Falls from height: injury and mortality

OBJECTIVES

To determine how Injury Severity Score (ISS) and mortality relate to height fallen, and to determine other predictors of mortality including intent and body region injured.

METHODS

A pre-hospital retrospective, observational database study was conducted. Injured or deceased patients following a fall from height (FFH), aged 16 or over, attended to by London Helicopter Emergency Medical Services (HEMS), between Jan 2008 to July 2009 were included in the study. In addition to the database, HEMS mission 'run sheets' provided further information.

RESULTS

117 (91 males and 26 females) patients met the inclusion criteria. The mean age was 37 years (range 16 - 85). 34/117 (29%) died. The mean ISS was 28.6 (median 17) and the mean height fallen 9.9m (3rd floor). In the group that died the mean height was 16.7m (5th floor). Height fallen was found to be a significant predictor of mortality (p < 0.001), as were injuries to the chest and/or head (p < 0.05). In patients with head and chest injuries, a 50% mortality rate was estimated to occur at falls from 10.5m, compared to 22.4m in those without injuries to head or chest. Deliberate falls were more common amongst females than males (chi-squared test, p = 0.001), were associated with greater ISS (Mann Whitney test, p < 0.001) and were more likely to result in death (chi-squared test, p < 0.001).

CONCLUSIONS

Height fallen correlates with ISS and is a significant predictor of death. Chest and/or head injuries significantly increased the likelihood of death following a FFH. This information may enhance triage criteria applied to tasking of emergency response vehicles, and strategies in injury prevention. Other potential predictors of mortality were not found to be significant.

P01-306-Adhd, gender, and psychiatric comorbidity in a populaiton-based birth cohort

Introduction

ADHD is frequently associated with comorbid psychiatric disorders. However, epidemiologic studies in the general population are rare.

Objective

To evaluate associations between ADHD and comorbid psychiatric disorders using research-identified incident ADHD cases and population-based controls.

Method

Subjects included a birth cohort of all children born 1976-1982 remaining in Rochester, MN after age five (n = 5718). Among them we identified 379 ADHD incident cases and 758 age-sex matched non-ADHD controls, passively followed to age 19. Through a systematic, multistaged process, utilizing detailed, routinely collected data, all psychiatric diagnoses confirmed by medical professionals were identified (n = 314 ADHD cases, n = 712 controls with research authorization). For each psychiatric disorder, cumulative incidence rates for subjects with and without ADHD were calculated; corresponding hazard ratios (HR) adjusted for sex, mothers age/education, were estimated using a Cox model. Associations between ADHD status and Internalizing-Externalizing dimensions were estimated using odds ratios (OR).

Results

ADHD was associated with significantly increased risk for adjustment disorders (HR = 3.82), conduct disorder/oppositional defiant disorder (HR = 9.45), mood disorders (HR = 3.57), anxiety disorders (HR = 2.95), tic disorders (HR = 6.41), eating disorders (HR = 5.52), personality disorders (HR = 5.49), and substance-related disorders (HR = 4.04). When psychiatric comorbidities were classified on the Internalizing-Externalizing dimension, ADHD was strongly associated with coexisting internalizing/externalizing (OR = 10.6, vs none), and externalizing-only (OR = 10.0), disorders. No significant gender x ADHD interactions were observed.

Conclusion

This population-based study confirms that children with ADHD are at significant risk for co-morbid psychiatric disorders. Besides treating the ADHD, clinicians should assess and monitor potential psychiatric comorbidities in children with ADHD.