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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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Fujii M, Shirakawa T, Nakamura M, Baba M, Hitosugi M. Factors influencing the injury severity score and the probability of survival in patients who fell from height. Sci Rep 2021; 11:15561. [PMID: 34330987 PMCID: PMC8324820 DOI: 10.1038/s41598-021-95226-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
In Japan, falls from height result in the second highest trauma mortality rate after traffic motor vehicle collisions and the highest trauma-related mortality rate amongst young people. We aimed to identify factors that worsen injury severity and lower survival probability of patients who fell from height and to contribute to the improvement of their prehospital and in-hospital care. This retrospective analysis retrieved hospital records of 179 patients aged ≥ 15 years who were transported to our hospital after a fall from height during April 2014–March 2020. On multiple regression analysis, fall height ≥ 5 m more significantly resulted in higher the injury severity score. Logistic regression analysis revealed that fall height ≥ 5 m with the reference of 2–3 m significantly resulted in lower the survival probability with odds ratio (95% confidence interval) of 0.10 (0.02–0.55). Using ‘feet-first’ as the reference body position, the odds ratios (95% confidence interval) of survival for those who impacted the surface on the lateral or dorsal regions were 0.11 (0.02–0.64) and 0.17 (0.03–0.99), respectively. Collecting information on the abovementioned factors at pre-hospitalisation may facilitate prompt diagnosis and treatment. These results may help improve prehospital and in-hospital care, avoiding preventable trauma deaths.
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Affiliation(s)
- Masashi Fujii
- Department of Anaesthesia, Nagahama Red Cross Hospital, 14-7 Miyamae, Nagahama, Otsu, Shiga, 526-8585, Japan. .,Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
| | - Tsutomu Shirakawa
- Department of Orthopaedic Surgery, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mineko Baba
- Centre for Integrated Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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Giudici R, Lancioni A, Gay H, Bassi G, Chiara O, Mare C, Latronico N, Pesenti A, Faccincani R, Cabrini L, Fumagalli R, Chieregato A, Briani L, Sammartano F, Sechi G, Zoli A, Pagliosa A, Foti G, Borotto E, Palo A, Valoti O, Botteri M, Carlucci M, Reitano E, Bini R. Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry. World J Emerg Surg 2021; 16:39. [PMID: 34281575 PMCID: PMC8287111 DOI: 10.1186/s13017-021-00383-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Backgrounds The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001). Conclusions The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.
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Affiliation(s)
- Riccardo Giudici
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy
| | - Armando Lancioni
- Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Monza, Italy
| | - Hedwige Gay
- Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Monza, Italy
| | - Gabriele Bassi
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy
| | - Osvaldo Chiara
- Emergency Department, General Surgery and Trauma Team, ASST Niguarda, University of Milano, Piazza Ospedale Maggiore 3, 20162, Milano, Italy.
| | - Claudio Mare
- Regional Agency of Emergency and Urgency, Milan, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione Policlinico, University of Milan, Milan, Italy
| | | | - Luca Cabrini
- Department of Anesthesia and Intensive Care, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Roberto Fumagalli
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy.,Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Milan, Italy
| | - Arturo Chieregato
- Department of Anesthesia and Intensive Care Medicine, Neuro Intensive Care, ASST Niguarda, Milan, Italy
| | - Laura Briani
- Emergency Department, Department of General Surgery and Trauma Team, ASST Niguarda, Milan, Italy
| | - Fabrizio Sammartano
- Emergency Department, Emergency and Trauma Surgery, ASST Santi Carlo e Paolo, Milan, Italy
| | | | - Alberto Zoli
- Regional Agency of Emergency and Urgency, Milan, Italy
| | | | - Giuseppe Foti
- Department of Anesthesia and Intensive Care Medicine, S.Gerardo Hospital, University Milano Bicocca, Monza, Italy
| | - Erika Borotto
- Department of Anesthesia and Intensive Care, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Marco Botteri
- Regional Agency of Emergency and Urgency, Brescia, Italy
| | - Michele Carlucci
- General and Emergency Surgery and Emergency Department, Ospedale San Raffaele, Milan, Italy
| | - Elisa Reitano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Roberto Bini
- Emergency Department, Department of General Surgery and Trauma Team, ASST Niguarda, Milan, Italy
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The Influence of Walking Height and Width on the Gait. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6675809. [PMID: 34257853 PMCID: PMC8249159 DOI: 10.1155/2021/6675809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/10/2021] [Indexed: 11/17/2022]
Abstract
Walking stability is an important factor that is related to working accidents at height. The understanding of the relationship between walking stability and walking conditions remains an unmet need. Therefore, this study aimed to investigate the effect of path height, width, and asymmetric conditions on the pressure and time information of the foot-ground interaction during walking. 12 subjects were required to walk at two height, three width, and asymmetric conditions. Plantar pressures during walking were measured with the F-scan insole sensors. The total pressures were normalized with body weight, and the temporal parameters were normalized with stance time. When the walking height increased, the plantar pressure at the "heel strike" phase did not change significantly, while that at "heel rise" and "toe off" phases significantly increased, and the "heel rise" occurred earlier, indicating a greater foot-ground interaction at the forefoot part of the sole. As the path width increased from 0.6 m to 1.2 m, the foot-ground interaction as well as the asymmetric effect approached to that of overground walking. The findings could help improve the risk assessment and footwear design.
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Difino M, Bini R, Reitano E, Faccincani R, Sammartano F, Briani L, Cimbanassi S, Chiara O. Epidemiology of trauma admissions in a level 1 trauma center in Northern Italy: a nine-year study. Updates Surg 2021; 73:1963-1973. [PMID: 34003478 PMCID: PMC8500878 DOI: 10.1007/s13304-021-00991-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/28/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study was to analyze the results of 9 years of trauma care and data collection in a level 1 urban trauma center in Northern Italy. Overall, 6065 patients have been included in the study; the number of patients managed yearly has doubled between 2011 and 2019. This rise mostly involved patients with injury severity score (ISS) < 16. Most injuries (94%) were blunt. Road traffic accidents, especially involving motorcycles, were the most common cause of injury. Self-inflicted injuries were responsible for less than 5% of trauma but they were severe in 56% of cases. The median age was 38 and it remained constant over the years; 43% of patients had 14-39 years of age. Different characteristics and patterns of injury were observed for each age group and gender. Males were more likely to be injured in the central years of life while females presented a trimodal pattern in the age distribution. Young adults (14-39 years old) were overall at higher risk of self-harm. Overall mortality was equal to 5.2%. Most deceased were male and ≥ 65 years of age.
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Affiliation(s)
- Margherita Difino
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Roberto Bini
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Elisa Reitano
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- University of Milano, Festa del Perdono 7, 20122, Milan, Italy
| | - Roberto Faccincani
- Emergency Department, IRCCS San Raffaele, Via Olgettina, 60, 20132, Milan, Italy
| | - Fabrizio Sammartano
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Laura Briani
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
- University of Milano, Festa del Perdono 7, 20122, Milan, Italy.
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