Pattern of fall injuries in Pakistan: the Pakistan National Emergency Department Surveillance (Pak-NEDS) study

Characteristics of fall-from-height patients: a retrospective comparison of jumpers and fallers using a multi-institutional registry

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.

Mortality from fall: A descriptive analysis of a multicenter Indian trauma registry

INTRODUCTION

Fall is the second most common mechanism of trauma worldwide after road traffic injuries. Data on fall predominantly comes from the high-income countries (HICs) and mostly includes injuries in children and elderly. There are very few studies from low- and middle-income countries(LMICs) that describe fall related injuries other than fragility fractures in elderly. This study describes the profile of poly-trauma patients admitted with a history of 'fall' and assesses the variables associated with mortality.

METHOD

We analyzed data from the 'Towards Improved Trauma Care Outcome' (TITCO) database which prospectively collected data of poly-trauma patients admitted to four major tertiary care hospitals of India between 2013 to 2015. Patients across all age groups admitted to hospital with the history of 'fall'; were included in our study. Single bone fractures were excluded.  The Kaplan Meier survival analysis was used to estimate the survival probability in different age groups.

RESULTS

A total of 3686 patients were included in our study. The median age of the patients was 28 years (IQR: 9, 47) with the majority being males (73.6%). Almost one-third of the patients were within the age group of 0-14 (30.4%). Most of the patients (79.9%) had a diagnosis of traumatic brain injury (TBI). The overall in-hospital mortality was 18% (664), but higher at 39.0% among patients over 65 years of age. Probability of survival decreased with increase of age.

CONCLUSION

Falling from height is a common injury mechanism in India, occurring more in young males and usually associated with TBI. Isolated TBI and TBI associated with other injuries are the main contributors of mortality in fall injuries. Mortality from these injuries increased with age and ISS.

Role of environmental and occupational factors in fall-related maxillofacial fractures

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.

Pattern and Outcomes of Fall Injuries and Associated Factors in Emergency Department at Addis Ababa Burn, Emergency and Trauma Hospital

INTRODUCTION

Fall injuries are an important public health concern and remain a growing health problem globally. Falls are predicted to rise in rank compared to other causes of death, to become the 17th leading cause of death by 2030 unless necessary intervention is given.

PURPOSE

This study was aimed to assess the pattern, outcomes of fall injuries, and associated factors.

METHODS

A cross-sectional study design was employed to review a patient's registration chart from January 1, 2019 to December 31, 2019. Data were collected using a structured checklist developed from previous similar studies. The checked data were entered into Epi data 4.1 versions. Then, it was exported to SPSS 25 versions for analysis. Data were analyzed using descriptive statistics and logistic regression. In the multivariate logistic regression predictors having a P-value < 0.05 were considered to be statistically associated.

RESULTS

A total of 331 patients' charts were reviewed. The most common outcome of falling injury was alive 284 (85.8%) while death accounts for 47 (14.2%). Among injured body parts, extremity accounts for around one-fourth, 88 (26.6%), followed by head injury 68 (20.5%). In multivariate logistic regression, those patients aged ≥65 years had 6.15 times more likely to die than those patients aged between 15 and 30 years (AOR 6.15; 95% CI 2.82-14.37, P=0.015), and participants with comorbidity were 1.6 times more likely to die than to be discharged (AOR 1.60; 95% CI, 1.01-5.09, P=0.005) due to falling injury, whereas patient's occupation, marital status, and sex had no significant association with outcomes of a fall injury.

CONCLUSION

The most common outcomes of fall injury were discharged with improvement even though there was a high death rate. Extremity injuries were the most common pattern of injury. Fall is high-risk mortality in the older age group. Furthermore, patient with comorbidity, fall from height and injury to spinal cord and poly-trauma is more likely to die relative to other patients.

Suicidal intent as a risk factor for mortality in high-level falls: a comparative study of suicidal and accidental falls

OBJECTIVE

Suicide is a major issue in South Korea, and falling is a common method of suicide. Further, accidental falls are a common cause of death. However, whether suicidal falls differ from accidental falls is inconclusive. This study aimed to compare suicidal and accidental falls to identify risk factors for mortality.

METHODS

From March 2010 to December 2016, patients admitted to our hospital because of falls were reviewed retrospectively. Characteristics and outcomes were compared between suicide and accident groups. Injury distribution was compared using the Injury Severity Score and Abbreviated Injury Scales. Multivariate analysis was performed to identify risk factors, including suicide intent, for mortality.

RESULTS

Of 242 patients, 42 were included in the suicide group and 200 were included in the accident group. The suicide group showed higher fall heights and injuries of greater severity. The accident group was younger and included a higher number of men. The suicide group showed a higher mortality (23.8% vs. 6.5%, P=0.001) and a higher proportion of injuries in the lower extremities or abdomen. In the multivariate analysis, Glasgow Coma Scale score (0.575 [0.433-0.764], P<0.001), body mass index (1.638 [1.194-2.247], P=0.002), suicide intent (9.789 [1.026-93.404], P=0.047) and Injury Severity Score (1.091 [1.000-1.190], P=0.049) were identified as risk factors for mortality.

CONCLUSION

Suicidal falls were associated with poorer outcomes and a greater tendency to land feet first relative to accidental falls. Suicide intent was a risk factor for mortality.

Fall-related hospitalization of patients in Iran

PURPOSE

Trauma has been called the neglected disease of modern society. According to WHO, fall is the second major cause of trauma or deaths resulting from unintentional accidents. The aim of this study was to investigate the different types of fall according to International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) in hospitalized patients visiting specialized accident and trauma hospitals of Mashhad, Iran.

METHODS

This was a cross sectional retrospective study performed between March 20, 2013 and March 20, 2014. The research population consisted of all medical records of patients for fall injuries in three specialized accident and trauma hospitals. ICD-10 was adopted to categorize all types of falls (w00-w19). The results obtained were analyzed by SPSS 16.

RESULTS

Altogether 7,448 cases were included. The codes w18 (fall on same level) and w09 (fall involving playground equipment) with the frequencies of 1,856 and 1,303, respectively in both genders had the maximum number of falls. The maximum percentage of mortality has been related to "fall on and from ladder"," fall from cliff "and "fall on same level involving ice and snow".

CONCLUSION

As falls can cause irrecoverable injuries including mortality of people, thus health authorities and policymakers should take preventive measures given the causes of falls and the root of this type of injuries, so that the costs resulting from this cause and its injuries can be reduced.

The interventions and outcomes associated with fall-related injuries at tertiary hospitals in the Kingdom of Saudi Arabia: a cross sectional study

Introduction

fall-related injuries are an important health concern around the globe, imposing an immense economic burden. The aim of this study is to evaluate the interventions and outcomes associated with fall-related injuries in a tertiary hospital in the Kingdom of Saudi Arabia (KSA).

Methods

a cross-sectional study including 264 patients with fall-related injuries was conducted at the King Khalid Hospital and Prince Sultan Centre for Health Care and other hospitals in Al Kharj from March 01, 2019 to November 30, 2019. The patients were recruited, identified at the point of presentation to the emergency department and followed through the triage, admission and discharge processes. The researchers analysed the participant´s clinical notes on the electronic health record (EHR) to obtain information relevant to the study, including demographic information, the injury patterns and their management.

Results

most patients studied were children under the age of 10 (25.7%). The vast majority (96.9%) of patients fell from a height, while the rest fell from a height onto a sharp object. Most of them (90.9%) had experienced no shock symptoms. Upper limb injuries had the highest prevalence (37.8%), followed by lower limb injuries (22.7%), head injuries (19.7%) and skull fractures (13.6%). Invasive surgery, blood transfusions, admission to intensive care (ICU) and thoracostomy (chest tube) were required by 74%, 3%, 3% and 2% of patients, respectively.

Conclusion

fall-related injuries may result in invasive surgery, chest drain insertion, or ICU admission, increasing the burden on the healthcare system.

Analysis of Injury Patterns and Outcomes of Blunt Thoracic Trauma in Elderly Patients

Introduction

In the elderly population, trauma is a leading cause of utilization of healthcare, institutionalization, disability, and mortality. In this study, we will assess the injury patterns and the factors associated with the outcomes of blunt thoracic trauma in elderly individuals.

Methods

This prospective observational study was conducted in the Department of Thoracic Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from September 2019 to April 2020. The study included patients of both genders aged 60 years and above with blunt thoracic trauma. Patients with concomitant neurological injuries and penetrating trauma to the chest were excluded.

Results

There were a total of 80 patients in this study; majority were males (n = 66 [82.5%]). The mean age was 70.18 ± 8.3 years. Road traffic accident was the most common mode of injury (n = 45 [56.3%]) followed by fall (n = 32 [40%]). Hemothorax and hemopneumothorax were the most common primary diagnosis. Rib fractures were encountered in 72 (90%) patients. Mortality rate was 21.3% (n = 17). Factors significantly related to mortality were age ≥ 80 years (p = 0.00), tension pneumothorax (p = 0.036), pre-existing cardiopulmonary disease (p = 0.032), blood loss ≥ 500 mL (p = 0.004), flail chest (p = 0.018), and chest trauma score ≥ 5 (p = 0.001). Mean hospital stay in our study was 5.3 ± 3.4 days. Factors lengthening hospital stay by more than five days included lung contusion (p = 0.02), more than two rib fractures (p = 0.004), hemopneumothorax (p = 0.026), pneumonia (p = 0.003), acute respiratory distress syndrome (p = 0.003), and flail chest (p = 0.013).

Conclusions

Elderly patients with blunt thoracic trauma have higher mortality. Proactive evaluation of injuries using the chest trauma score in the elderly population helps in recognizing patients at high risk of mortality and helps in the timely management to prevent adverse outcomes.

Severity of Injury and Associated Factors among Injured Patients Who Visited the Emergency Department at Wolaita Sodo Teaching and Referral Hospital, Ethiopia

Background

An injury is a physical damage that occurs when the body is exposed to an excessive amount of energy. Physical agents, radiation, chemical agents, biological agents and physiological needs deprivation can cause injury. The study was aimed at assessing the severity of injury and identifying the factors associated with it among injured patients.

Methods

A cross-sectional study was conducted among patients who visited the emergency department of Wolaita Sodo Teaching and Referral Hospital from January 1, 2012 – January 1, 2017. A total of 320 patient records were included in the study and selected using simple random sampling. Statistical association was done for categorical variables using Chi-square. Rank correlation was done for three ordered options independent variables, Chi-squared test for trend used for two options independent variables, and General Chi-square test of independence used for independent variables with not ordered three and above options. Multivariate multinomial logistic regression was conducted. A P-value <0.05 was taken as a significant association.

Results

The study indicated that the majority (45.3%), 128(40%) and 47(14.7%) had minor, moderate and severe injury, respectively. Residence (AOR 0.462; 95%CI 0.268, 0.798), cause of injury (AOR 3.602; 95%CI 1.336, 9.714), night time injury (AOR 4.895; 95%CI 1.472, 16.277), afternoon time injury (AOR 8.776; 95%CI 2.699, 28.537), and chest injury (AOR 2.391; 95%CI 1.048, 5.454) were significant predictors of moderate injury. Afternoon time of injury (AOR; 4.683; 95%CI 1.137, 19.296) and head, neck and spinal cord injury (AOR; 4.933; 95%CI 1.945, 12.509) were predictors of severe injury.

Burden of injuries in Nepal, 1990-2017: findings from the Global Burden of Disease Study 2017

Background

Nepal is a low-income country undergoing rapid political, economic and social development. To date, there has been little evidence published on the burden of injuries during this period of transition.

Methods

The Global Burden of Disease Study (GBD) is a comprehensive measurement of population health outcomes in terms of morbidity and mortality. We analysed the GBD 2017 estimates for deaths, years of life lost, years lived with disability, incidence and disability-adjusted life years (DALYs) from injuries to ascertain the burden of injuries in Nepal from 1990 to 2017.

Results

There were 16 831 (95% uncertainty interval 13 323 to 20 579) deaths caused by injuries (9.21% of all-cause deaths (7.45% to 11.25%)) in 2017 while the proportion of deaths from injuries was 6.31% in 1990. Overall, the injury-specific age-standardised mortality rate declined from 88.91 (71.54 to 105.31) per 100 000 in 1990 to 70.25 (56.75 to 85.11) per 100 000 in 2017. In 2017, 4.11% (2.47% to 6.10%) of all deaths in Nepal were attributed to transport injuries, 3.54% (2.86% to 4.08%) were attributed to unintentional injuries and 1.55% (1.16% to 1.85%) were attributed to self-harm and interpersonal violence. From 1990 to 2017, road injuries, falls and self-harm all rose in rank for all causes of death.

Conclusions

The increase in injury-related deaths and DALYs in Nepal between 1990 and 2017 indicates the need for further research and prevention interventions. Injuries remain an important public health burden in Nepal with the magnitude and trend of burden varying over time by cause-specific, sex and age group. Findings from this study may be used by the federal, provincial and local governments in Nepal to prioritise injury prevention as a public health agenda and as evidence for country-specific interventions.

The epidemiology of emergency presentations for falls from height across Western Victoria, Australia

BACKGROUND

In order to implement intervention strategies to prevent falls from height, epidemiological data are needed. The aim of this study was to map emergency presentations for falls from height in residents aged ≥40yr of the western region of Victoria, Australia.

METHODS

Emergency presentations following a fall from height (≥1m) were obtained from electronic medical records for 2014-2016 inclusive. For each Local Government Area, age-standardised incidence rates (per 10,000 population/year) were calculated.

RESULTS

The age-standardised incidence rate was lowest in the Northern Grampians (3.4 95%CI 0.8-5.9), which has several main industries including health care, agriculture and manufacturing. The highest rates occurred in Corangamite (26.0 95%CI 19.9-32.0), Colac-Otway (23.7 95%CI 18.5-28.8) and Moyne (22.5 95%CI 16.8-28.3), which are sparsely populated (15,000-20,000 people each). Patterns were similar for men and women. Most falls occurred during "leisure" (38.0%), followed by "other work" (15.4%). Men were more likely than women to experience a fall from height while undertaking work activities. Many falls occurred in the home (53.2%).

CONCLUSION

Future research should inform strategies to prevent falls from height in the region. This could include specific locations such as the home or farm, and during leisure activities or work.

A survey of prehospital and acute hospital care in three low and middle income countries

A prospective survey of neurotrauma admitted to neurosurgical units in three low and middle income countries (LMIC) indicated a frequent lack of organised prehospital care. On site care was usually provided by a member of the public. The accident victim was rarely accompanied within an equipped ambulance by trained personnel. Intensive care management and intracranial pressure monitoring was rare. There appeared to be limited rehabilitation in all regions.

Epidemiology of Fall Injury in Rural Bangladesh

Globally, falls are the second leading cause of unintentional injury deaths, with 80% occurring in low-and middle-income countries. The overall objective of this study is to describe the burden and risk factors of falls in rural Bangladesh. In 2013, a large household survey covering a population of 1,169,593 was conducted in seven rural sub-districts of Bangladesh to assess the burden of all injuries, including falls. The recall periods for non-fatal and fatal injuries were six and 12 months, respectively. Descriptive, bivariate and multiple logistic regression analyses were conducted. The rates of non-fatal and fatal falls were 36.3 per 1000 and 5 per 100,000 population, respectively. The rates of both fatal and non-fatal falls were highest among the elderly. The risk of non-fatal falls was higher at extremes of age. Lower limb and waist injuries were frequent following a fall. Head injuries were frequent among infants (35%), while lower limb and waist injuries were frequent among the elderly (>65 years old). Injuries to all body parts (except the waist) were most frequent among men. More than half of all non-fatal falls occurred in a home environment. The injury patterns and risk factors of non-fatal falls differ by sociodemographic factors.

Balconing: An alcohol-induced craze that injures tourists. Characterization of the phenomenon

BACKGROUND

Balconing is the term that has been given to consciously jumping into a swimming pool from a balcony or falling from height while climbing from one balcony to another in hotels during holidays METHOD: A 5 years retrospective study was conducted in a tertiary referral centre for severe trauma in the Balearic Islands, where balconing is endemic. Demographic data such as age, sex, nationality, personal records, alcohol or drug consumption, height of the fall and season of the year were collected. Scales of trauma severity and mortality rates were also included.

RESULTS

Most of the patients were males, 45 (97.83%), aged 24.20±5.98years, 28 of them of British nationality (60.87%). In 44 (95.65%) cases, alcohol consumption was present accompanied by other drugs in 17 (36.96%) cases. The mean height of the fall was approximately 3 floors. Only 6 (13.04%) were intentional jumpers whereas 40 (86.96%) fell while trying to reach another balcony.

CONCLUSION

Balconing is a new injury mechanism for alcohol-related falls from heights. Alcohol and other drug consumption are almost always involved, so balconing could be addressed as another consequence of alcohol abuse and binge drinking.