Low falls causing major injury: a retrospective study
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ORIGINAL ARTICLE
Low falls causing major injury: a retrospective study Kathryn Lesko 1
&
Conor Deasy 1,2
Received: 9 January 2020 / Accepted: 11 March 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background Falling from a height of under 2 m (low fall) is the most common mechanism of injury causing major trauma in Ireland. This presentation encompasses a wide patient cohort, from paediatric sport injuries to elderly falls. Aims Our aim is to characterise major trauma resulting from a low fall, and its various sub-populations, to identify preventative strategies and care pathways to improve outcomes for patients. Methods The Trauma Audit and Research Network (TARN) which is used to provide Major Trauma Audit was used to retrospectively identify patients presenting to the Cork University Hospital Emergency Department with trauma resulting from a low fall from January 2015 to June 2018. Results The database returned 1066 qualifying cases (49.3% of cases in the time period), with a mean age of 67.3 years (SD = 21) and a median age of 71.3 years (IQR = 23); 44% were male. ‘Mechanical falls’ accounted for n = 513 (48%) of low-fall injuries, followed by ‘stationary falls’ n = 265 (25%). Injuries occurred most often at home n = 515 (48%), followed by public places n = 208 (19.5%). The most severely injured body region was the limbs n = 526 (49.3%), followed by the head n = 253 (23.7%). A number of patients with Glasgow Outcome Scores of 4 (moderate disability) and 5 (good recovery) were n = 488 (45.8%) and n = 390 (36.6%). Conclusions Low falls occur in patients over 55 years of age; many do not return to independent living. Wait times to initial assessment, length of hospital stay and mortality increase with age. Mechanical falls at home are the most common cause of lowfall major trauma. Keywords Cohort . Low fall . Major trauma . Mechanical fall
Introduction Falling from a height of under 2 m is the most common mechanism of life-threatening or life-changing injury in Ireland [1]. Research has shown that this presentation encompasses a wide age demographic, from paediatric sport injuries to elderly falls, includes all socioeconomic classes, and is not discriminatory for previous mental and physical health [2–6]. The World Health Organization in 2018 identified the elderly as the most at-risk group for fatal falls, and stated that over 37 million non-fatal traumatic falls occur worldwide every year, resulting in over 17 million disability-adjusted life years (DALYs) [7]. The * Kathryn Lesko [email protected] 1
School of Medicine, University College Cork, Cork, Ireland
2
Cork University Hospital, Cork, Ireland
Major Trauma Audit 2017 national report described that 57% of major trauma patients in Ireland in 2017 had a low fall as their mechanism of injury [8]. This report, and many others recently published, highlights that increasing focus on low-fall prevention will be of significant benefit. Previous research into low falls has focused on specific sub-populations, commonly elderly falls [1, 9–1
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