Falls from height: A retrospective analysis

doi:10.5847/wjem.j.1920-8642.2018.01.007

Abstract

Abstract:

BACKGROUND: Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of falls from height and their relationship to the mortality.
METHODS: A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively. Demographic parameters, fall characteristics and their effect to mortality were evaluated statistically.
RESULTS: The study comprised of 292 (63.5%) men and 168 (36.5%) women patients. The mean age of all patients was 27±24.99 years. Twenty-six (5.6%) patients died and the majority of them were in ≥62 years old group. The highest percentage of falls was at 0-5 years age group (28.3%). People fell mainly from 1.1-4 metres(m) level (46.1%). The causes of falls were ordered as unintentional (92.2%), workplace (8.1%) and suicidal (1.7%). Skin and soft tissue injuries (37.4%) were the main traumatic lesions.
CONCLUSION: Age, fall height, fall place, linear skull fracture, subarachnoidal hemorrhage, cervical fracture, thoracic vertebra fracture and trauma scores had statistically significant effect on mortality. The casualties died because of subarachnoid hemorrhage mostly.

Key words: Trauma, Falls, Mortality, Emergency medicine

Kasim Turgut, Mehmet Ediz Sarihan, Cemil Colak, Taner Güven, Ali Gür, Sükrü Gürbüz. Falls from height: A retrospective analysis[J]. World Journal of Emergency Medicine, 2018, 9(1): 46-50.

Figures/Tables 4

Table 1

Table 2

Table 3

Table 4

References 24

1	Ersoy S, Sonmez BM, Yilmaz F, Kavalci C, Ozturk D, Altinbilek E, et al. Analysis and injury paterns of walnut tree falls in central anatolia of turkey. World J Emerg Surg. 2014;9:42. doi: 10.1186/1749-7922-9-42 pmid: 25006346
2	WorkSafeBC’s 2013 Annual Report. 2013 Statistics Serving British Columbians. Available from: https://www.worksafebc.com/en/search#q=2013%20report&sort=relevancy&f:language-facet=[English]
3	Gulatı D, Aggarwal AN, Kumar S, Agarwal A. Skeletal injuries following unintentional fall from height. Ulus Travma Acil Cerrahi Derg. 2012;18(2):141-6. doi: 10.5505/tjtes.2012.12058 pmid: 22792820
4	Oguztürk H, Turgut K, Turtay MG, Sarihan ME, Gur A, Beydilli I, et al. Apricot tree falls: a study from Malatya, Turkey. Biomedical Research. 2016; 27(1):210-3.
5	İcer M, Güloglu C, Orak M, Ustundag M. Factors affecting mortality caused by falls from height. Ulus Travma Acil Cerrahi Derg. 2013;19(6):529-35. doi: 10.5505/tjtes.2013.77535 pmid: 24347212
6	Guneytepe UI, Aydin SA, Gokgoz S, Ozguc H, Ocakoglu G, Aktas H. Factors affecting mortality and scoring systems in geriatric trauma patients. Uludag Medical Journal. 2008;34:15-9.
7	Jain V, Jain S, Dhaon BK. A multi factorial analysis of the epidemiology of injuries from falls from heights. Int J Crit Illn Inj Sci. 2014;4(4):283-7. doi: 10.4103/2229-5151.147519 pmid: 25625058
8	Guzel A, Karasalihoglu S, Kucukugurluoglu Y. Evaluation of patients applied to pediatric emergency department due to falls. Turkish Journal of Trauma and Emergency Surgery. 2007;13:211-6. pmid: 17978896
9	Yavuz M, Tomruk O, Baydar C, Kupeli A. Evaluation of accidental fall from high cases who admitted to emergency service. Journal of Forensic Medicine. 2004;18:8-12.
10	Pressley JC, Barlow B. Child and adolescent injury as a result of falls from buildings and structures. Inj Prev. 2005;11(5):267-73. doi: 10.1136/ip.2004.007724 pmid: 16203834
11	Eren A, Arslan M, Hilal A, Cekin N. Deaths due to fall from a height in Adana. Adli Tıp Bülteni. 2009;14:12-5.
12	Southerland LT, Stephens JA, Robinson S, Falk J, Phieffer L, Rosenthal JA, et al. Head trauma from falling increases subsequent emergency department visits more than other fall-related injuries in older adults. J Am Geriatr Soc. 2016;64(4):870-4. doi: 10.1111/jgs.14041 pmid: 27100582
13	Buckman RF, Buckman PD. Vertical deceleration trauma. Principles of management. Surg Clin North Am. 1991;71(2):331-44. doi: 10.1016/s0039-6109(16)45383-1 pmid: 2003254
14	Lee BS, Eachempati SR, Bacchetta MD, Levine MR, Barie PS. Survival after a documented 19-story fall: a case report. J Trauma. 2003;55(5):869-72. doi: 10.1097/01.TA.0000075347.57152.B4 pmid: 14608159
15	Liu CC, Wang CY, Shih HC, Wen YS, Wu JJ, Huang CI, et al. Prognostic factors for mortality following falls from height. Injury. 2009;40(6):595-7. doi: 10.1016/j.injury.2008.11.014
16	Velmahos GC, Demetriades D, Theodorou D, Cornwell EE 3rd, Belzberg H, Asensio J, et al. Patterns of injury in victims of urban free falls. World J Surg. 1997;21(8):816-20; discussion 820-1. doi: 10.1007/BF01655250 pmid: 3095993
17	Al B, Yıldırım C, Coban S. Falls from heights in and around the city of Batman. Ulus Travma Acil Cerrahi Derg. 2009;15(2):141-7. pmid: 19353316
18	Yagmur Y, Guloglu C, Aldemir M, Orak M. Falls from flatroofed houses: a surgical experience of 1,643 patients. Injury. 2004;35(4):425-8. doi: 10.1016/S0020-1383(03)00198-0
19	Kohli A, Banerjee KK. Pattern of injuries in fatal falls from buildings. Med Sci Law. 2006;46(4):335-41. doi: 10.1258/rsmmsl.46.4.335 pmid: 17191637
20	Zahavi A, Luckman J, Yassur I, Michowiz S, Goldenberg-Cohen N. Severe cranial neuropathies caused by falls from heights in children. Graefes Arch Clin Exp Ophthalmol. 2016;254(4):765-72. doi: 10.1007/s00417-015-3199-4 pmid: 26553199
21	Shields BJ, Burkett E, Smith GA. Epidemiology of balcony fall-related injuries, United States, 1990-2006. Am J Emerg Med. 2011;29(2):174-80. doi: 10.1016/j.ajem.2009.08.023
22	Eryilmaz M, Durusu M. Fall from heights among adults. Meandros Medical and Dental Journal. 2008; 9:29-32.
23	Kleber C, Giesecke MT, Tsokos M, Haas NP, Schaser KD, Stefan P, et al. Overall distribution of trauma-related deaths in Berlin 2010: advancement or stagnation of German trauma management? World J Surg. 2012;36(9):2125-30.
24	Kleber C, Giesecke MT, Tsokos M, Haas NP, Buschmann CT. Trauma-related preventable deaths in Berlin 2010: need to change prehospital management strategies and trauma management education. World J Surg. 2013;37(5):1154-61. doi: 10.1007/s00268-013-1964-2

Variables	Survivor (n=434)	Died (n=26)	Total	P
Gender
Male	162 (96.4)	6 (3.6)	168 (100)	0.21
Female	272 (93.1)	20 (6.9)	192 (100)
Age(years)
0-5	129^a (99.2)	1^b (0.8)	130 (100)
6-15	83^a (97.6)	2^a (2.4 )	85 (100)
16-30	74^a (96.1)	3^a (3.9)	77 (100)
31-45	48^a (96)	2^a (4)	50 (100)	<0.001
46-61	49^a (94.2 )	3^a (5.8)	52 (100)
≥62	51^a (77.3)	15^b (22.7)	66 (100)
Fall height (meters)
≤1	183^a (97.9)	4^b (2.1)	187 (100)	<0.001
1.1-4	202^a (95.3)	10^a (4.7)	212 (100)
4.1-9	36^a (81.8)	8^b (18.2)	44 (100)
>9	13^a (76.5)	4^b (23.5)	17 (100)
Ground of fall
Hard	360 (93.5)	25 (4.5)	385 (100)	0.10
Soft	74 (98.8)	1 (1.2)	75 (100)
Cause of fall
Workplace accident	34 (91.9)	3 (8.1)	37 (100)
Suicide	7 (87.5)	1 (12.5)	8 (100)	0.44
Unintentional	393 (94.7)	22 (5.3)	415 (100)
Place of fall
Balcony	104^a (92.9)	8^a (7.1)	112 (100)
Stairs	99^a (94.3)	6^a (5.7)	105 (100)
Tree	38^a (97.4)	1^a (2.6)	39 (100)
Domestic furniture	68^a (100)	0^b (0)	68 (100)
Roof	27^a (84.4)	5^b (15.6)	32 (100)	0.008
Lap	8^a (88.9)	1^a (11.1)	9 (100)
Child park	42^a (100)	0^a (0)	42 (100)
Construction scaffold	9^a (75)	3^b (25)	12 (100)
Others	39 (95.1)	2^b (4.9)	41 (100)
Fall time (o’clock)
00:01-06:00	16 (100)	0 (0 )	16 (100)
06:01-12:00	92 (93.9)	6 (6.1)	98 (100)	0.83
12:01-18:00	196 (94.2)	12 (5.8)	208 (100)
18:01-24:00	130 (94.2)	8 (5.8)	138 (100)

Variables	Survivor	Died	Total	P
Skin and soft tissue injuries	172 (100)	0 (0)	172 (100)
Head
Lineer fracture	33^a (94.3)	2^b (5.7)	35 (100)
Facial bone fracture	16^a (94.1)	1^a (5.9)	17 (100)
Epidural hemorhage	9^a (90)	1^a (10)	10 (100)	0.002
Subdural hemorhage	18^a (72)	7^a (18)	25 (100)
Subarachnoidal hemorhage	17^a (56.7)	13^b (43.3)	30 (100)
Thorax
Rib fracture	26 (74.3)	9 (25.7)	35 (100)
Pneumothorax	13 (68.4)	6 (31.6)	19 (100)	0.79
Hemothorax	5 (62.5)	3 (37.5)	8 (100)
Abdomen-pelvis
Liver injury	5 (71.4)	2 (28.6)	7 (100)
Splenic injury	6 (100)	0 (0)	6 (100)	0.44
Pelvic fracture	7 ( 70 )	3 (30)	10 (100)
Vertebral system
Cervical fracture	8^a (66.7)	4^b (33.3)	12 (100)
Thoracic fracture	10^a (100)	0^b (0)	10 (100)	<0.001
Lumbosacral fracture	27^a(96.4)	1^a (3.6)	28 (100)
Extremities
Upper extremity fracture	61 (98.4)	1 (1.6)	62 (100)
Lower extremity fracture	43 (95.6)	2 (4.4)	45 (100)	0.57

Variables	≤1 meters	1.1-4 meters	4.1-9 meters	>9 meters	P
GCS	14.50±1.46	14.20±2.10	11.60±4.20	11.00±11.00	<0.000001
AIS	3.10±1.70	4.70±2.31	8.00±3.70	8.80±3.66	<0.000001
ISS	8.24±9.10	11.67±10.00	24.70±15.63	30.76±16.03	<0.000001
NISS	8.33±9.64	12.10±11.23	27.50±18.39	31.20±16.03	<0.000001
RTS	7.70±0.46	7.58±0.76	6.63±1.80	5.79±2.34	<0.000001
TRISS	97.10±10.10	94.47±16.65	78.10±33.45	71.61±36.22	<0.000001
CRAMS	9.40±1.15	9.16±1.59	7.50±2.77	6.41±2.50	<0.000001

Variables	Survivor (n=434)	Died (n=26)	P
GCS	14.40±1.55	6.00±2.73	0.0001
AIS	4.21±2.42	10.00±3.62	0.0001
ISS	10.64±10.00	38.70±13.04	0.0001
NISS	11.07±11.20	40.85±14.93	0.0001
RTS	7.68±0.46	4.00±1.56	0.0001
CRAMS	9.30±1.30	4.11±1.82	0.0001
TRISS	97.05±8.63	27.40±25.45	0.0001

[1]	Janett Kreutziger, Philip Puchner, Stefan Schmid, Wolfgang Mayer, Harald Prossliner, Wolfgang Lederer. Accuracy of training blood volume quantification using a visual estimation tool [J]. World Journal of Emergency Medicine, 2021, 12(3): 174-178.
[2]	Gui-long Feng, Miao-miao Zheng, Shi-hong Yao, Yin-qi Li, Shao-jun Zhang, Wei-jing Wen, Kai Fan, Jia-li Zhang, Xiao Zhang. Risk factors and predictive model of adrenocortical insufficiency in patients with traumatic brain injury [J]. World Journal of Emergency Medicine, 2021, 12(3): 179-184.
[3]	Yu-qing Cui, Xian-fei Ding, Huo-yan Liang, Dong Wang, Xiao-juan Zhang, Li-feng Li, Quan-cheng Kan, Le-xin Wang, Tong-wen Sun. Efficacy and safety of low-dose corticosteroids for acute respiratory distress syndrome: A systematic review and meta-analysis [J]. World Journal of Emergency Medicine, 2021, 12(3): 207-213.
[4]	Wen Gao, Yu-ping Zhang, Jing-fen Jin. Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study [J]. World Journal of Emergency Medicine, 2021, 12(2): 117-123.
[5]	Hao-tian Chen, Jian-feng Xu, Xiao-xia Huang, Ni-ya Zhou, Yong-kui Wang, Yue Mao. Blood eosinophils and mortality in patients with acute respiratory distress syndrome: A propensity score matching analysis [J]. World Journal of Emergency Medicine, 2021, 12(2): 131-136.
[6]	Yong Liang, Hong Zeng, Yu-geng Liu, Ai-min Xu, Wen-hong Liu. Prevalence of post-traumatic stress disorder after earthquakes among the elderly in China: A meta-analysis [J]. World Journal of Emergency Medicine, 2021, 12(2): 137-142.
[7]	Wei Guo, Lin-yu Ran, Ji-hong Zhu, Qing-gang Ge, Zhe Du, Fei-long Wang, Wei-bo Gao, Tian-bing Wang. Identifying critically ill patients at risk of death from coronavirus disease [J]. World Journal of Emergency Medicine, 2021, 12(1): 18-23.
[8]	Rui-xue Sun, Priscilla Song, Joseph Walline, He Wang, Ying-chun Xu, Hua-dong Zhu, Xue-zhong Yu, Jun Xu. Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia [J]. World Journal of Emergency Medicine, 2020, 11(3): 164-168.
[9]	Shao-hua Liu, Huo-yan Liang, Hong-yi Li, Xian-fei Ding, Tong-wen Sun, Jing Wang. Effect of low high-density lipoprotein levels on mortality of septic patients: A systematic review and meta-analysis of cohort studies [J]. World Journal of Emergency Medicine, 2020, 11(2): 109-116.
[10]	Samantha Shwe, Lauren Witchey, Shadi Lahham, Ethan Kunstadt, Inna Shniter, John C. Fox. Retrospective analysis of eFAST ultrasounds performed on trauma activations at an academic level-1 trauma center [J]. World Journal of Emergency Medicine, 2020, 11(1): 12-17.
[11]	Wei He, Yue-yang You, Kai Sun, Chen Xie, Yue Ming, Li-na Yu, Feng-jiang Zhang, Min Yan. Admission delay is associated with worse surgical outcomes for elderly hip fracture patients: A retrospective observational study [J]. World Journal of Emergency Medicine, 2020, 11(1): 27-32.
[12]	Elaine Situ-LaCasse, Helpees Guirguis, Lucas Friedman, Asad E. Patanwala, Seth E. Cohen, Srikar Adhikari. Can emergency physicians perform extended compression ultrasound for the diagnosis of lower extremity deep vein thrombosis? [J]. World Journal of Emergency Medicine, 2019, 10(4): 205-209.
[13]	Chang Pan, Xiao-ran Huang, Jiao-jiao Pang, Kai Cheng, Feng Xu, Yu-guo Chen. Trends in mortality of emergency departments patients in China [J]. World Journal of Emergency Medicine, 2019, 10(3): 152-155.
[14]	Robert D. Willmore, Damjan Veljanoski, Feray Ozdes, Bethan Stephens, James Mooney, Seamus G. Crumley, Arpan Doshi, Philippa Davies, Shreya Badhrinarayanan, Emily Day, Kristian Tattam, April Wilson, Nathan Crang, Lorna Green, Craig A. Mounsey, Howell Fu, Joseph Williams, Michelle S. D'souza, Dhanya Sebastian, Liam A. Mcgiveron, Matthew G. Percy, James Cohen, Imogen J. John, Alice Lethbridge, Imogen Watkins, Omar Amin, Mubasher A. Qamar, John Gerrard Hanrahan, Emily Cramond-Wong. Do medical students studying in the United Kingdom have an adequate factual knowledge of basic life support? [J]. World Journal of Emergency Medicine, 2019, 10(2): 75-80.
[15]	Amairah Fahad Aloushan, Faisal Abdullah Almoaiqel, Raid Naysh Alghamdi, Fatmah Ismail Alnahari, Abdulaziz Fahad Aldosari, Nazish Masud, Nawfal Abdullah Aljerian. Assessment of knowledge, attitude and practice regarding oxygen therapy at emergency departments in Riyadh in 2017: A cross-sectional study [J]. World Journal of Emergency Medicine, 2019, 10(2): 88-93.