An Elucidation of Pattern of Injuries in Patients with Fall from Height
Chinta Annie Jyothirmayi, Abhilash P Kundavaram
Citation Information :
Jyothirmayi CA, Kundavaram AP. An Elucidation of Pattern of Injuries in Patients with Fall from Height. Indian J Crit Care Med 2020; 24 (8):683-687.
Background: Fall from height (FFH) is the second most common cause of trauma presenting to the emergency department (ED). They account for majority of the polytrauma cases. This study was done to determine the pattern of injuries sustained due to FFH and outcome. Materials and methods: This was a retrospective observational study of all patients with history of FFH presenting to the ED of a large tertiary care hospital in South India. Details of the incident, fall height, injuries, and outcome were noted and analyzed. Results: This study cohort included 861 patients with a mean age was 36.2 (SD 20.8) years. A male predominance (74%) was noted. Majority of the patients, i.e., 62%, were triaged as priority 2, depending on the hemodynamic stability. Approximately a quarter (26%) sustained injury to the lower limbs with 18% sustaining spinal cord injury (SCI). Among the patients suffering SCI (35%), patients were further categorized in the American Spinal cord Injury Association (ASIA) classification. New Injury Severity Score (NISS) was more than 8 in 47% of the total study population. Majority of the patients, i.e., 62%, were discharged stable from ED after primary care with a plan of follow-up in the outpatient department. One-third (30%) of the total patients required hospital admission and among them 20% of the patients had to undergo major surgical intervention. The rest were either discharged stable or left against medical advice (LAMA) after primary care. The in-hospital mortality rate was 1.04%. Conclusion: This study has expressed the pattern of injuries in patients with FFH. An alarmingly high number of young adults with significant lower limbs and spinal injuries were noted. We observed that with increase in fall height there was a proportional increase in SCI and decrease in lower limb injuries.
Atanasijevic TC, Slobodan NS, Slobodon DN, Djokic VM. Frequency and severity of in correlation with the height of fall. J Forensic Sci 2005;50(3):608–612.
Stephanie A, Andrea B. Injury pattern in correlation with the height of fatal falls. Eur J Med 2014;639(9):1–5.
Turk E, Tsokos M. Pathologic features of fatal fall from height. Am J Foren Pathol 2004;25(3):194–199. DOI: 10.1097/01.paf.0000136441.53868.a4.
Buckman RF, Buckman PD. Vertical deceleration trauma. Principles of management. Surg Clin North Am 1991;71(2):331–344. DOI: 10.1016/S0039-6109(16)45383-1.
Turgut K, Sarihan ME, Colak C, Güven T, Gür A, Gürbüz S. Falls from height: a retrospective analysis. World J Emerg Med 2018;9(1):46–50. DOI: 10.5847/wjem.j.1920-8642.2018.01.007.
Rastogi D, Meena S, Sharma V, Singh G. Epidemiology of patients admitted to a major trauma centre in northern india. Chinese J Traumatol 2014;17(2):103–107.
Abhilash KP, Chakraborthy N, Pandian GR, Dhanawade VS, Bhanu TK, Priya K. Profile of trauma patients in the emergency department of a tertiary care hospital in south India. J Family Med Prim Care 2016;5(3):558–563. DOI: 10.4103/2249-4863.197279.
Yavuz M, Tomruk O, Baydar C, Kupeli A. Evaluation of accidental fall from high cases who admitted to emergency service. J Forensic Med 2004;18:8–12.
Eren A, Arslan M, Hilal A, Cekin N. Deaths due to fall from a height in Adana. Adli Tip Bülteni 2009;14:12–15.
Abhilash KP, Sivanandan A. Early management of trauma: the golden hour. Curr Med Issues 2020;18:36–39. DOI: 10.4103/cmi.cmi_61_19.
Chen Y, Tang Y, Allen V, DeVivo MJ. Fall-induced spinal cord injury: external causes and implications for prevention. J Spinal Cord Med 2016;39(1):24–31. DOI: 10.1179/2045772315Y.0000000007.
Accidental Deaths and Suicides in India 2015. New Delhi: Ministry of Home Affairs, Government of India; 2008. National Crime Records Bureau. http://ncrb.gov.in/StatPublications/ADSI/ADSI2015/adsi-2015-full-report.pdf.
Lalwani S, Singh V, Trikha V, Sharma V, Kumar S, Bagla R, et al. Mortality profile of patients with traumatic spinal injuries at a level I trauma care centre in India. Indian J Med Res 2014;140(1):40–45.
Dkhar I, Hazra D, Madhiyazhagan M, Joseph JV, Abhilash KP. A retrospective study on the profile of long bone injuries in trauma patients presenting to emergency department. Curr Med Issues 2019;17:60–65. DOI: 10.4103/cmi.cmi_35_19.
Dean LA, Aaronson EL, Wittels K, Wilcox SR. Fall from height. J Emerg Med 2019;57(2):241–244. DOI: 10.1016/j.jemermed.2019. 04.002.
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):2125–2130. DOI: 10.1007/s00268-012-1650-9.