Skip to main content
SpringerLink
Log in

Facteurs de risque de mortalité lors de traumatisme par défenestration

Risk factors of mortality in trauma by defenestration

  • Article Original / Original Article
  • Published:
Annales françaises de médecine d'urgence

Résumé

Objectif

Les défenestrations constituent une entité spécifique fréquente en milieu urbain. L’identification de facteurs prédictifs de mortalité autres que la hauteur de chute permettrait d’optimiser la prise en charge des patients.

Type d’étude

Analyse rétrospective sur la base de données standardisées des interventions médicalisées du Smur de Lausanne, Suisse.

Matériel

Interventions préhospitalières médicalisées effectuées entre 1995 et 2008 pour défenestrations (n = 430 cas).

Méthode

Description des caractéristiques démographiques et analyse de corrélation univariée, puis multivariée entre caractéristique démographiques, traumatismes, paramètres vitaux sur site, hauteur de chute et mortalité.

Résultats

La majorité des patients sont des hommes (64 %). L’âge moyen est de 38 ± 21 ans. La mortalité à 48 h est de 20 %. La gravité des lésions (évaluée par l’Injury Severity Score) est corrélée avec la hauteur de la chute (p < 0,001). L’analyse multivariée montre toutefois qu’un score de Glasgow sur site ≤ 8 est un meilleur élément prédictif de mortalité. L’âge supérieur à 65 ans et la présence d’une hypotension sur site sont également prédictifs de mortalité.

Conclusion

Les défenestrations touchent une population jeune. La hauteur de la chute ne suffit pas pour prédire la mortalité des patients. La mortalité et la gravité des lésions sont corrélées avec la présence d’un traumatisme crânien ou d’un état de choc.

Abstract

Objective

The accidental or intentional fall from height (defenestration) is a specific entity especially common in urban areas. The predictors of survival other than height and the medical consequences are poorly described.

Study design

Retrospective analysis of prospectively collected data from the prehospital emergency registry.

Patients

Prehospital interventions with emergency physicians for defenestration recorded between 1995 and 2008 (n = 430 cases).

Methods

Description of demographic characteristics and correlation analysis (uni/multivariate) between the heights, vital signs on site, injuries, and mortality.

Results

Most patients are men (64%). The mean age is 38 ± 21 years. Mortality at 48 hours is 20%. As expected, the severity of injury (assessed by the Injury Severity Score) is correlated with the height of fall (p <0.001). A multivariate regression analysis shows that an initial GCS < 8/15 is however the best predictor of mortality, related to the high rate of brain injury (94%). Advanced age (> 65 years) and hypotension are independent predictors of mortality.

Conclusion

The defenestrations disproportionately affect a young population. The height of the fall does not by itself predict mortality of patients. Mortality and severity of injuries are directly related to the presence of head injury or hemodynamic shock.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Spaniolas K, Cheng JD, Gestring ML, et al (2010) Ground level falls are associated with significant mortality in elderly patients. J Trauma 69:821–825

    Article  PubMed  Google Scholar 

  2. Thélot B, Rigou A, Bonaldi C, et al (2005) Défenestrations accidentelles d’enfants en Ile-de-France de mai à septembre. Urg Pratique 77:51–52

    Google Scholar 

  3. Lapostolle F, Gere C, Borron SW, et al (2005) Prognostic factors in victims of falls from height. Crit Care Med 33:1239–1242

    Article  PubMed  Google Scholar 

  4. Rigou A, Meyer P, Thélot B (2008) Les défenestrations accidentelles d’enfants dans trois régions de France en 2006. J Ped Puericult 21:299–304

    Google Scholar 

  5. Behera C, Rautji R, Dogra TD (2010) Fatal accidental fall from height in infants and children: a study from South Delhi. Med Sci Law 50:22–24

    Article  PubMed  CAS  Google Scholar 

  6. Melo JRT, Di Rocco F, Lemos-Junior LP, et al (2009) Defenestration in children younger than 6 years old: mortality predictors in severe head trauma. Childs Nerv Syst 25:1077–1083

    Article  PubMed  Google Scholar 

  7. Boyle MJ, Smith E, Archer F (2008) Is mechanism of injury alone a useful predictor of major trauma? Injury 39:986–992

    Article  PubMed  Google Scholar 

  8. Demetriades D, Murray J, Brown C, et al (2005) High-level falls: type and severity of injuries and survival outcome according to age. J Trauma 58:342–345

    Article  PubMed  Google Scholar 

  9. Centers for Disease Control and Prevention (2012) Guidelines for field triage of injured patients. MMWR 61:1–21

    Google Scholar 

  10. American College of Surgeons’ Committee on Trauma (1999) Resources for Optimal Care of the Injured Patient. Chicago, IL: American College of Surgeons

    Google Scholar 

  11. Riou B, Thicoïpé M, Atain-Kouadio P, et al (2002) Comment évaluer la gravité ? In: Samu de France Éd. Actualités en réanimation préhospitalière: le traumatisé grave. Paris: SFEM Editions, p. 115–128

    Google Scholar 

  12. Kohn M, Hammel J, Bretz S, Stangby A (2004) Trauma team activation criteria as predictors of patient disposition from the Emergency Department. Acad Emerg Med 11:1–9

    Article  PubMed  Google Scholar 

  13. Goodacre S, Than M, Goyder E, Joseph A (1999) Can the distance fallen predict serious injury after a fall from height? J Trauma 46:1055–1058

    Article  PubMed  CAS  Google Scholar 

  14. Ringdal K, Coats T, Lefering R, et al (2008) The Utstein template for uniform reporting of data following major trauma: a joint revision by SCANTEM, TARN, DGU-TR and RITG. Scand J Trauma Resusc Emerg Med 16:7

    Article  PubMed  Google Scholar 

  15. Dick WF, Baskett PJF (1999) Recommendations for uniform reporting of data following major trauma — the Utstein style. Resuscitation 42:81–100

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  17. Association for the Advancement of Automotive Medicine (1998) The Abbreviated Injury Scale; 1990 revision, Update 98. Des Plaines, IL: Association for the Advancement of Automotive Medicine

    Google Scholar 

  18. Mosenthal AC, Livingston DH, Elcavage J, et al (1995) Falls: epidemiology and strategies for prevention. J Trauma 38:753–756

    Article  PubMed  CAS  Google Scholar 

  19. Santaniello JM, Esposito TJ, Luchette FA, et al (2003) Mechanism of injury does not predict acuity or level of service need: field triage criteria revisited. Surgery 134:698–703

    Article  PubMed  Google Scholar 

  20. Ocak G, Sturms LM, Hoogeveen JM, et al (2009) Prehospital identification of major trauma patients. Lengenbecks Arch Surg 394:285–292

    Article  Google Scholar 

  21. Scalea T, Goldstein A, Phillips T, et al (1986) An analysis of 161 falls from a height: the “jumper syndrome”. J Trauma 26:706–712

    Article  PubMed  CAS  Google Scholar 

  22. Badjatia N, Carney N, Crocco TJ, et al (2008) Guidelines for prehospital management of traumatic brain injury 2nd edition. Prehosp Emerg Care 12:S1–S52

    Article  PubMed  Google Scholar 

  23. Ryynänen OP, Iirola T, Reitala J, et al (2010) Is advanced life support better than basic life support in prehospital care? A systematic review. Scand J Trauma Resusc Emerg Med 18:62

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service des urgences, centre hospitalier universitaire Vaudois, CH-1011, Lausanne, Suisse

    P. -N. Carron, P. Gonin, B. Yersin & L. Vallotton

  2. Service d’anesthésiologie, centre hospitalier universitaire Vaudois, CH-1011, Lausanne, Suisse

    L. Vallotton

Authors
  1. P. -N. Carron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Gonin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Yersin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Vallotton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. -N. Carron.

About this article

Cite this article

Carron, P.N., Gonin, P., Yersin, B. et al. Facteurs de risque de mortalité lors de traumatisme par défenestration. Ann. Fr. Med. Urgence 2, 237–242 (2012). https://doi.org/10.1007/s13341-012-0220-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13341-012-0220-y

Mots clés

Keywords

Search

Navigation