Relating factors to severe injury from outdoor falls in older people

Clinical trauma severity of indoor and outdoor injurious falls requiring emergency medical service response

BACKGROUND

Injurious falls represent a significant public health burden. Research and policies have primarily focused on falls occurring indoors despite evidence that outdoor falls account for 47-58% of all falls requiring some medical attention. This study described the clinical trauma severity of indoor versus outdoor injurious falls requiring Emergency Medical Services (EMS) response.

METHODS

Using the 2019 National Emergency Medical Services Information System (NEMSIS) dataset, we identified the location of patients injured from falls that required EMS response. We classified injury severity using (1) the Revised Trauma Score for Triage (T-RTS): ≤ 11 indicated the need for transport to a Trauma Center; (2) Glasgow Coma Scale (GCS): ≤ 8 and 9-12 indicated severe and moderate neurologic injury; and (3) patient clinical acuity by EMS: Dead, Critical, Emergent, Low.

RESULTS

Of 1,854,909 encounters for patients with injurious falls, the vast majority occurred indoors (n = 1,596,860) compared to outdoors (n = 152,994). For patients who fell indoors vs outdoors on streets or sidewalks, the proportions were comparable for moderate or severe GCS scores (3.0% vs 3.9%), T-RTS scores indicating need for transport to a Trauma Center (5.2% vs 5.9%) and EMS acuity rated as Emergent or Critical (27.7% vs 27.1%). Injurious falls were more severe among male patients compared to females and males injured by falling on streets or sidewalks had higher percentages for moderate or severe GCS scores (5.2% vs 1.9%) and T-RTS scores indicating the need for transport to a Trauma Center (7.3% vs 3.9%) compared to falling indoors. Young and middle-aged patients who fell on streets or sidewalks had higher proportions for a T-RTS score indicating the need for Trauma Center care compared to those in this subgroup who fell indoors. Yet older patients injured by falling indoors were more likely to have a T-RTS score indicating the need for transport to a Trauma Center than older patients who fell on streets or sidewalks.

CONCLUSIONS

There was a similar proportion of patients with severe injurious falls that occurred indoors and outdoors on streets or sidewalks. These findings suggest the need to determine outdoor environmental risks for outdoor falls to support location-specific interventions.

Clinical Trauma Severity of Indoor and Outdoor Injurious Falls Requiring Emergency Medical Service Response

Background

Injurious falls represent a significant public health burden. Research and polices have primarily focused on falls occurring indoors despite evidence that outdoor falls account for 47-58% of all falls requiring some medical attention. This study compared the clinical trauma severity of indoor versus outdoor injurious falls requiring Emergency Medical Services (EMS) response.

Methods

Using the 2019 National Emergency Medical Services Information System (NEMSIS) dataset, we identified the location of patients injured from falls that required EMS response. We classified injury severity using 1) the Revised Trauma Score for Triage (T-RTS): ≤ 11 indicated the need for transport to a Trauma Center; 2) Glasgow Coma Scale (GCS): ≤8 and 9-12 indicated moderate and severe neurologic injury; and 3) patient clinical acuity by EMS: Dead, Critical, Emergent, Low.

Results

Of 1,854,909 encounters for patients with injurious falls, the vast majority occurred indoors (n=1,596,860) compared to outdoors (n=152,994). The proportions of patients with moderate or severe GCS scores, were comparable between those with indoor falls (3.0%) and with outdoor falls on streets or sidewalks (3.8%), T-RTS scores indicating need for transport to a Trauma Center (5.2% vs 5.9%) and EMS acuity rated as Emergent or Critical (27.7% vs 27.1%).Injurious falls were more severe among male patients compared to females: and males injured by falling on streets or sidewalks had higher percentages for moderate or severe GCS scores (4.8% vs 3.6%) and T-RTS scores indicating the need for transport to a Trauma Center (7.3% vs 6.5%) compared to indoor falls. Young and middle-aged patients whose injurious falls occurred on streets or sidewalks were more likely to have a T-RTS score indicating the need for Trauma Center care compared to indoor falls among this subgroup. Yet older patients injured by falling indoors were more likely to have a T-RTS score indicating the need for Trauma Center than older patients who fell on streets or sidewalks.

Conclusions

There was a similar proportion of patients with severe injurious falls that occurred indoors and on streets or sidewalks. These findings suggest the need to determine outdoor environmental risks for outdoor falls to support location-specific interventions.

Severe Ground Fall Injury Associated with Alcohol Consumption in Geriatric Patients

This study investigated characteristics of geriatric patients sustaining ground fall injury related to alcohol consumption and analyzed factors associated with the severity of such injuries in both alcohol- and non-alcohol-related cases. We retrospectively reviewed geriatric patients sustaining ground falls who were admitted to six university hospitals from 2011 to 2018. Patients were classified into alcohol and non-alcohol groups. Their general characteristics, clinical characteristics, and factors of injury severity were analyzed. A total of 31,177 patients were reviewed. Factors significantly associated with alcohol-related ground-fall injuries were: male, 65~84 years old, injury time other than 06:00~11:59, transportation to emergency department (ED) by ambulance and from other hospitals, injured in residential facilities, transportation areas, public or commercial facilities, activities other than paid or unpaid, non-slippery floor, obstacles, concrete floor, and absence of lights. Factors associated with severe injury after ground fall in alcohol-related cases were: male, injury time at between 06:00 and 17:59, transportation to the ED via ambulance from other hospitals, injured in residential facility, and slippery floor. Risk factors for severity in alcohol-related geriatric fall injury included: male sex, daytime injury, transportation by ambulance, injury in a residential facility, and slippery floor condition. Prophylactic measures and therapeutic interventions by ED teams are needed for the management of such cases.

The Relationship Between Falling Distance and Trauma Severity Among Fall Injury Survivors Who Were Transported to a Trauma Center

Introduction

Falls from >6 meters have been shown to cause multiple traumas and serious injuries. However, especially among fall survivors who were transported to trauma centers, the relationship between falling distance and trauma severity remains unclear. This study aimed to investigate the relationship between falling distance and trauma severity among fall injury survivors who were transported to a trauma center and clarify the characteristics of trauma among survivors of falls from high places from an orthopedic surgeon’s perspective.

Methods

We retrospectively reviewed the medical records of 65 fall injury survivors who were transported to a trauma center for falling distance; whether the fall was a suicide attempt; abdominal, chest, and head trauma; the numbers of upper-limb, lower-limb, and spinal vertebral fractures; McCormack load-sharing classification score; unstable pelvic fracture; Frankel classification; injury severity score (ISS); and duration of intensive care unit (ICU) and hospital stay. We evaluated the correlations between falling distance and the other factors and compared all factors between those falling <6 meters and those falling >6 meters.

Results

Falling distance was weakly positively correlated with durations of ICU and hospital stay. The percentage of cases that were suicide attempts, the number of lower-limb fractures, the McCormack load-sharing classification score, and the durations of ICU and hospital stay were significantly higher among those falling from >6 meters than among those falling from <6 meters. Conversely, there were no significant differences in abdominal trauma, chest trauma, head trauma, number of upper-limb fractures, number of vertebral fractures, unstable pelvic fracture, or Frankel classification between the two groups.

Conclusion

The findings indicate that falling from a higher distance may increase lower-limb and vertebral fracture severity and may lead to longer ICU and hospital stays among fall injury survivors who are transported to trauma centers.

Seasonal variation in fall-related emergency department visits by location of fall - United States, 2015

INTRODUCTION

In the United States, fall-related emergency department (ED) visits among older adults (age 65 and older) have increased over the past decade. Studies document seasonal variation in fall injuries in other countries, while research in the United States is inconclusive. The objectives of this study were to examine seasonal variation in older adult fall-related ED visits and explore if seasonal variation differs by the location of the fall (indoors vs. outdoors), age group, and sex of the faller.

METHODS

Fall-related ED visit data from the National Electronic Injury Surveillance System-All Injury Program were analyzed by season of the ED visit, location of the fall, and demographics for adults aged 65 years and older.

RESULTS

Total fall-related ED visits were higher during winter compared with other seasons. This seasonal variation was found only for falls occurring outdoors. Among outdoor falls, the variation was found among males and adults aged 65 to 74 years. The percentages of visits for weather-related outdoor falls were also higher among males and the 65-74 year age group.

CONCLUSIONS

In 2015, there was a seasonal variation in fall-related ED visits in the United States. Weather-related slips and trips in winter may partially account for the seasonal variation.

PRACTICAL IMPLICATIONS

These results can inform healthcare providers about the importance of screening all older adults for fall risk and help to identify specific patients at increased risk during winter. They may encourage community-based organizations serving older adults to increase fall prevention messaging during winter.

Characteristics of fall-related head injury versus non-head injury in the older adults

Background

This study aimed to examine the characteristics of older adults patients who suffered a head injury after a ground-level fall in comparison to non-head injury patients as well as the factors associated with severity in those with head injury only.

Methods

Patients were classified into two groups, the head injury group and the non-head injury group. The characteristics were compared and factors associated with head injury were evaluated. Factors relating to severe injury in the head injury group were also investigated.

Results

The head injury group comprised 42 % of a study subjects. Male sex; fall time of 18:00–23:59; fall location of medical facility, transportation area, and public or commercial facility; fall in an outdoor area; fall during daily activity; alcohol ingestion; fall from stairs; non-slippery floor conditions; concrete flooring; sloped flooring; and presence of obstacles on the floor were risk factors for head injury in the older adults after a ground-level fall. Male sex and age over 70 years; fall time of 00:00–05:59; fall in a residential facility; fall in an indoor area; fall during daily activity; fall from stairs; non-slippery floor conditions; and presence of obstacles on the floor were factors associated with severe injury in the head injury group.

Conclusions

Male sex with advanced age, indoor fall, and the presence of obstacles on the floor were risk factors for severe injury in the head injury group in older adults individuals who suffered a ground-level fall. It is necessary to develop appropriate ground-level fall prevention programs by evaluating the individual and environmental characteristics of older adults patients.

Examining the relationships between walkability and physical activity among older persons: what about stairs?

BACKGROUND

Walkability is considered an important dimension of healthy communities. However, variable associations between measures of walkability and physical activity have been observed, particularly among older persons. Given the challenges older persons may have navigating stairs on walking routes, the presence of stairs may be an explanatory factor for these mixed associations. The purposes of this scoping review were to determine whether studies examining the relationship between walkability and physical activity included items that assessed stairs and what relationships were found.

METHODS

Systematic reviews were identified by entering search terms into five database search engines. Eligibility criteria were: a) published between 2008 and 2017, b) examined the relationship between walkability and physical activity, c) included a focus on persons aged 65 years and older, and d) written in English. The full articles for all primary studies included in eligible systematic reviews were then retrieved. Duplicates were removed. Information about where the study took place, walkability measures used, types of walkability data obtained (objective and/or subjective) and questions asked about stairs were extracted from the full text articles.

RESULTS

Eleven systematic reviews were identified; seven were eligible. After removing duplicates, 289 primary studies remained for review. Measures of neighborhood walkability were present in 205 studies; a minority (n = 5, 2.4%) included items about stairs. No information was obtained on the structural features of the stairs.

CONCLUSIONS

The presence of stairs may deter older persons (and others) from walking outdoors. Standard measures to document the presence and characteristics of stairs, and sampling approaches to select stairs for assessment are needed. The inclusion of these measures would augment the utility and comparability of studies examining relationships between walkability and physical activity and better inform planning and policy decisions.