.8% vs. 69.2%). The mean age at death was 43.6 ± 17.9 years. Suicidal falls occurred in a private house in the majority of cases (70.5%), while accidental falls occurred most frequently at workplace (43.8%). Suicidal falls were higher than accidental falls (10.4 ± 7.3 m vs. 7.1 ± 5.7 m). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequentl in the suicidal falls group. Pelvic fractures were 2.1 times more likely to occur in the suicidal falls. Head injuries were more frequent in the accidental falls group. The survival delay was shorter in the suicidal falls group. CONCLUSIONS our study highlights the differences in the profile of the victims and in the pattern of injuries caused by falls from height, depending on the victim's intention to fall.
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Affiliation(s)
- Ikram Kort
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.
| | - Ons Hmandi
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Mariem Grayaa
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.
| | - Mohamed Bellali
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Rihem Kouada
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.
| | - Meriem Gharbaoui
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Mongi Zhioua
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Mohamed Allouche
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
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Watkins PM, Masters S, Hill AM, Tohira H, Brink D, Finn J, Buzzacott P. The prehospital management of ambulance-attended adults who fell: A scoping review. Australas Emerg Care 2023; 26:45-53. [PMID: 35909044 DOI: 10.1016/j.auec.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The ageing population is requiring more ambulance attendances for falls. This scoping review aimed to map and synthesise the evidence for the prehospital management of Emergency Medical Services (EMS) attended adult patients who fall. METHODS The Joanna Briggs Institute methods for scoping reviews were used. Six databases were searched (Medline, Scopus, CINAHL, Cochrane, EMBASE, ProQuest), 1st August 2021. Included sources reported: ambulance attended (context), adults who fell (population), injuries, interventions or disposition data (concept). Data were narratively synthesised. RESULTS One-hundred and fifteen research sources met the inclusion criteria. Detailed information describing prehospital delivered EMS interventions, transport decisions and alternative care pathways was limited. Overall, adults< 65 years were less likely than older adults to be attended repeatedly and/or not transported. Being male, falling from height and sustaining severe injuries were associated with transport to major trauma centres. Older females, falling from standing/low height with minor injuries were less likely to be transported to major trauma centres. CONCLUSION The relationship between patient characteristics, falls and resulting injuries were well described in the literature. Other evidence about EMS management in prehospital settings was limited. Further research regarding prehospital interventions, transport decisions and alternative care pathways in the prehospital setting is recommended.
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Affiliation(s)
- Paige Marie Watkins
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia.
| | - Stacey Masters
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia
| | - Anne-Marie Hill
- School of Allied Health, University of Western Australia, Crawley, WA, Australia
| | - Hideo Tohira
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia; Emergency Medicine, Medical School, the University of Western Australia, Crawley, WA, Australia
| | - Deon Brink
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia; St John Western Australia ambulance service, Belmont, WA, Australia
| | - Judith Finn
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia; Emergency Medicine, Medical School, the University of Western Australia, Crawley, WA, Australia; St John Western Australia ambulance service, Belmont, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Peter Buzzacott
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia
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Tsellou M, Dona A, Antoniou A, Goutas N, Skliros E, Papadopoulos IN, Spiliopoulou C, Papadodima SA. A comparative autopsy study of the injury distribution and severity between suicidal and accidental high falls. Forensic Sci Med Pathol 2022; 18:407-414. [PMID: 35771377 DOI: 10.1007/s12024-022-00496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
Falls are the second cause of accidental deaths worldwide. Falls from height are also a common method of suicide. The aim of this study is to compare the characteristics of the victims, the circumstances of the fall and the severity and distribution of the injuries reported in an autopsy case series of falls from height. This study is a retrospective analysis of consecutive autopsy cases of suicidal and accidental falls from height which were investigated in the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens during the period 2011-2019. The recorded variables included demographic data of the victim, height of fall, length of hospital stay, toxicological results, the existence and location of injuries and Injury Severity Score (ISS). Victims of suicidal falls were younger (55.53 vs. 62.98, p = 0.001), they fell from higher heights (12.35 vs. 5.18 m, p < 0.001), and they sustained more severe injuries compared with victims of accidental falls (ISS 51.01 vs. 40.88, p < 0.001). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequently observed after a suicidal fall (93.6% vs. 67.3%, 72.1% vs. 21.4%, 72.1% vs. 27.6%, 42.9% vs. 15.3%, 45.7% vs. 13.3%, respectively-p < 0.001), probably due to the higher height of fall. Our study outlines the differences in the profile of the victims and in the severity of injuries caused by falls from height depending on the intention of the victim to fall. However, a distinctive injury pattern in victims of suicidal falls was not demonstrated.
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Affiliation(s)
- Maria Tsellou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | - Artemis Dona
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Goutas
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Papadodima
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece.
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Sattar N, Rabia Rahat Gillani S, Erkin M, Khan M, Abbas M, Khurshid Khattak N. Role of environmental and occupational factors in fall-related maxillofacial fractures. Clin Exp Dent Res 2022; 8:737-741. [PMID: 35362673 PMCID: PMC9209790 DOI: 10.1002/cre2.545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/29/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives The objective of this study was to determine the frequency and patterns of maxillofacial fractures in falls due to environmental and occupational reasons. Material and Methods One hundred and nineteen patients were included in this study who presented to the department of Oral and maxillofacial surgery at Khyber College of Dentistry, Peshawar. The duration of study was 3 years from January 1, 2017 to December 31, 2019. Demographic data such as age, gender and data environmental or occupational etiology of falls and pattern of fractures was noted in a customized Performa after detailed history, clinical and radiographic examination. Patients of maxillofacial fractures resulting due to falls with age ranging from 16 to 64 years were included. Those cases of falls that presented with systemic diseases or had chances of pathological fractures were excluded from the study. Results Male population was affected more than females (60% vs. 39.4%). The mean age was 32.39 SD ± 16.031. Falls due to environmental factors were more common than occupational factors (81.5% vs 18.5%). Fracture of midface was more common (57.1%) than fracture of mandible (36.7%) in patients of falls. 5.5% had both midface and mandible fractures. Conclusion We concluded that Environmental and work‐related facial fractures in falls are common in third and fourth decade of life. Falls due to stumbling, tripping and slipping, falls from height and falls from stairs most commonly result in midface fractures. Mandible fractures are commonly seen in sportsmen and laborers. Preventive strategies shall be adopted to prevent morbidity and mortality associated with such injuries.
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Affiliation(s)
- Nigam Sattar
- Department of Oral Surgery, IIDC, Riphah International University, Islamabad
| | | | - Mahiwsh Erkin
- Department of Oral Surgery, Shifa College of Dentistry, Islamabad
| | - Muslim Khan
- Department of Oral Surgery, Khyber College of Dentistry, Peshawar
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Fujii M, Shirakawa T, Nakamura M, Baba M, Hitosugi M. Factors influencing the injury severity score and the probability of survival in patients who fell from height. Sci Rep 2021; 11:15561. [PMID: 34330987 PMCID: PMC8324820 DOI: 10.1038/s41598-021-95226-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
In Japan, falls from height result in the second highest trauma mortality rate after traffic motor vehicle collisions and the highest trauma-related mortality rate amongst young people. We aimed to identify factors that worsen injury severity and lower survival probability of patients who fell from height and to contribute to the improvement of their prehospital and in-hospital care. This retrospective analysis retrieved hospital records of 179 patients aged ≥ 15 years who were transported to our hospital after a fall from height during April 2014–March 2020. On multiple regression analysis, fall height ≥ 5 m more significantly resulted in higher the injury severity score. Logistic regression analysis revealed that fall height ≥ 5 m with the reference of 2–3 m significantly resulted in lower the survival probability with odds ratio (95% confidence interval) of 0.10 (0.02–0.55). Using ‘feet-first’ as the reference body position, the odds ratios (95% confidence interval) of survival for those who impacted the surface on the lateral or dorsal regions were 0.11 (0.02–0.64) and 0.17 (0.03–0.99), respectively. Collecting information on the abovementioned factors at pre-hospitalisation may facilitate prompt diagnosis and treatment. These results may help improve prehospital and in-hospital care, avoiding preventable trauma deaths.
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Affiliation(s)
- Masashi Fujii
- Department of Anaesthesia, Nagahama Red Cross Hospital, 14-7 Miyamae, Nagahama, Otsu, Shiga, 526-8585, Japan. .,Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
| | - Tsutomu Shirakawa
- Department of Orthopaedic Surgery, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mineko Baba
- Centre for Integrated Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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High energy pediatric fall with minor injuries. Trauma Case Rep 2021; 33:100466. [PMID: 36246844 PMCID: PMC9562431 DOI: 10.1016/j.tcr.2021.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/23/2022] Open
Abstract
Fall from height traumas are considered of high energy, being a significant cause of morbidity and mortality, especially when greater heights are involved. Minor repercussions or expectant health care provided in high-energy falling trauma have been scarcely reported. This case report describes a healthy female child's history, a victim from a high energy trauma, and considerable potential risk of severe injuries, which surprisingly showed minor repercussions. She was founded on the floor, walking, and was brought to the hospital by the local primary trauma emergency service. The initial trauma evaluation found nothing, except a small wound on the chin. A full-body CT-SCAN (Computerized Tomography Scan) was performed and diagnosed with a small laminar pneumothorax, which did not need medical procedures or interventions. She evolved well during the hospitalization, and daily chest X-rays showed the regression of the pulmonary lesion. She had hospital discharge after a few days with no sequels. This case report is probably unique, and apparently, few situations like this were previously published.
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Abstract
Introduction In response to emergency department over-crowding primary care practitioners (PCPs) have been incorporated into care pathways to provide integrated care. We consider why a pilot project of PCP-led streaming in a German emergency department failed, the challenges encountered transplanting models between differing systems and cultures, and if the concept constitutes integrated care. Theory and Methods The original design was a mixed methods data gather around PCP-streaming of non-urgent self-referrers in an emergency department. Results The demand for the PCP-streaming was low, which was at odds with pre-study estimates. The study was stopped prematurely without adequate data; this is an opinion-based article. Discussion A fundamental of emergency care is a central emergency department. An emergency department can be the fulcrum from which urgent inter-disciplinary hospital care is initiated and coordinated. Objective triage is fundamental to this and regional healthcare planning. With such fundamentals in place, PCP integration has the potential to facilitate and provide integrated care. Relevant elements of the Rainbow Model of Integrated Care frame the discussion. Conclusion The key element deficient in each barrier to our project, yet present in successful studies, was normative integration.
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Giordano V, Santos FSE, Prata C, do Amaral NP. Patterns and management of musculoskeletal injuries in attempted suicide by jumping from a height: a single, regional level I trauma center experience. Eur J Trauma Emerg Surg 2020; 48:915-920. [PMID: 32936309 DOI: 10.1007/s00068-020-01499-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Suicide is a common cause of death in Brazil, with an overall increase of 62.5% during the last 30-year period. The study aims to determine overall patient characteristics and symptomatic indicators of complications among survivors. METHODS In this retrospective cross-sectional study, we collected and analyzed clinical information of all patients aged > 10 years who presented to our hospital with a history of attempted suicide by jumping from a height in a 7-year period. Records were searched for primary demographic data, radiographs and CT scans were reviewed to determine injury characteristics, and records and operative notes were searched to look for symptomatic indicators of complications among survivors. Baseline demographics and the distribution on skeletal injuries were compared between the survivor and non-survivor patients using the Chi-squared for categorical variables and the Student's t-test for continuous variables. Among survivors, univariate and multivariate analysis were performed to investigate independent risk factors of attempted suicide and complications. RESULTS A total of 222 patients attempted suicide by jumping from a height. At multivariate analysis, the middle-aged patient was the unique identified risk factor for suicide by jumping from a height. Overall mortality was 67.6%. The main independent cause for death was traumatic brain injury. Among survivors, there was a higher incidence of foot and ankle fractures, and pelvic ring injuries. The overall complication rate for survivor patients was 51.4%, with acute infection being the most prevalent complication. At multivariate analysis, middle-aged men, foot and ankle injuries, open pelvic injuries, and open fractures were identified as risk factors for acute complications. CONCLUSION Middle-aged people are at significant risk for attempting suicide by jumping from a height in Brazil, independently of gender, with 67.6% deaths. Traumatic brain injury, higher ISS, and more than 3 skeletal injuries are independent variables related to this fatal outcome. Acute complications occur in approximately 50% of survivors. Middle-aged men, foot and ankle injuries, open pelvic injuries, and open fractures are risk factors for complications.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil.
- Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil.
| | - Fabrício Santos E Santos
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Celso Prata
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Ney Pecegueiro do Amaral
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
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Nohl A, Ohmann T, Kamp O, Waydhas C, Schildhauer TA, Dudda M, Hamsen U. Major trauma due to suicide attempt: increased workload but not mortality. Eur J Trauma Emerg Surg 2020; 48:519-523. [PMID: 32696117 DOI: 10.1007/s00068-020-01436-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/11/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Suicide attempt is a common cause for major trauma. Due to the underlying psychiatric disease, patients` compliance or even prognosis may be reduced. Modalities of discharge after surgical acute care might differ. METHODS Retrospective study including trauma patients of two urban level 1 trauma centers between 2013 and 2017. Data originally collected for quality management using the German trauma registry were supplemented after review of medical charts with details on psychiatric disease and discharge modalities. RESULTS We included 2118 consecutive patients of which 108 (5%) attempted suicide. Most common psychiatric diagnosis were depression (38%) and schizophrenia (25.9%). Comparing patients after suicide attempt with others, suicide attempt was associated with a younger age (42.3 vs. 49.0 years), a higher injury severity (mean ISS 24.7 vs. 16.8) and consecutively, a higher expected mortality (risk-adjusted prognosis for mortality 18.0 vs. 8.1%), while observed mortality was lower than expected in both groups (16.7 vs. 6.4%). Survivors after suicide attempt had a longer stay on ICU (mean days on ICU 17 vs. 7). 56% were transferred to psychiatric facilities and only 4% could be discharged home after acute surgical care. CONCLUSION Incidence of suicide attempts among major trauma patients is high. Mean injury severity is higher than in unintended trauma and associated with a prolonged stay on intensive care unit even after adjustment for injury severity and age. Risk-adjusted mortality is not increased. Proportion of patients discharged home or to out-patient rehabilitation is very low. Specialized institutions who offer both, musculoskeletal rehabilitation and psychiatric care are required for rehabilitative treatment after the acute surgical care.
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Affiliation(s)
- André Nohl
- Department of Trauma Surgery, BG Klinikum Duisburg, Duisburg, Germany.
- University Duisburg - Essen, Essen, Germany.
| | - Tobias Ohmann
- Department of Research, BG Klinikum Duisburg, Duisburg, Germany
| | - Oliver Kamp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christian Waydhas
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
- Medical Faculty, University Duisburg - Essen, Essen, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Marcel Dudda
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
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Effect of Height of Fall on Mortality in Patients with Fall Accidents: A Retrospective Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114163. [PMID: 32545236 PMCID: PMC7312001 DOI: 10.3390/ijerph17114163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 12/03/2022]
Abstract
Background: Accidental falls are a common cause of injury and deaths. Both ground-level falls (GLF) and non-GLF may lead to significant morbidity or mortality. This study aimed to explore the relationship between height of falls and mortality. Method: This is a retrospective study based on the data from a registered trauma database and included 8699 adult patients who were hospitalized between 1 January 2009 and 31 December 2017 for the treatment of fall-related injuries. Study subjects were divided into three groups of two categories based on the height of fall: GLF (group I: < 1 m) and non-GLF (group II: 1–6 m and group III: > 6 m). The primary outcome was in-hospital mortality. The adjusted odds ratio (AOR) of mortality adjusted for age, sex, and comorbidities with or without an injury severity score (ISS) was calculated using multiple logistic regression. Results: Among the 7001 patients in group I, 1588 in group II, and 110 in group III, patients in the GLF group were older, predominantly female, had less intentional injuries, and had more pre-existing comorbidities than those in the non-GLF group. The patients in the non-GLF group had a significantly lower Glasgow Coma Scale (GCS), a higher injury severity score (ISS), worse physiological responses, and required more procedures performed in the emergency department. The mortality rate for the patients in group I, II, and III were 2.5%, 3.5%, and 5.5%, respectively. After adjustment by age, sex, and comorbidities, group II and group III patients had significantly higher adjusted odds of mortality than group I patients (AOR 2.2, 95% CI 1.64–2.89, p < 0.001 and AOR 2.5, 95% CI 1.84–3.38, p < 0.001, respectively). With additional adjustment by ISS, group II did not have significantly higher adjusted odds of mortality than group I patients (AOR 1.4, 95% CI 0.95–2.22, p = 0.082), but group III patients still had significantly higher adjusted odds of mortality than group I patients (AOR 10.0, 95% CI 2.22–33.33, p = 0.002). Conclusion: This study suggested that patients who sustained GLF and non-GLF were distinct groups of patients, and the height of fall did have an impact on mortality in patients of fall accidents. A significantly higher adjusted odds of mortality was found in the GLF group than in the non-GLF group after adjusting for age, sex, and comorbidities.
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Papadakis SA, Pallis D, Galanakos S, Georgiou DF, Kateros K, Macheras G, Sapkas G. Falls from height due to accident and suicide attempt in Greece. A comparison of the injury patterns. Injury 2020; 51:230-234. [PMID: 31902573 DOI: 10.1016/j.injury.2019.12.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls from height are a common cause of death and disability. Falls from height can be divided between accidental and suicide attempts. The aim of this study is to ascertain the demographic characteristics of these patients, and to identify the fracture patterns. METHODS In this retrospective cross sectional comparative study we present 244 patients who sustained injuries as a result of a fall from height. They were divided into those with accidental falls (n = 180, group I) and those with suicide attempts (n = 64, group II). Data collected included age, gender, associated trauma, injury severity score (ISS), Glasgow Coma Scale (GCS), haemodynamic status, length of intensive care unit (ICU) and hospital stay. The diagnosis of mental disorder was ascertained by psychiatric specialists using the criteria of the International Classification of Disease Ninth Version Clinical Modification (ICD - 9CM). Postoperative follow-up ranged from 12 months to 10 years. RESULTS The injuries sustained were as follows: Abdominal trauma in 9 cases (5 in group I, 4 in II), thoracic trauma in 81 cases (49 in group I, 32 in II), head injury in 23 cases (7 in group I, 16 in II), 383 extremities fractures (184 in group I, 199 in II) and 133 spinal fractures (101 in group I, 32 in II). Twenty-one patients died in hospital while 223 patients survived to hospital discharge. The mean height from which the fall occurred was 5.4 m (range, 3 - 25 m). The mean Injury Severity Score was 19 (range, 6 to 58) for all fall victims. CONCLUSIONS Patients following an accidental high fall mostly had upper limb fractures. Patients following a suicidal high fall mostly had lower limb fractures, pelvis, spinal fractures and head injuries. Spinal fractures are common either when the fall is accidental or following suicide attempt.
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Affiliation(s)
- Stamatios A Papadakis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece.
| | - Dimitrios Pallis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - Spyridon Galanakos
- D' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - Dimitrios Florin Georgiou
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - Konstantinos Kateros
- A' Department of Orthopaedics, "G Gennimatas" General Hospital, Athens 15343, Greece
| | - George Macheras
- D' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - George Sapkas
- Orthopaedic Department, Metropolitan Hospital, Athens, Greece
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Suicide attempts by jumping and length of stay in general hospital: A retrospective study of 225 patients. J Psychosom Res 2019; 119:34-41. [PMID: 30947815 DOI: 10.1016/j.jpsychores.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Violent suicide attempts, such as jumping from a height, frequently lead to hospitalization in general hospital with high length of stay (LOS). We investigated features associated with LOS in this context. METHODS We retrospectively included all patients admitted after suicide attempts by jumping in non-psychiatric wards of a university hospital between 2008 and 2016. Several socio-demographic and clinical data were collected, including psychiatric diagnoses, coded with the International Classification of Diseases-10th Revision. We used general linear models to identify factors associated with LOS. RESULTS Among 225 patients (125 men; mean age ± sd: 37.5 ± 15.4 years), several clinical factors were independently associated with a longer LOS: number of injuries (β = 8.2 p < .001), external fixator (β = 18.1 p = .01), psychotic disorder (β = 14.6 p = .02) and delirium (β = 16.6 p = .005). Admission in psychiatric ward at discharge tended to be associated with lower LOS (β = -15.3 p = .07). CONCLUSION In patients admitted in non-psychiatric wards after suicide attempt by jumping, the presence of a psychotic disorder may increase LOS by several days, and indirectly costs of hospitalization, to a similar extent of non-psychiatric factors. The association of transfer in psychiatric ward with lower LOS suggests that the psychiatric disorder might interfere with medical care.
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Piazzalunga D, Rubertà F, Fugazzola P, Allievi N, Ceresoli M, Magnone S, Pisano M, Coccolini F, Tomasoni M, Montori G, Ansaloni L. Suicidal fall from heights trauma: difficult management and poor results. Eur J Trauma Emerg Surg 2019; 46:383-388. [PMID: 30840092 DOI: 10.1007/s00068-019-01110-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Self-inflicted injuries represent a consistent cause of trauma and falls from heights (FFH) represent a common dynamic used for suicidal attempts. The aim of the current report is to compare, among FFH patients, unintentional fallers and intentional jumpers in terms of demographical characteristics, clinical-pathological parameters and mortality, describing the population at risk for suicide by jumping and the particular patterns of injury of FFH patients. MATERIALS AND METHODS The present study is a retrospective analysis of prospectively collected data regarding FFH patients, extracted from the Trauma Registry of the Papa Giovanni XXIII Hospital in Bergamo, Italy. Demographic characteristics, clinical-pathological parameters, patterns of injury, outcomes including mortality rates of jumpers and fallers were analyzed and compared. RESULTS The FFH trauma group included 299 patients between April 2014 and July 2016: 259 of them (86.6%) were fallers and 40 (13.4%) were jumpers. At multivariate analysis both young age (p = 0.01) and female sex (p < 0.001) were statistical significant risk factors for suicidal attempt with FFH. Systolic blood pressure (SBP) at the arrival was lower and ISS was higher in the self-inflicted injury group (SBP 133.35 ± 23.46 in fallers vs 109.89 ± 29.93 in jumpers, p < 0.001; ISS in fallers 12.61 ± 10.65 vs 18.88 ± 11.80 in jumpers, p = 0.001). Jumpers reported higher AIS score than fallers for injuries to: face (p = 0.023), abdomen (p < 0.001) and extremities (p = 0.004). The global percentage of patients who required advanced or definitive airway control was significantly higher in the jumper group (35.0% vs 16.2%, p = 0.005). In total, 75% of jumpers and the 34% of fallers received surgical intervention (p < 0.001). A higher number of jumpers needed ICU admission, as compared to fallers (57.5% vs 23.6%, p < 0.001); jumpers showed longer total length of stay (26.00 ± 24.34 vs 14.89 ± 13.04, p = 0.007) and higher early mortality than fallers (7.5% vs 1.2%, p = 0.008). CONCLUSIONS In Northern Italy, the population at highest risk of suicide by jumping and requiring Trauma Team activation is greatly composed by middle-aged women. Furthermore, FFH is the most common suicidal method. Jumpers show tendency to "feet-first landing" and seem to have more severe injuries, worse outcome and a higher early mortality rate, as compared to fallers. The Trauma Registry can be a useful tool to describe clusters of patients at high risk for suicidal attempts and to plan preventive and clinical actions, with the aim of optimizing hospital care for FFH trauma patients.
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Affiliation(s)
- Dario Piazzalunga
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Rubertà
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Fugazzola
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy. .,Ospedale M. Bufalini, Viale Ghirotti, 286, 47521, Cesena, Italy.
| | - Niccolò Allievi
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Ceresoli
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Magnone
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Pisano
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Coccolini
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy.,Ospedale M. Bufalini, Viale Ghirotti, 286, 47521, Cesena, Italy
| | - Matteo Tomasoni
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy.,Ospedale M. Bufalini, Viale Ghirotti, 286, 47521, Cesena, Italy
| | - Giulia Montori
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Ansaloni
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy.,Ospedale M. Bufalini, Viale Ghirotti, 286, 47521, Cesena, Italy
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A study of fatal falls from height. J Forensic Leg Med 2019; 61:17-21. [DOI: 10.1016/j.jflm.2018.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 09/08/2018] [Accepted: 10/24/2018] [Indexed: 11/18/2022]
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Experimental Study of Thoracoabdominal Injuries Suffered from Caudocephalad Impacts Using Pigs. Appl Bionics Biomech 2018; 2018:2321053. [PMID: 29861783 PMCID: PMC5971294 DOI: 10.1155/2018/2321053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/26/2018] [Accepted: 03/12/2018] [Indexed: 11/17/2022] Open
Abstract
To know the caudocephalad impact- (CCI-) induced injuries more clearly, 21 adult minipigs, randomly divided into three groups: control group (n = 3), group I (n = 9), and group II (n = 9), were used to perform the CCI experiments on a modified deceleration sled. Configured impact velocity was 0 m/s in the control group, 8 m/s in group I, and 11 m/s in group II. The kinematics and mechanical responses of the subjects were recorded and investigated. The functional change examination and the autopsies were carried out, with which the injuries were evaluated from the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). The subjects in group I and group II experienced the caudocephalad loading at the peak pelvic accelerations of 108.92 ± 58.87 g and 139.13 g ± 78.54 g, with the peak abdomen pressures, 41.24 ± 16.89 kPa and 63.61 ± 65.83 kPa, respectively. The injuries of the spleen, lung, heart, and spine were detected frequently among the tested subjects. The maximal AIS (MAIS) of chest injuries was 4 in group I and 5 in group II, while both the MAIS of abdomen injuries in group I and group II were 5. The ISS in group II was 52.71 ± 6.13, significantly higher than in group I, 26.67 ± 5.02 (p < 0.05). The thoracoabdomen CCI injuries and the mechanical response addressed presently may be useful to conduct both the prevention studies against military or civilian injuries.
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Abstract
BACKGROUND Suicide is currently a topic of high priority for policy-makers, researchers and clinicians. The World Health Organization estimated 804,000 suicide deaths worldwide in 2012. Some studies that focused on patients with self-inflicted injury revealed that mortality in this group is higher than for patients who sustain unintentional injury. However little is known about the impact of psychiatric disorders on health care resources including length of hospital stay. OBJECTIVES To determine whether trauma patients with a psychiatric disorder or after attempting suicide are at higher risk of a complicated course than patients without a psychiatric disorder or accidental cause. The secondary objective was to provide an overview of the current literature on the same group of trauma patients with psychiatric comorbidity in regard to mortality rate, length of stay, hospital costs and quality of life. Our primary outcome measure, complicated course, was found to be most clinically relevant. METHODS We searched PubMed, Embase and PsycInfo electronic databases. All searches were updated to March 2016. The methodological quality was assessed using the QUIPS tool. RESULTS Our search identified 9284 articles (PubMed 3660, Embase 2590, PsycInfo 3034). Of these, 18 articles were included. Four studies investigated the association between psychiatric disorders and a complicated course after trauma, three found a significant higher risk of complications. Mortality was reviewed in 14 studies, of which seven showed significant higher risk of in-hospital mortality for trauma patients with psychiatric disorder. Eight of nine studies found significant prolonged length of stay for these patients. CONCLUSION Patients who have a psychiatric disorder or who have attempted suicide are at higher risk of increased in-hospital mortality and prolonged length of stay after sustaining injuries. These patients also tend to be at higher risk of complications after severe trauma, however future research is needed to confirm these potentially important implications. LEVEL OF EVIDENCE Systematic review, level III.
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Abstract
INTRODUCTION Falls from heights are an important cause of unintentional fatal injury. We investigated the relationship between the characteristics of fatal falls and resulting injury patterns. MATERIALS AND METHODS We reviewed prospectively collected data from the Office of Chief Medical Examiner in New York City between 2000 and 2010. Data included fall height, work or non-work related, use of safety equipment, intentionality, specific organ injuries, and death on impact. The primary outcome was organ injury based on fall height. RESULTS Higher falls were associated with hemorrhage as well as rib and various organ injuries. Organ injury pattern did not differ based on work status. The presence of equipment misuse or malfunction was associated with more deaths upon impact. Victims of falls from 200 ft or higher were 11.59 times more likely to die on impact than from lower than 25 ft. CONCLUSIONS Fall height and work-related falls were significantly associated with death on impact. This is a public health issue, as 13% of falls were work related and 4% of falls were due to improper use of safety equipment. Some work-related falls are potentially preventable with proper safety equipment use. Understanding patterns of injury may play a role in prevention and management of survivors in the acute period.
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Rocos B, Chesser TJ. Injuries in jumpers - are there any patterns? World J Orthop 2016; 7:182-187. [PMID: 27004166 PMCID: PMC4794537 DOI: 10.5312/wjo.v7.i3.182] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/31/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023] Open
Abstract
Suicide as a cause of death, affects every health system, and is a particular problem in heavily urbanised states and low and middle income countries (which account for 75% of suicide deaths). The World Health Organisation records that 800000 commit suicide each year, representing 1.4% of annual global deaths, and that suicide was the second leading cause of death in 15-29 year-olds across the world in 2012. In the United Kingdom, jumping from height accounts for 3%-5% of the 140000 suicide attempts annually is similar incidence to the rest of Europe. The Medline and EMBASE were interrogated for studies examining suicide caused by jumping from height. Manual screening of titles and abstracts was used to identify relevant works before data was extracted and systematically reviewed to identify the characteristics of a patient who jumps from height to commit suicide, delineate their patterns of injury and explore techniques that could be used to limit its occurrence. Emergency departments receiving patients who jump from a height need to have an understanding of the potential pathology that is likely to be encountered in order to deliver multidisciplinary, efficient and timely care in order that the impact of this devastating physical, psychological and social problem could modified to the benefit of the patients involved.
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Carroll JT, Chapman AJ, Davis AT, Rodriguez CH. The impact of tree-stand falls on a Level 1 trauma center in West Michigan. Am J Surg 2016; 211:555-8. [PMID: 26800865 DOI: 10.1016/j.amjsurg.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Falls from tree stands are common during the hunting season. We examined the impact of this injury mechanism on a Level 1 trauma center in West Michigan. METHODS Retrospective cohort study examining tree-stand fall patients between 2001 and 2013. RESULTS A total of 193 patients were included. Less than 3% of patients were wearing a harness. Falls from greater than 20 feet were associated with a higher injury severity score (P = .018). The injury severity score and Glasgow coma scale of the normal weight and overweight (OW) groups were the same. Overall 91.3% of normal weight patients were discharged home vs 63.5% of OW patients (P = .009). Median rehab stay was 12 days (3 to 92), and median charge was $24,048 (2,398 to 134,752). CONCLUSIONS Tree-stand falls cause significant injury, especially from heights greater than 20 feet. OW patients more frequently require rehabilitation. The infrequent use of safety harnesses is alarming.
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Affiliation(s)
- Joseph T Carroll
- GRMEP/MSU General Surgery Residency, 221 Michigan Street 200A, Grand Rapids, MI 49503, USA.
| | - Alistair J Chapman
- GRMEP/MSU General Surgery Residency, 221 Michigan Street 200A, Grand Rapids, MI 49503, USA
| | - Alan T Davis
- Department of General Surgery, Michigan State University, Grand Rapids, MI, USA; GRMEP Research Department, Grand Rapids, MI, USA
| | - Carlos H Rodriguez
- GRMEP/MSU General Surgery Residency, 221 Michigan Street 200A, Grand Rapids, MI 49503, USA; Department of General Surgery, Michigan State University, Grand Rapids, MI, USA; Division of Trauma Surgery, Spectrum Health, Grand Rapids, MI, USA
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Rocos B, Acharya M, Chesser TJS. The Pattern of Injury and Workload Associated with Managing Patients After Suicide Attempt by Jumping from a Height. Open Orthop J 2015; 9:395-8. [PMID: 26401162 PMCID: PMC4578128 DOI: 10.2174/1874325001509010395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/19/2015] [Accepted: 05/18/2015] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The aim of this study is to examine the pattern of injuries sustained and the hospital workload generated by patients who deliberately jump from height. METHOD One regional trauma centre's admissions were scrutinized to find all patients who jumped, or were suspected of jumping from one storey or greater over a four year period. Patients who died prior to admission were excluded. RESULTS 41 patients were included. Each patient suffered a mean of 3 injuries. The probability of calcaneal fracture was 0.32, of ankle injury 0.2, tibial fracture 0.2, femoral fracture 0.17, pelvic fracture 0.34, spinal injury 0.51, upper limb injury 0.26, head injury 0.2 and trunk injury 0.32. The mean length of inpatient stay was 7.9 days, rising to 17.9 for the 11 patients requiring intensive care. The average number of operations per patient was 1.5. CONCLUSION Patients who jump from height generate large volumes of operative and inpatient workloads. Our data show that there may be a protective effect of limb trauma against lethal head, chest or pelvic injury. Injury to the upper limb is associated with a 4 times greater risk of head injury. The incidence of pelvic injury in this series is higher than in previous work. There was a high incidence of spinal fracture. Patients generated 64 surgical procedures and consumed a mean of 17.9 inpatient days, including prolonged stay in intensive care.
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Affiliation(s)
- B Rocos
- Department of Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - M Acharya
- Department of Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - T J S Chesser
- Department of Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
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Injury Severity Score based estimation of height of fall in bus rolling down the cliff. J Forensic Leg Med 2015; 34:133-8. [PMID: 26165672 DOI: 10.1016/j.jflm.2015.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/22/2015] [Accepted: 06/03/2015] [Indexed: 11/23/2022]
Abstract
A case of bus rollover into the canyon, 40 m down the road, with 47 occupants out of which 18 were fatally injured, was used to compute the Injury Severity Score (ISS) for each passengers as well as the equivalent free fall for this particular accident, to be compared to the height of fall as estimated by the Lau's model based on ISS, resulting the conclusion whether Lau's model and the computation of ISS can be considered reliable to estimate the height of fall in any other case. Dealing with this, we would be also able to assess a protective potential of the bus on occupants while it falls from the height. By using classic energy-related mechanical formulas the presented rollover down the cliff has been transferred into a corresponding free fall from the height (10 m). ISS for each passenger has been used to establish height bands of the corresponding free fall. The analysis of the presented case showed that only 30% of bus passengers sustained injuries similar to the injuries expected in the fall from height in the range of 10-20 m. The chances to be non-severely injured as a consequence of the fall in a bus is 43%, but still remains a very high chance (27%) to sustain injures more severe than expected for the equivalent free fall from height out of a vehicle. Moreover, eight passengers sustained pulmonary detraction which is characteristic of the fall above 40 m. The conclusion is that this mathematical computing for transferring one way of motion into another one may be useful for any other event similar to the fall from height and further usage of Lau's modules. Also, estimated severity of the injuries expressed through ISS can be merely an approximating indicator of the height of the fall of the bus, so ISS is not able to estimate the exact height. Finally, in majority of cases the protective potential of the bus may preserve from severe body damage, but the mortality rate still stands on a very high level.
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Kafadar S, Kafadar H. The medico-legal evaluation of injuries from falls in pediatric age groups. J Forensic Leg Med 2015; 31:52-5. [PMID: 25735785 DOI: 10.1016/j.jflm.2015.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/18/2014] [Accepted: 01/26/2015] [Indexed: 11/25/2022]
Abstract
Blunt trauma from accidental falls or intentional jumping from great heights occurs frequently in forensic medicine. The goal of this study was to investigate injuries due to falls in children under 19 years of age. Injuries from falls are the leading cause of visits to emergency departments and to deaths due to injuries. Various methods are used in the classification of falls. In this study, we have classified falls as "high-level" (≥ 5 m), "low-level" (<5 m) and "ground-level". We have retrospectively evaluated 814 boys (61.18%) and 512 girls (38.62%), making up a total of 1326 children (under 19 years old) with the mean age of 7.85 ± 3.46, that were admitted to State Hospital between January 2009 and December 2013 due to falls from heights and falls on ground-level. Falls were low-level in 738 cases, high-level in 176 cases, and ground-level in 412 cases. Cases were categorized by gender, age, age group, fall height, Glasgow Coma Scale (GCS), injured body part(s), mortality rate, and distribution according to months. In conclusion, falls merit attention because of their high risk of mortality and morbidity, as well as their burden on medical budgets. If the medico-legal aspects of falls were evaluated with regard to preventive event or death, the importance of the topic could be better understood.
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Affiliation(s)
| | - Hüseyin Kafadar
- Firat University, Department of Forensic Medicine, 23110, Elazığ, Turkey.
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Roccia F, Boffano P, Bianchi FA, Zavattero E. Maxillofacial Fractures due to Falls: does Fall Modality Determine the Pattern of Injury? EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2014; 5:e5. [PMID: 25635212 PMCID: PMC4306323 DOI: 10.5037/jomr.2014.5405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/17/2014] [Indexed: 11/16/2022]
Abstract
Objectives In several epidemiological studies of maxillofacial trauma, falls were one of the most frequent causes of facial injury. The aim of this study is to analyse the patterns of fall-related maxillofacial injuries based on the height of the fall. Material and Methods Using a systematic computer-assisted database of patients hospitalised with maxillofacial fractures, only those with fall-related injuries were considered. The falls were divided into four groups: falls from slipping, tripping or stumbling (STSF), loss of consciousness (LOCF), stairs (SAF), and height (HF). Data on the age, gender, fracture site, Facial Injury Severity Scale (FISS), facial lacerations, associated lesions, type of treatment, and length of hospital stay were also analysed. Results This study included 557 patients (338 males, 219 females; average age 51.5 years [range 4 - 99 years]). In the over 60 age group, females were more prevalent in STSF than males. According to aetiology, STSF was the most frequent cause of maxillofacial fractures (315 patients; 56.5%) followed by LOCF (157; 28.2%), HF (55; 9.9%), and SAF (30; 5.4%). The middle third of the face was affected most frequently. After LOCF, however, the inferior third was prevalently involved. The majority of associated fractures, as well as the most severe injuries and greatest rate of facial lacerations, occurred secondary to HF. Conclusions This study showed that fracture severity and site are influenced not only by patient age, but also by the nature of the fall.
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Affiliation(s)
- Fabio Roccia
- Surgical Science Department, San Giovanni Battista Hospital, University of Turin, Turin Italy
| | - Paolo Boffano
- Surgical Science Department, San Giovanni Battista Hospital, University of Turin, Turin Italy
| | - Francesca A Bianchi
- Surgical Science Department, San Giovanni Battista Hospital, University of Turin, Turin Italy
| | - Emanuele Zavattero
- Surgical Science Department, San Giovanni Battista Hospital, University of Turin, Turin Italy
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Arbes S, Berzlanovich A. Injury pattern in correlation with the height of fatal falls. Wien Klin Wochenschr 2014; 127:57-61. [DOI: 10.1007/s00508-014-0639-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
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Parreira JG, Matar MR, Tôrres ALB, Perlingeiro JAG, Solda SC, Assef JC. Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma. Rev Col Bras Cir 2014; 41:272-7. [DOI: 10.1590/0100-69912014004009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/15/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To analyze the lesions diagnosed in victims of falls, comparing them with those diagnosed in other mechanisms of blunt trauma.METHODS: We conducted a retrospective study of trauma protocol charts (prospectively collected) from 2008 to 2010, including victims of trauma over 13 years of age admitted to the emergency room. The severity of injuries was stratified by the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). Variables were compared between the group of victims of falls from height (Group 1) and the other victims of blunt trauma (Group 2). We used the Student t, chi-square and Fisher tests for comparison between groups, considering the value of p <0.05 as significant.RESULTS: The series comprised 4,532 cases of blunt trauma, of which 555 (12.2%) were victims of falls from height. Severe lesions (AISe"3) were observed in the extremities (17.5%), in the cephalic segment (8.4%), chest (5.5%) and the abdomen (2.9%). Victims of Group 1 had significantly higher mean age, AIS in extremities / pelvis, AIS in the thoracic segment and ISS (p <0.05). The group 1 had significantly (p <0.05) higher incidence of tracheal intubation on admission, pneumothorax, hemothorax, rib fractures, chest drainage, spinal trauma, pelvic fractures, complex pelvic fractures and fractures to the upper limbs.CONCLUSION: Victims of fall from height had greater anatomic injury severity, greater frequency and severity of lesions in the thoracic segment and extremities.
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Affiliation(s)
| | | | | | | | - Silvia C. Solda
- Irmandade da Santa Casa de Misericórdia de São Paulo; Santa Casa de São Paulo
| | - José Cesar Assef
- Irmandade da Santa Casa de Misericórdia de São Paulo; Santa Casa de São Paulo
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