Skip to main content

Low falls causing major injury: a retrospective study

Irish Journal of Medical Science (1971 -) volume 189, pages 1435–1443 (2020)Cite this article

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 low-fall major trauma.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Lee H, Bein KJ, Ivers R, Dinh MM (2015) Changing patterns of injury associated with low-energy falls in the elderly: a 10-year analysis at an Australian Major Trauma Centre: low-energy falls in the elderly. ANZ J Surg 85(4):230–234. https://doi.org/10.1111/ans.12676

    Article  PubMed  Google Scholar 

  2. Weingart G, Glueckert L, Cachaper G, Zimbro K, Maduro R, Counselman F (2017) Injuries associated with hoverboard use: a case series of emergency department patients. West J Emerg Med 18(6):993–999. https://doi.org/10.5811/westjem.2017.6.34264

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wang H et al (2017) Traumatic fractures as a result of falls in children and adolescents: a retrospective observational study. Medicine 96(37):e7879. https://doi.org/10.1097/MD.0000000000007879

    Article  PubMed  PubMed Central  Google Scholar 

  4. Shankar KN, Treadway NJ, Taylor AA, Breaud AH, Peterson EW, Howland J (2017) Older adult falls prevention behaviors 60 days post-discharge from an urban emergency department after treatment for a fall. Injury Epidemiol 4(1). https://doi.org/10.1186/s40621-017-0114-y

  5. Denver D, Shetty A, Unwin D (2015) Falls and implementation of NEXUS in the elderly (the FINE study). J Emerg Med 49(3):294–300. https://doi.org/10.1016/j.jemermed.2015.03.005

    Article  PubMed  Google Scholar 

  6. Beck B, Teague W, Cameron P, Gabbe BJ (2019) Causes and characteristics of injury in paediatric major trauma and trends over time. Arch Dis Child 104(3):256–261. https://doi.org/10.1136/archdischild-2018-315565

    Article  PubMed  Google Scholar 

  7. ‘WHO | Falls’, WHO. [Online]. Available: http://www.who.int/mediacentre/factsheets/fs344/en/. [Accessed: 26-Mar-2018]

  8. National Office of Clinical Audit, ‘Major Trauma Audit National Report 2017’. National Office of Clinical Audit, 06-Feb-2019

  9. Evans D, Pester J, Vera L, Jeanmonod D, Jeanmonod R (2015) Elderly fall patients triaged to the trauma bay: age, injury patterns, and mortality risk. Am J Emerg Med 33(11):1635–1638. https://doi.org/10.1016/j.ajem.2015.07.044

    Article  PubMed  Google Scholar 

  10. Miu J, Curtis K, Balogh ZJ (2016) Profile of fall injury in the New South Wales older adult population. Australas Emerg Nurs J 19(4):179–185. https://doi.org/10.1016/j.aenj.2016.07.001

    Article  PubMed  Google Scholar 

  11. Scheetz LJ (2015) Injury patterns, severity and outcomes among older adults who sustained brain injury following a same level fall: a retrospective analysis. Int Emerg Nurs 23(2):162–167. https://doi.org/10.1016/j.ienj.2014.09.003

    Article  PubMed  Google Scholar 

  12. Kuo SCH, Kuo P-J, Rau C-S, Wu S-C, Hsu S-Y, Hsieh C-H (2017) Hyponatremia is associated with worse outcomes from fall injuries in the elderly. Int J Environ Res Public Health 14(5). https://doi.org/10.3390/ijerph14050460

  13. Rau C-S et al (2014) Geriatric hospitalizations in fall-related injuries. Scand J Trauma Resusc Emerg Med 22. https://doi.org/10.1186/s13049-014-0063-1

  14. Majdan M, Brazinova A, Wilbacher I, Rusnak M, Mauritz W (2015) The impact of body mass index on severity, patterns and outcomes after traumatic brain injuries caused by low level falls. Eur J Trauma Emerg Surg 41(6):651–656. https://doi.org/10.1007/s00068-014-0490-8

    CAS  Article  PubMed  Google Scholar 

  15. Sanderson W, Scherbov S (2008) Rethinking age and aging. 63(4):20

  16. National Office of Clinical Audit, ‘The National Office of Clinical Audit (NOCA)’

  17. National Office of Clinical Audit, ‘The Trauma Audit Research Network (TARN)’

  18. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage: a practical scale. Lancet 305(7905):480–484. https://doi.org/10.1016/S0140-6736(75)92830-5

    Article  Google Scholar 

  19. Jennett B, Snoek J, Bond MR, Brooks N (1981) Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 44(4):285–293

    CAS  Article  Google Scholar 

  20. Greenspan L, McLellan BA, Greig H (1985) Abbreviated injury scale and injury severity score: a scoring chart. J Trauma 25(1):60–64

    CAS  Article  Google Scholar 

  21. Baker SP, O’Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187–196

    CAS  Article  Google Scholar 

  22. Chang W-R, Leclercq S, Lockhart TE, Haslam R (2016) State of science: occupational slips, trips and falls on the same level. Ergonomics 59(7):861–883. https://doi.org/10.1080/00140139.2016.1157214

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wang K et al (2017) Differences between gait on stairs and flat surfaces in relation to fall risk and future falls. IEEE J Biomed Health Inform 21(6):1479–1486. https://doi.org/10.1109/JBHI.2017.2677901

    Article  PubMed  Google Scholar 

  24. Cohen HH, Templer J, Archea J (1985) An analysis of occupational stair accident patterns. J Saf Res 16(4):171–181. https://doi.org/10.1016/0022-4375(85)90004-0

    Article  Google Scholar 

  25. Lew FL, Qu X (2014) Effects of mental fatigue on biomechanics of slips. Ergonomics 57(12):1927–1932. https://doi.org/10.1080/00140139.2014.937771

    Article  PubMed  Google Scholar 

  26. Strong BL, Torain JM, Greene CR, Smith GS (2016) Outcomes of trauma admission for falls: influence of race and age on inhospital and post-discharge mortality. Am J Surg 212(4):638–644. https://doi.org/10.1016/j.amjsurg.2016.06.002

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the invaluable help of Ann Deasy and Karina Caine, the TARN coordinators for CUH.

Author information

Authors and Affiliations

  1. School of Medicine, University College Cork, Cork, Ireland

    Kathryn Lesko & Conor Deasy

  2. Cork University Hospital, Cork, Ireland

    Conor Deasy

Authors
  1. Kathryn Lesko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Conor Deasy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathryn Lesko.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lesko, K., Deasy, C. Low falls causing major injury: a retrospective study. Ir J Med Sci 189, 1435–1443 (2020). https://doi.org/10.1007/s11845-020-02212-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-020-02212-8

Keywords

  • Cohort
  • Low fall
  • Major trauma
  • Mechanical fall