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Palacio C, Hovorka M, Acosta M, Bautista R, Chen C, Hovorka J. Predicting factors for extremity fracture among border-fall patients using machine learning computing. Heliyon 2024; 10:e32185. [PMID: 38961975 PMCID: PMC11219316 DOI: 10.1016/j.heliyon.2024.e32185] [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: 02/10/2024] [Accepted: 05/29/2024] [Indexed: 07/05/2024] Open
Abstract
Background The factors causing the injuries sustained from falls at US-Mexican border include falls from border wall or fence, fleeing from border patrols, ejecting from vehicle, and others. This study aimed to determine the factors leading to anatomical injuries and to identify the importance of factors leading to limb fracture and internal organ injuries. Methods A total of 178 patients who sustained musculoskeletal injuries or internal organ injuries and were admitted to our hospital were included in this retrospective study. Factors indexed for analysis included demographics, comorbidities, and falling mechanic factors. Correlations between anatomical injuries and mechanical injuries were analyzed. Multilayer perceptron neural network (MPNN) was used to identify predictive factors and to stratify the importance of these factors leading to injuries. The SPSS software was used for statistical analysis and predictive factor analysis. Results The extremity fracture was associated with border wall/fence fall (p = 0.001) and fleeing (p = 0.002). The spine fracture was correlated with bridge jump/fall (p = 0.007), fence jump/fall (p = 0.026). The vehicle ejecting/MVA was correlated with head injury (P < 0.001), chest injury (P < 0.001), and abdominal injury p < 0.001). MNPP stratify the importance of factor causing injury with multiple factor considered. Conclusion The various injury factors caused different anatomical injuries. Multifactorial assessment associated with these injuries can improve the accuracy of diagnosis and develop a predictive model for clinical applications.
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Affiliation(s)
- Carlos Palacio
- South Texas Health System – McAllen Department of Trauma, McAllen, TX, 78503, USA
| | - Maximillian Hovorka
- South Texas Health System – McAllen Department of Trauma, McAllen, TX, 78503, USA
| | - Marie Acosta
- South Texas Health System – McAllen Department of Trauma, McAllen, TX, 78503, USA
| | - Ruby Bautista
- South Texas Health System – McAllen Department of Trauma, McAllen, TX, 78503, USA
| | - Chaoyang Chen
- South Texas Health System – McAllen Department of Trauma, McAllen, TX, 78503, USA
- Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, 48201, USA
| | - John Hovorka
- South Texas Health System – McAllen Department of Trauma, McAllen, TX, 78503, USA
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Çakmur BB, Duramaz A, Çakmur KN, Duramaz A. Do the management and functional outcomes of the surgically treated spinal fractures change in suicidal jumpers? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08259-w. [PMID: 38652295 DOI: 10.1007/s00586-024-08259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 02/20/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The aim of the study was to determine the effect of trauma etiology on the management, functional outcomes and psychiatric characteristics of suicide jumpers and patients who accidentally fall from height. METHODS 89 patients (48 accidental falls and 41 suicidal jumpers) who had undergone spinal surgery were included in the study. The patients were evaluated clinically and radiologically. Visual Analog Scale (VAS), Roland Morris Disability Questionnaire (RMDQ) and McGill Pain Questionnaire (MPQ) were performed for functional evaluation. BECK hopelessness scale (BHS), BECK depression inventory (BDI), and SF-36 scales were used for the psychiatric evaluation. All outcomes were compared between suicidal jumpers and accidental falls. RESULTS The RMDQ and ODI questionnaires stated a higher disability in the suicide jump group (p = 0.001 and p = 0.029, respectively). However, the VAS and MPQ questionnaires did not differ in significance between groups (p = 0.182 and p = 0.306, respectively). The SF-36 scale showed that physical function, role emotional, vitality and mental health subdomains were worse in the suicide jump group (p = 0.001, p = 0.029, p = 0.014 and p = 0.030, respectively). BDI scores were significantly higher in the suicide jump group while no difference was observed between the groups in terms of BSH (p = 0.017 and p = 0.940, respectively). CONCLUSION Psychiatric disorders are more common in patients in the suicidal jumpers. The presence of underlying psychiatric problems adversely affects the postoperative functional outcomes of patients with surgically treated spinal fractures. A multidisciplinary approach together with raising awareness in this way can improve the clinical outcomes after orthopedic treatment, even if there is physical disability.
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Affiliation(s)
- Başar Burak Çakmur
- Department of Orthopedics and Traumatology, Hamidiye Medical School, Istanbul Başakşehir Çam ve Sakura City Hospital, University of Health Sciences, Başakşehir St., G-434 Ave., Number 2L Başakşehir, 34494, Istanbul, Turkey
| | - Altuğ Duramaz
- Department of Orthopedics and Traumatology, Hamidiye Medical School, Bakırköy Dr. Sadi Konuk Education and Research Hospital, University of Health Sciences, Tevfik Sağlam St. Number 11, Bakırköy, 34147, Istanbul, Turkey.
| | - Kadriye Nur Çakmur
- Department of Psychiatry, Hamidiye Medical School, Bakırköy Prof Mazhar Osman Education and Research Hospital for Psychiatry Neurology and Neurosurgery, University of Health Sciences, Tevfik Sağlam St. Number 11 Bakırköy, 34147, Istanbul, Turkey
| | - Altan Duramaz
- Republic of Turkey Ministry of National Education, Gazi Mustafa Kemal Street, Number 1 Yenişehir, 27090, Mersin, Turkey
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Jun J, Lee JH, Han J, Kim SH, Kim S, Cho GC, Park EJ, Lee DH, Hong JY, Kim MJ. Characteristics of fall-from-height patients: a retrospective comparison of jumpers and fallers using a multi-institutional registry. Clin Exp Emerg Med 2024; 11:79-87. [PMID: 38018072 PMCID: PMC11009701 DOI: 10.15441/ceem.23.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ. METHODS This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis. RESULTS Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746-9.240). CONCLUSION Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.
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Affiliation(s)
- Jinhae Jun
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Juhee Han
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sunpyo Kim
- Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Eun Jung Park
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ju Young Hong
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
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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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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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Falls from scaffolds: a nationwide analysis. Eur J Trauma Emerg Surg 2022; 49:813-823. [PMID: 36266478 DOI: 10.1007/s00068-022-02130-7] [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: 05/23/2022] [Accepted: 10/02/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Falls from scaffolds are a common cause of occupational injuries and fatalities, however, the data concerning these injuries are scarce. The purpose of this study was to characterize the epidemiology, injury patterns, and outcomes of falls from scaffolds. METHODS Retrospective cohort study using data from the National Trauma Data Bank (2007-2017). All adult patients who sustained injuries following falls from scaffolds and as a comparator, falls from ladders, were identified using the external cause of injury codes. The primary outcome was differences in the type and severity of injuries between the groups. RESULTS A total of 183,853 patients were analyzed. Of these, 18,189 (9.9%) fell from scaffolds and 165,664 (90.1%) from ladders. Patients who fell from scaffolds were younger, more often male, and more likely to sustain severe trauma (ISS > 15: 24.1% vs 17.3%, p < 0.001). Falls from scaffolds resulted in more severe head injuries (head AIS ≥ 3: 18.6% vs 14.7%, p < 0.001) and more spinal fractures (30.3% vs 25.2%, p < 0.001). Falls from scaffolds were associated with higher mortality (2.5% vs 1.8%, p < 0.001), higher ICU admission rate (25.0% vs 21.5%, p < 0.001), and longer hospitalization. On multivariable analysis, the strongest predictors of mortality were GCS < 9 and hypotension on admission, severe (AIS ≥ 3) head injury, and age > 65 years. CONCLUSION Falls from scaffolds are associated with more severe injuries and worse outcomes compared to ladder falls. Males in the fourth decade of life were disproportionally affected. Further research on fall prevention is warranted to decrease this important cause of death and disability.
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The Ground Fell Away: An Autobiographical Study of Surviving a Fall From Height. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2119174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Dwight KD, Kent WT, Hughes-Austin JM. Musculoskeletal injuries sustained at the California, USA: Baja California, Mexico border. Inj Epidemiol 2022; 9:27. [PMID: 36008848 PMCID: PMC9403971 DOI: 10.1186/s40621-022-00392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Individuals attempting to enter the USA from Mexico at non-authorized points along the border fence often sustain injuries requiring medical intervention. We evaluated characteristics of this patient population and their hospital care to better understand patient treatment needs. Given the high-velocity nature of these injuries, we hypothesized that higher pain scores would be associated with longer lengths of hospital stay. Methods In this cross-sectional study, we selected records of all patients from 2013 to 2019 who received care by the Orthopaedic Surgery department following an injury sustained at the California-Baja California border. We evaluated demographics, musculoskeletal injuries, procedures, length of hospital stay (LOS), follow-up, and pain scores via retrospective chart review. We used linear regression, adjusting for age and gender, to evaluate associations between pain scores and hospital LOS. Results Among all 168 patients, there were 248 total injuries comprised of 46% lower extremity, 15% upper extremity, 17% spine, and 4% pelvic injuries. Average age at injury was 33 ± 10, 74% were male, and 85% identified as Hispanic. Of this patient population, 68% underwent operative interventions, 26% sustained open injuries, and 21% required external fixation for initial injury stabilization. Thirteen percent were seen for follow-up after discharge. Spine (n = 42), pilon (n = 36), and calcaneus fractures (n = 25) were the three most common injury types. Average LOS for all patients was 7.8 ± 8.1 days. Pain scores were not significantly associated with LOS ( p = 0.08). However, for every surgical procedure performed, hospital LOS was increased by 5.16 ± 0.47 days (p < 0.001). Conclusion Many injuries incurred by patients crossing the border were severe, requiring multiple surgical interventions and a prolonged LOS. The higher number of procedures was significantly associated with longer LOS in all operatively treated patients. Future studies are needed to determine how we can optimize care for this unique patient population and facilitate post-discharge care.
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Affiliation(s)
- Kathryn D Dwight
- Department of Orthopaedic Surgery, University of California, San Diego, 9500 Gilman Drive, Mail Code 0863, La Jolla, CA, 92093, USA
| | - William T Kent
- Department of Orthopaedic Surgery, University of California, San Diego, 9500 Gilman Drive, Mail Code 0863, La Jolla, CA, 92093, USA
| | - Jan M Hughes-Austin
- Department of Orthopaedic Surgery, University of California, San Diego, 9500 Gilman Drive, Mail Code 0863, La Jolla, CA, 92093, USA.
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Cuthbert R, Walters S, Ferguson D, Karam E, Ward J, Arshad H, Culpan P, Bates P. Epidemiology of pelvic and acetabular fractures across 12-mo at a level-1 trauma centre. World J Orthop 2022; 13:744-752. [PMID: 36159624 PMCID: PMC9453279 DOI: 10.5312/wjo.v13.i8.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/07/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite motor-vehicle safety advancements and increasingly rigorous workplace safety regulations, trauma/suicide remains the leading cause of death under the age of 45 in the United Kingdom. To promote centralisation of care and optimisation of major trauma outcomes, in 2012 the National Health Service introduced the Trauma Network System. To our knowledge, this is the first study to analyse the epidemiology of pelvic and acetabular trauma over a one-year period at a level-1 trauma centre in the United Kingdom, since nationwide introduction of the Trauma Network System.
AIM To characterize the epidemiology of high-energy pelvic and acetabular fractures over a one-year period at a level-1 trauma centre, and explore both resources required to care for these patients and opportunities for future research and injury prevention initiatives.
METHODS 227 consecutive patients at a level-1 trauma centre with pelvic and acetabular fractures were analysed between December 2017-December 2018. Paediatric patients (< 18 years) and fragility fractures were excluded, leaving 175 patients for inclusion in the study. Statistical analysis was performed using Fisher’s exact test for categorical variables.
RESULTS 72% of pelvic and acetabular fractures occurred in male patients at a median age of 45 years. 15% were the result of a suicide attempt. 48% of patients required pelvic or acetabular surgery, with 38% undergoing further surgery for additional orthopaedic injuries. 43% of patients were admitted to intensive care. The median inpatient stay was 13 days, and the 30- day mortality was 5%. Pelvic ring trauma was more commonly associated with abdominal injury (P = 0.01) and spine fractures (P < 0.001) than acetabular fractures. Vertical shear pelvic ring fractures were associated with falls (P = 0.03) while lateral compression fractures were associated with road traffic accidents (P = 0.01).
CONCLUSION High energy pelvic and acetabular fractures are associated with concomitant orthopaedic fractures (most commonly spine and lower limb), intensive care admission and prolonged inpatient stays. Most pelvic ring injuries secondary to road traffic accidents are lateral compression type, demonstrating the need for future research to drive advancements in lateral impact vehicle safety along with mental health surveillance for those deemed to be potential suicide risks.
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Affiliation(s)
- Rory Cuthbert
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Samuel Walters
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - David Ferguson
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Edward Karam
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Jonathan Ward
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Homa Arshad
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Paul Culpan
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Peter Bates
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
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Terayama T, Toda H, Tanaka Y, Saitoh D, Yoshino A. Differences in Trauma Injury Patterns and Severity Between Intentional and Accidental Falls From a Height: A Japanese Nationwide Trauma Database Study. Cureus 2022; 14:e25861. [PMID: 35698466 PMCID: PMC9188667 DOI: 10.7759/cureus.25861] [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: 06/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Fall from a height is a common cause of trauma requiring emergency care; in many cases, the trauma team needs to urgently develop the initial treatment strategy. The mechanism of injury (intentional or accidental) is an important factor in predicting trauma patterns and severity. We aimed to describe how the severity of injuries in each body region contributes to overall trauma severity and skeletal trauma patterns in intentional and accidental falls. Methods Data accumulated between January 1, 2004 and May 31, 2019 were obtained from a nationwide trauma database. Patients aged ≥18 years and injured by falls from a height were included. The median Abbreviated Injury Scale (AIS) score for the Injury Severity Score (ISS) for each body region (region 1: head, face, and neck; region 2: thorax; region 3: abdomen; region 4: lower extremity and pelvis; and region 5: upper extremity) was investigated. Skeletal injury patterns were classified into four groups: group I (intentional/severe), group II (accidental/severe), group III (intentional/not severe), and group IV (accidental/not severe). Severe trauma was defined as a trauma with an ISS of 16 or more. The groups were compared using the chi-square test and Mann-Whitney U test. Results Among the 342,263 patients enrolled in the database, 28,409 met the inclusion criteria: 6,812 in group I, 11,754 in group II, 2,384 in group III, and 7,459 in group IV. The intentional fall group showed an increase in the AIS score for region 4 as the ISS increased, whereas the accidental fall group showed an increase in the AIS score for region 1. Both groups showed an increase in the AIS score for region 2 as the ISS increased. The intentional fall group had a higher proportion of fractures in the lower extremities and pelvis than the accidental fall group. Conclusions There were differences in trauma patterns and trauma severity levels between patients who experienced intentional and accidental falls from a height. Our findings provide a comprehensive understanding of this topic. Further studies are required to assess the usefulness of our findings for the development of initial treatment strategies at the ED.
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Falls from height: Ambulation following spinal cord injury and lower extremity polytrauma. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Nau C, Leiblein M, Verboket RD, Hörauf JA, Sturm R, Marzi I, Störmann P. Falls from Great Heights: Risk to Sustain Severe Thoracic and Pelvic Injuries Increases with Height of the Fall. J Clin Med 2021; 10:jcm10112307. [PMID: 34070640 PMCID: PMC8199183 DOI: 10.3390/jcm10112307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 11/24/2022] Open
Abstract
Falls from a height are a common cause of polytrauma care in Level I Trauma Centers worldwide. The expected injury consequences depend on the height of the fall and the associated acceleration, as well as the condition of the ground. In addition, we further hypothesize a correlation between the cause of the fall, the age of the patient, and the patient’s outcome. A total of 178 trauma patients without age restriction who were treated in our hospital after a fall >3 m within a 5-year period were retrospectively analyzed. The primary objective was a clinically and radiologically quantifiable increase in the severity of injuries after falls from different relevant heights (>3 m, >6 m, and >9 m). The cause of the fall, either accidental or suicidal; age and duration of intensive care unit stay, including duration of ventilation; and total hospital stay were analyzed. Additionally, the frequency of urgent operations, such as, external fixation of fractures or hemi-craniectomies, laboratory parameters; and clinical outcomes were also among the secondary objectives. Sustaining a thoracic trauma or pelvis fractures increases significantly with height, and vital parameters are significantly compromised. We also found significant differences in urgent pre- and in-hospital emergency interventions, as well as organ complications and outcome parameters depending on the fall’s height.
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13
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Fall from heights: possible factors influencing the onset of complications. Musculoskelet Surg 2021; 106:297-301. [PMID: 33580450 DOI: 10.1007/s12306-021-00701-2] [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: 09/21/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Fall from a height is high energy trauma. The causes include both accidental falls and suicide attempts. The literature and also our previous study demonstrated that this kind of patients, during their recovery time, need a high multidisciplinary workload with significant costs. The present study is the first researching the patterns of the non-acute orthopedic complications after a trauma precipitation that required a new hospitalization and surgical procedure. METHODS Retrospective study and analysis of orthopedic complication characteristics of patients fallen from height. We researched the possible relation between the complication pattern (soft tissue or bone involvement) and the case character (psychiatric or non-psychiatric patients, type of fracture and kind of fixation). RESULTS The 18.83% of all patients (154 cases included) needed a new admission to perform further surgical procedures (9.74% of psychiatric patients and 9.09% of unvoluntary victims). Our data showed that patients with psychiatric disorder were associated with a statistically significant (p < 0.05) increase in soft tissue complications (46.67%) and onset of non-union after internal osteosynthesis and external fixation (72.72%), respectively. CONCLUSION According to the results obtained, we can conclude that osteosynthesis in psychiatric patients is related to well-defined and predictable complications.
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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: 3] [Impact Index Per Article: 0.8] [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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