Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma

Mechanisms of traumatic cardiac arrest in Kuwait: A retrospective study

The objective of this study is to describe the epidemiology and causes of traumatic cardiac arrest (TCA) in Kuwait aiming to provide a preliminary background to update the current guidelines and improve patients' management.This is a retrospective analysis of TCA cases retrieved from emergency medical services archived data between 1 January and 31 December 2017. The TCA cases were sub-grouped based on mechanism of injury then compared in terms of patient demographics, vital signs, patterns of injuries, resuscitation practices, and outcomes.Outcomes; On scene mortality rate and pre-hospital return of spontaneous circulation.Among the 204 TCA patients, 140 patients met the inclusion criteria. This whole group was then divided in to 4 subgroups: road traffic accident (RTA) 76% (n=106), fall from height (FFH) 13% (n = 18), slip/fall 4% (n = 6), and assaults 7% (n = 10). There was significant difference between the four mechanisms in: mean age (P =  < .001), type of injury (P = .005), head injury (P = .005), chest injury (P = .003), GCS score < 9 (P = .004) and initial hypertension (P =  < .001). Initial hypertension and GCS score < 9 were only documented in head injuries of RTA and slip/fall groups. Significant difference was also seen in cardiopulmonary resuscitation (P = .006), airway management (P = .035) and on scene mortality rate (P = .003). All patients who had isolated head injury in FFH were pronounced dead on scene, 60%.Not all TCA incidents are the same, there are different pattern of injuries in each TCA mechanism. Head injuries are predominantly seen in RTA, FFH, slip /falls and chest injuries are seen in assaults. This can influence emergency medical services personals resuscitation plan. Further research is required to address the resuscitation of TCA of different mechanisms.

Accuracy of Height Estimation Among Bystanders

INTRODUCTION

High-risk mechanisms in trauma usually dictate certain treatment and evaluation in protocolized care. A 10-15 feet (ft) fall is traditionally cited as an example of a high-risk mechanism, triggering trauma team activations and costly work-ups. The height and other details of mechanism are usually reported by lay bystanders or prehospital personnel. This small observational study was designed to evaluate how accurate or inaccurate height estimation may be among typical bystanders.

METHODS

This was a blinded, prospective study conducted on the grounds of a community hospital. Four panels with lines corresponding to varying heights from 1-25 ft were hung within a building structure that did not have stories or other possibly confounding factors by which to judge height. The participants were asked to estimate the height of each line using a multiple-choice survey-style ballot. Participants were adult volunteers composed of various hospital and non-hospital affiliated persons, of varying ages and genders. In total, there were 96 respondents.

RESULTS

For heights equal to or greater than 15 ft, less than 50% of participants of each job description were able to correctly identify the height. When arranged into a scatter plot, as height increased, the likelihood to underestimate the correct height was evident, having a strong correlation coefficient (R=+0.926) with a statistically significant p value = <0.001.

CONCLUSION

The use of vertical height as a predictor of injury severity is part of current practice in trauma triage. This data is often an estimation provided by prehospital personnel or bystanders. Our small study showed bystanders may not estimate heights accurately in the field. The greater the reported height, the less likely it is to be accurate. Additionally, there is a higher likelihood that falls from greater than 15 ft may be underestimated.

Usual Alcohol Consumption and Risks for Nonfatal Fall Injuries in the United States: Results From the 2004-2013 National Health Interview Survey

BACKGROUND

Acute alcohol consumption is known to be a risk factor for fall injuries.

OBJECTIVE

The study sought to determine whether usual alcohol consumption increases the risk for nonfatal fall injuries.

METHOD

Data from 289,187 sample adults in the 2004-2013 U.S. National Health Interview Surveys were analyzed. Of these, 3,368 (∼1%) reported a total of 3,579 fall-injury episodes requiring medical consultation in the past 3 months. Latent class analysis based on four contextual indicators identified four ecological subtypes of fall injury within two age groups (18-49 and 50+). Five drinking patterns (i.e., lifetime abstainer, former drinker, low-risk drinker, increased-risk drinker, and highest-risk drinker) were categorized according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) low-risk drinking guidelines. Controlling for potential confounders, negative binomial regression estimated the adjusted rates of any type and subtypes of fall injury, by gender, for each drinking pattern relative to lifetime abstainer.

RESULTS

Compared with lifetime abstainers, the adjusted rate of any fall injury for adults ages 18-49 was significantly higher among highest-risk drinkers (men: incidence rate ratio [IRR] = 2.59, 95% confidence interval [CI] [1.60, 4.20]; women: IRR = 1.90, 95% CI [1.24, 2.91]) and increased-risk drinkers (men: IRR = 1.94, 95% CI [1.25, 3.00]; women: IRR = 1.51, 95% CI [1.11, 2.07]). Furthermore, highest-risk drinkers had higher adjusted rates of either leisure- or sports-related fall injuries than lifetime abstainers.

CONCLUSIONS

Alcohol consumption exceeding NIAAA's low-risk drinking guidelines is associated with elevated rates of nonfatal fall injuries. Findings underscore the importance of adhering to these recommendations.

Injury Severity Score based estimation of height of fall in bus rolling down the cliff

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.

Hollow-organ perforation following thoracolumbar spinal injuries of fall from height

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We describe two cases of Hollow-organ perforation following thoracolumbar injury.

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All patient have mild inferior motoric parapareses 4/5 and 3/5 also complaint diffusely abdominal tenderness.

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The mechanism of hollow organ perforation. The mechanism of hollow organ perforation following blunt thoracoabdominal is the theory suggests that these injuries may arise due to the shear stress exerted on the hollow organ wall.

Introduction

Spinal trauma is the cause of high mortality and morbidity, the fall from height as mechanism that can cause a wide variety of lesions, associated both with the direct impact on the ground and with the deceleration. In such fall cases greater heights and higher mortality are involved.

Presentation of case

We report the successful management of life-threatening hollow-organ perforation following thoracolumbar spinal injury.

Discussion

Perforation of the hollow-organ in the setting of thoracolumbar trauma may delay the diagnosis and can have devastating consequences.

Conclusions

This case supports the recommendation for neurosurgeon in the setting of thoracolumbar injury that perforation of the hollow-organ can have devastating consequences. It is vital to achieve an early diagnosis to improve survival rate.