Falls from ladders: age matters more than height

Older adults do not consistently overestimate their action opportunities across different settings

Am I still able to climb the ladder? Aging accompanies changes in physical constitution and a higher risk of injuries. At the same time, the judgment of action opportunities needs to be highly adaptive to the given task setting. We examined older adults' (n = 40) judgment tendencies in four different tasks by use of a detection theory approach. The tasks' setting differed in their boundaries' proximity to the actor with either proximal (e.g., judging one's hand fit into an opening) or distal boundaries (e.g., judging the reachability of a distant object). The older participants showed significantly more liberal judgments in tasks with distal boundaries. Body awareness and alertness were associated with the extent of judgment disparity between setting types. Subsequently, we compared a gender- and education-matched subsample of the group (n = 24) to a younger sample (n = 24). Older participants' judgment tendencies were significantly more extreme, with stronger under- or overestimations depending on the type of setting. We discuss potential links between more extreme judgments in older adults and higher reliance on learned patterns. Future research is needed to further unravel these setting-dependent behavioral differences and the factors contributing to more extreme judgment tendencies with growing age.

Geriatric Trauma: Identifying Research Gaps and Opportunities for Improvement

Geriatric trauma is a critical area of research owing to the increasing elderly population and the unique challenges associated with their injuries. This study aimed to explore the intellectual structure, growth, spatial analysis, seminal publications, most frequent keywords, trending topics, conceptual structure, and thematic evolution of geriatric trauma research (GTR). A comprehensive analysis was conducted using VOSviewer (Centre for Science and Technology Studies, Leiden University, The Netherlands) and Biblioshiny (K-Synth Srl, University of Naples Federico II, Italy) to examine a corpus of scholarly publications (N = 682) related to GTR (2004-2024). Bibliographic data were collected from the Scopus database and analyzed to highlight the key findings and trends. The analysis revealed the leading contributors to GTR. Over the years, there has been an increased interest in geriatric trauma, as demonstrated by the increasing trend in research publications. Collaboration patterns among nations were determined through spatial analysis, and insights into significant topics and their influence were offered by influential publications. Keywords used frequently as well as current issues formed part of this study's findings, which give insight into what was most focused on within the GTR. Themes and their development over time were made explicit by revealing their conceptual structures and thematic evolutions. GTR has increased significantly. Interdisciplinary approaches are suggested for future research. Furthermore, gaps need to be addressed using technological advancements that will help improve geriatric trauma management and lead to better patient outcomes.

Predicting factors for extremity fracture among border-fall patients using machine learning computing

BACKGROUND

The factors causing the injuries sustained from falls at US-Mexican border include falls from border wall or fence, fleeing from border patrols, ejecting from vehicle, and others. This study aimed to determine the factors leading to anatomical injuries and to identify the importance of factors leading to limb fracture and internal organ injuries.

METHODS

A total of 178 patients who sustained musculoskeletal injuries or internal organ injuries and were admitted to our hospital were included in this retrospective study. Factors indexed for analysis included demographics, comorbidities, and falling mechanic factors. Correlations between anatomical injuries and mechanical injuries were analyzed. Multilayer perceptron neural network (MPNN) was used to identify predictive factors and to stratify the importance of these factors leading to injuries. The SPSS software was used for statistical analysis and predictive factor analysis.

RESULTS

The extremity fracture was associated with border wall/fence fall (p = 0.001) and fleeing (p = 0.002). The spine fracture was correlated with bridge jump/fall (p = 0.007), fence jump/fall (p = 0.026). The vehicle ejecting/MVA was correlated with head injury (P < 0.001), chest injury (P < 0.001), and abdominal injury p < 0.001). MNPP stratify the importance of factor causing injury with multiple factor considered.

CONCLUSION

The various injury factors caused different anatomical injuries. Multifactorial assessment associated with these injuries can improve the accuracy of diagnosis and develop a predictive model for clinical applications.

Ladder Use Ability, Behavior and Exposure by Age and Gender

This study aimed to quantify and compare ladder use ability and behavior in younger and older men and women from three ladder use behavior experiments. The experimental tasks comprised (1) changing a lightbulb on a household stepladder under two cognitive demands (single and dual task), (2) clearing a simulated roof gutter on a straight ladder and (3) querying ladder choice in different exigency scenarios. Ladder use ability and behavior data were captured from recorded time, performance, motion capture and user choice data. In addition, this study surveyed ladder use frequency and habitual behaviors. The experimental findings indicate that older adults require more time to complete ladder tasks; younger adults display riskier ladder use behaviors; men and women display similar ladder use ability; and men are more willing to climb riskier ladders. The survey found older adults to report more frequent ladder use than younger adults, and men use straight ladders more frequently than women. These results suggest that the reported higher ladder fall rates experienced by older adults and men are linked to increased ladder use exposure and riskier ladder choice. This knowledge can help guide population-specific interventions to reduce ladder falls in both young and older people.

Examination and Scientific Analysis of Thoracic Vertebral Fractures

Background Thoracic vertebral fractures are clinically important due to their association with the thoracic spinal cord and the potential to cause devastating neurological injury. Using the National Electronic Injury Surveillance System (NEISS) data, this study investigated fracture patterns to understand associated factors to improve prevention strategies. We explored different factors associated with thoracic vertebral fractures to improve our understanding of preventative strategies and patient care standards, focusing on spatial distribution, sex-age dynamics, and location of injury. Methodology This retrospective, cross-sectional study examines thoracic vertebral fractures across diverse age groups from 2013 to 2022, utilizing the NEISS database from the U.S. Consumer Product Safety Commission. Inclusion criteria based on specific terms related to thoracic fractures were employed. Descriptive statistics illustrated fracture distribution by age groups and associated products. Statistical analyses, including chi-square tests and multivariate logistic regressions, were conducted to explore associations between fracture occurrence, locations, products, age, and gender. Results The analysis of thoracic vertebral fractures by location and associated products yielded several statistically significant findings. Notably, the prevalence of fractures at home (39.67%) was significantly higher than in other locations, and these differences in fracture distribution were statistically significant (χ² = 7.34, p < 0.001). Among the associated products, ladders (10.46%) emerged as the most frequent product associated with fractures. Multivariate logistic regression analysis showed that the age groups of 41-50, 51-60, and 61-70 had increased odds of fractures with adjusted odds ratios (AORs) of 1.08 (95% confidence interval (CI) = 1.04-1.42, p < 0.05), 1.21 (95% CI = 1.13-1.56, p < 0.001), and 1.17 (95% CI = 1.08-1.39, p < 0.001), respectively. The likelihood of thoracic vertebral fractures did not significantly differ between males and females (AOR = 1.12, 95% CI = 0.87-1.53, p = 0.262). Fracture distribution by age groups and products indicated increasing ladder-related fractures within the 41-50 age group and 51-60 age group. Football-related fractures peaked within the 21-30 age group. Fracture distribution patterns for bicycles had increased prevalence within the 11-20 and 21-30 age groups, and football-related fractures in younger age groups. Conclusions This study analyzed factors associated with thoracic vertebral fractures, showing the significance of targeted preventative interventions, such as earlier screening, physical therapy, and nutritional status assessment, in the setting of significant location and age-related susceptibilities. The observed patterns of injury provide a foundation for future research to elucidate the underlying mechanisms between different environments and the likelihood of injury to improve preventive strategies.

Falls from ladders in New South Wales: A data-linkage study

INTRODUCTION

Fall from ladders is increasingly identified as a significant cause of injury and mortality, yet large-scale research into ladder fall outcomes and trends is limited.

OBJECTIVES

To explore the nature and severity of injuries resulting from ladder falls and to determine predictors of Injury Severity Score (ISS) and 6-month mortality.

METHODS

Data were obtained from the New South Wales (NSW) Trauma Registry, Admitted Patient Data Collection and Registry of Births, Deaths, and Marriages on patients aged 15 and over who had major trauma from a ladder fall and were admitted to hospital between January 1st, 2012, and July 31st, 2019. Data linkage and descriptive statistics were carried out alongside bivariate and multivariable regression analysis.

RESULTS

963 patients injured after ladder falls were identified. The mean age was 61.9 years (SD 14.2), 91.0% were male, and 489 (50.8%) were born in Australia. The height of fall was between one and five meters in 827 (86.2%) patients, and the place of fall was home and residential places in 27.5%. The most common body areas injured were the head (26.5%), spine (21.2%) and thorax (20.6%), and the median injury severity score was 17. The median length of stay of patients' in-hospital and intensive care unit was six days and two days, respectively. Six months post-discharge mortality was 6.4%. The unadjusted association between the presence of comorbidities or socio-economic class and ISS or mortality was not statistically significant. Increasing ISS was found to be associated with increasing age (Estimate (Est), 15.2; 95% Confidence Interval (CI), 12.3-18.1) and a fall height greater than five metres (Est, 5.8; CI, 3.2-8.4). Mortality was found to be associated with increasing age (Odds ratio (OR), 1.06; CI, 1.03-1.08) and increasing ISS (OR, 1.19; CI, 1.15-1.24).

CONCLUSION

People presenting to the hospital after falling from a ladder were predominately male, aged over 60 and had fallen in a residential setting. Increasing age and fall height are associated with more severe injuries.

Falls from scaffolds: a nationwide analysis

INTRODUCTION

Falls from scaffolds are a common cause of occupational injuries and fatalities, however, the data concerning these injuries are scarce. The purpose of this study was to characterize the epidemiology, injury patterns, and outcomes of falls from scaffolds.

METHODS

Retrospective cohort study using data from the National Trauma Data Bank (2007-2017). All adult patients who sustained injuries following falls from scaffolds and as a comparator, falls from ladders, were identified using the external cause of injury codes. The primary outcome was differences in the type and severity of injuries between the groups.

RESULTS

A total of 183,853 patients were analyzed. Of these, 18,189 (9.9%) fell from scaffolds and 165,664 (90.1%) from ladders. Patients who fell from scaffolds were younger, more often male, and more likely to sustain severe trauma (ISS > 15: 24.1% vs 17.3%, p < 0.001). Falls from scaffolds resulted in more severe head injuries (head AIS ≥ 3: 18.6% vs 14.7%, p < 0.001) and more spinal fractures (30.3% vs 25.2%, p < 0.001). Falls from scaffolds were associated with higher mortality (2.5% vs 1.8%, p < 0.001), higher ICU admission rate (25.0% vs 21.5%, p < 0.001), and longer hospitalization. On multivariable analysis, the strongest predictors of mortality were GCS < 9 and hypotension on admission, severe (AIS ≥ 3) head injury, and age > 65 years.

CONCLUSION

Falls from scaffolds are associated with more severe injuries and worse outcomes compared to ladder falls. Males in the fourth decade of life were disproportionally affected. Further research on fall prevention is warranted to decrease this important cause of death and disability.

Musculoskeletal injuries sustained at the California, USA: Baja California, Mexico border

Background

Individuals attempting to enter the USA from Mexico at non-authorized points along the border fence often sustain injuries requiring medical intervention. We evaluated characteristics of this patient population and their hospital care to better understand patient treatment needs. Given the high-velocity nature of these injuries, we hypothesized that higher pain scores would be associated with longer lengths of hospital stay.

Methods

In this cross-sectional study, we selected records of all patients from 2013 to 2019 who received care by the Orthopaedic Surgery department following an injury sustained at the California-Baja California border. We evaluated demographics, musculoskeletal injuries, procedures, length of hospital stay (LOS), follow-up, and pain scores via retrospective chart review. We used linear regression, adjusting for age and gender, to evaluate associations between pain scores and hospital LOS.

Results

Among all 168 patients, there were 248 total injuries comprised of 46% lower extremity, 15% upper extremity, 17% spine, and 4% pelvic injuries. Average age at injury was 33 ± 10, 74% were male, and 85% identified as Hispanic. Of this patient population, 68% underwent operative interventions, 26% sustained open injuries, and 21% required external fixation for initial injury stabilization. Thirteen percent were seen for follow-up after discharge. Spine (n = 42), pilon (n = 36), and calcaneus fractures (n = 25) were the three most common injury types. Average LOS for all patients was 7.8 ± 8.1 days. Pain scores were not significantly associated with LOS ( p =  0.08). However, for every surgical procedure performed, hospital LOS was increased by 5.16 ± 0.47 days (p < 0.001).

Conclusion

Many injuries incurred by patients crossing the border were severe, requiring multiple surgical interventions and a prolonged LOS. The higher number of procedures was significantly associated with longer LOS in all operatively treated patients. Future studies are needed to determine how we can optimize care for this unique patient population and facilitate post-discharge care.

Development and Validation of Indicators for Population Injury Surveillance in Hong Kong: Development and Usability Study

BACKGROUND

Injury is an increasingly pressing global health issue. An effective surveillance system is required to monitor the trends and burden of injuries.

OBJECTIVE

This study aimed to identify a set of valid and context-specific injury indicators to facilitate the establishment of an injury surveillance program in Hong Kong.

METHODS

This development of indicators adopted a multiphased modified Delphi research design. A literature search was conducted on academic databases using injury-related search terms in various combinations. A list of potential indicators was sent to a panel of experts from various backgrounds to rate the validity and context-specificity of these indicators. Local hospital data on the selected core indicators were used to examine their applicability in the context of Hong Kong.

RESULTS

We reviewed 142 articles and identified 55 indicators, which were classified into 4 domains. On the basis of the ratings by the expert panel, 13 indicators were selected as core indicators because of their good validity and high relevance to the local context. Among these indicators, 10 were from the construct of health care service use, and 3 were from the construct of postdischarge outcomes. Regression analyses of local hospitalization data showed that the Hong Kong Safe Community certification status had no association with 5 core indicators (admission to intensive care unit, mortality rate, length of intensive care unit stay, need for a rehabilitation facility, and long-term behavioral and emotional outcomes), negative associations with 4 core indicators (operative intervention, infection rate, length of hospitalization, and disability-adjusted life years), and positive associations with the remaining 4 core indicators (attendance to accident and emergency department, discharge rate, suicide rate, and hospitalization rate after attending the accident and emergency department). These results confirmed the validity of the selected core indicators for the quantification of injury burden and evaluation of injury-related services, although some indicators may better measure the consequences of severe injuries.

CONCLUSIONS

This study developed a set of injury outcome indicators that would be useful for monitoring injury trends and burdens in Hong Kong.

Falls from Ladders: Injury Patterns and Outcomes

BACKGROUND

Our contemporary understanding of the impact of falls from ladders remains limited. The purpose of this study was to examine the injury patterns and outcomes of falls from ladders. Our hypothesis was that age affects both injury type and outcomes.

METHODS

The NTDB was queried for all patients who fell from a ladder (01/2007-12/2017). Participants were stratified into 4 groups according to age: ≤15, 16-50, 51-65, and > 65 years. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups.

RESULTS

A total of 168,227 patients were included for analysis. Median age was 56 years (IQR: 45-66), 86.1% were male, and median ISS was 9 (IQR: 4-13). Increasing age was associated with a higher risk of severe trauma (ISS > 15: 8.8% vs 13.7% vs 17.5% vs 22.0%, p < 0.001). Head injuries followed a U-shaped distribution with pediatric and elderly patients representing the most vulnerable groups. Overall, fractures were the most common type of injury, in the following order: lower extremity 27.3%, spine 24.9%, rib 23.1%, upper extremity 20.1%, and pelvis 10.3%. The overall ICU admission rate was 21.5%; however, it was significantly higher in the elderly (29.1%). In-hospital mortality was 1.8%. The risk of death progressively increased with age with a mortality rate of 0.3%, 0.9%, 1.5%, and 3.6%, respectively (p < 0.001). Strong predictors of mortality were GCS ≤8 on admission (OR 29.80, 95% CI 26.66-33.31, p < 0.001) and age > 65 years (OR 4.07, 95% CI 3.535-4.692, p < 0.001). Only 50.8% of elderly patients were discharged home without health services, 16.5% were discharged to nursing homes and 15.2% to rehabilitation centers.

CONCLUSION

Falls from ladders are associated with considerable morbidity and mortality, especially in the elderly. Head injuries and fractures are common and often severe. An intensified approach to safe ladder use in the community is warranted.

LEVEL OF EVIDENCE

IV.

Changing Demographic Trends in spine trauma: The presentation and outcome of Major Spine Trauma in the elderly

INTRODUCTION

Major trauma has seen a demographic shift in recent years and it is expected that the elderly population will comprise a greater burden on the major trauma service in the near future. However, whether a similar trend exists in those undergoing operative intervention for spinal trauma remains to be elucidated.

AIMS

To compare the presentation and outcomes of patients ≥65 years of age sustaining spine trauma to those <65 years at a national tertiary referral spine centre.

METHODS

The local Trauma Audit Research Network (TARN) database was analysed to identify spinal patients referred to our institution, a national tertiary referral centre, between 01/2016 and 05/2019. Patients were divided into a young cohort (16-64 years old) and an elderly cohort (> 64 years old). No explicit distinction was made between major and minor spine trauma cases. Variables analysed included patient demographics, injury severity, mortality, interventions, mechanism of injury and length of hospital stay.

RESULTS

A total of 669 patients were admitted of which 480 patients underwent operative intervention for spinal trauma. Within the elderly cohort, this represented 75.3% of cases. Among the younger population, road traffic collisions were the most common mechanism of injury (37.1%), while low falls (<2 m) (57.4%) were the most common mechanism among the older population. Patients ≥65 years old had significantly longer length of stay (21 days [1-194] v 14 days [1-183]) and suffered higher 30-day mortality rates (4.6% [0-12] v 0.97% [0-4]).

CONCLUSION

Orthopaedic spinal trauma in older people is associated with a significantly higher mortality rate as well as a longer duration of hospitalization. Even though severity of injury is similar for both young and old patients, the mechanism of injury for the older population is of typically much lower energy compared to the high energy trauma affecting younger patients.

Age-Dependent Patient and Trauma Characteristics and Hospital Resource Requirements-Can Improvement Be Made? An Analysis from the German Trauma Registry

Background and objectives: The burden of geriatric trauma patients continues to rise in Western society. Injury patterns and outcomes differ from those seen in younger adults. Getting a better understanding of these differences helps medical staff to provide a better care for the elderly. The aim of this study was to determine epidemiological differences between geriatric trauma patients and their younger counterparts. To do so, we used data of polytraumatized patients from the TraumaRegister DGU^®. Materials and Methods: All adult patients that were admitted between 1 January 2013 and 31 December 2017 were included from the TraumaRegister DGU^®. Patients aged 55 and above were defined as the elderly patient group. Patients aged 18–54 were included as control group. Patient and trauma characteristics, as well as treatment and outcome were compared between groups. Results: A total of 114,169 severely injured trauma patients were included, of whom 55,404 were considered as elderly patients and 58,765 younger patients were selected for group 2. Older patients were more likely to be admitted to a Level II or III trauma center. Older age was associated with a higher occurrence of low energy trauma and isolated traumatic brain injury. More restricted utilization of CT-imaging at admission was observed in older patients. While the mean Injury Severity Score (ISS) throughout the age groups stayed consistent, mortality rates increased with age: the overall mortality in young trauma patients was 7.0%, and a mortality rate of 40.2% was found in patients >90 years of age. Conclusions: This study shows that geriatric trauma patients are more frequently injured due to low energy trauma, and more often diagnosed with isolated craniocerebral injuries than younger patients. Furthermore, utilization of diagnostic tools as well as outcome differ between both groups. Given the aging society in Western Europe, upcoming studies should focus on the right application of resources and optimizing trauma care for the geriatric trauma patient.

The GERtality Score: The Development of a Simple Tool to Help Predict in-Hospital Mortality in Geriatric Trauma Patients

Feasible and predictive scoring systems for severely injured geriatric patients are lacking. Therefore, the aim of this study was to develop a scoring system for the prediction of in-hospital mortality in severely injured geriatric trauma patients. The TraumaRegister DGU^® (TR-DGU) was utilized. European geriatric patients (≥65 years) admitted between 2008 and 2017 were included. Relevant patient variables were implemented in the GERtality score. By conducting a receiver operating characteristic (ROC) analysis, a comparison with the Geriatric Trauma Outcome Score (GTOS) and the Revised Injury Severity Classification II (RISC-II) Score was performed. A total of 58,055 geriatric trauma patients (mean age: 77 years) were included. Univariable analysis led to the following variables: age ≥ 80 years, need for packed red blood cells (PRBC) transfusion prior to intensive care unit (ICU), American Society of Anesthesiologists (ASA) score ≥ 3, Glasgow Coma Scale (GCS) ≤ 13, Abbreviated Injury Scale (AIS) in any body region ≥ 4. The maximum GERtality score was 5 points. A mortality rate of 72.4% was calculated in patients with the maximum GERtality score. Mortality rates of 65.1 and 47.5% were encountered in patients with GERtality scores of 4 and 3 points, respectively. The area under the curve (AUC) of the novel GERtality score was 0.803 (GTOS: 0.784; RISC-II: 0.879). The novel GERtality score is a simple and feasible score that enables an adequate prediction of the probability of mortality in polytraumatized geriatric patients by using only five specific parameters.

Study of Effectiveness of Prior Knowledge for Smart Home Kit Installation

Smart-Home in a Box (SHiB) is a ubiquitous system that intends to improve older adults’ life quality. SHiB requires self-installation before use. Our previous study found that it is not easy for seniors to install SHiB correctly. SHiB CBLE is a computer-based learning environment that is designed to help individuals install a SHiB kit. This article presents an experiment examining how smart home sensor installation was affected by knowledge gained from two methods, SHiB CBLE, and a written document. Results show that participants who were trained by the CBLE took significantly (p<0.05) less time in the installation session than those in the control group. The accuracy rate of SHiB kit installation is 78% for the group trained by the CBLE and 77% for the control group. Participants trained by the CBLE showed significantly (p<0.01) higher confidence in the actual installation than those in the control group. These results suggest that having a training before the actual installation will help installers avoid unnecessary work, shorten the installation time, and increase installers’ confidence.

Long term impact of ladder-related injuries as measured by the AQoL instrument

Introduction

Ladder-related falls are a common cause of patients presenting to emergency departments (ED) with serious injury. The impacts of ladder-related injuries were assessed at six-months post-injury using the quality of life, AQoL 4D Basic (AQoL) instrument.

Materials and methods

This was a prospective observational study, conducted and reported according to the STROBE statement. All adult patients with ladder-related injuries who presented to two EDs in southeast Queensland, Australia between October 2015 and October 2016 were approached. Initial participant interviews took place at the time of ED presentation or shortly thereafter, with follow-up telephone interview at six-months.

Results

There were 177 enrolments, 43 (24%) were lost to follow up. There were statistically significant changes post-injury for three of the four AQoL dimensions: independence, social relationships and psychological wellbeing, as well as the global AQoL. Twenty-four (18%) participants reported a clinically significant deterioration in independence, 26 (20%) participants reported a clinically significant deterioration in their social relationships, and 34 participants (40%) reporting a clinically significant deterioration in their psychological wellbeing. Nine of the twelve individual items (in AQoL dimension) deteriorated after injury, there was no change in two items (vision and hearing) and an improvement reported in one (communication). The largest changes (> 25% of participants) were reported with sleeping, anxiety worry and depression, and pain. Across the global AQoL dimension, 65 (49%) participants reported a clinically significant deterioration. The severity of injury as measured by the ISS was an independent predictor of the change in AQoL scores (p<0.001).

Conclusions

Injuries related to falls from ladders continue to have a profound impact on patients at six-months post-injury as measured using the AQoL instrument. This adds to previous research which has demonstrated considerable morbidity and mortality at the time of injury.

Prevention

Older males using ladders at home are at high risk for serious long-term injury. Injury prevention strategies and the safety instructions packaged with the ladder need to be targeted to this at-risk community group. There may also be a role for regulatory bodies to mandate a stabilising device to be included with the ladder at the time of purchase.

Head, Face, and Neck Fractures Secondary to Ladder-Related Injuries Treated in United States Emergency Departments in 2009-2018

BACKGROUND

Ladders are a commonly used piece of equipment; however, their use is accompanied by a significant potential for injury. Fractures of the head, face, and neck are potential consequences of ladder use and can be devastating due to potential for severe sequalae.

OBJECTIVES

To describe the frequency and pattern of ladder-related head, face, and neck fractures from 2009-2018.

METHODS

The National Electronic Injury Surveillance System (NEISS) was searched for ladder-related head, face, and neck fractures treated in U.S. emergency departments. Demographics, mechanism of injury, fracture type, setting in which fracture occurred, and patient disposition were analyzed.

RESULTS

There were 601 total cases (weighted national estimate of 20,450 total cases) of ladder-related head, face, and neck fractures obtained from the NEISS from 2009 to 2018. The mean age of injury was 53 years, and the majority of cases occurred in home settings. Approximately 25% of the cases were patients aged older than 65 years. The majority of fractures in individuals younger than 18 years and older than 46 years of age resulted in admission. The most commonly fractured locations included the face (51.0%), followed by cervical spine (28.3%) and cranial (20.7%) fractures.

CONCLUSIONS

Admission rates for ladder-related head, face, and neck fractures are substantially higher than those previously reported for all types of ladder-related injuries. Injury and admission patterns vary by age. Rigorous safety precautions may be indicated for the high-risk groups identified by this study, especially the elderly.

Stats and ladders: Injury risk and outcomes following falls from ladders

Fatal lower level falls commonly result from ladder fall injuries (LFIs), an often-avoidable injury. We hypothesized that older patients' injury severity differs from younger patients falling from the same mechanism with fall height determining overall morbidity. A retrospective review was completed of all traumatic LFIs during a 6-year period resulting in 178 patients. The mean LFI height was 10.9 ± 6.0 feet, the majority being male (87%), with a mean age of 50.7 ± 16.6 years. The mean ISS was 7.7 ± 7.0 (range, 1-38), 23.6% sustaining > 1 injury. Age inversely correlated with the mean LFI height with patients ≥66 years falling from significantly lower heights (12.3 ft For age group 18-45 y; 10.4 ft vs 9.0 ft (p = 0.003) and having longer LOS (7.3 vs 3.8 days, P = 0.011). No difference in ventilator requirement/days, blood product requirements, or mortality among age groups was observed. Geriatric patients sustain similar injury patterns at lower height levels compared to all ages. Injury prevention programs are necessary to reduce the incidence of a commonly preventable injury.

Accidental adult deaths involving ladders: A forensic perspective

A retrospective study was undertaken of autopsy cases at the Forensic Science South Australia state mortuary over a 20-year period from January 1999 to December 2018 for all cases aged ≥18 years where a ladder was mentioned in the death scene description and/or police reports. Twelve cases were identified, all of whom were male, with an average age of 56 years (range 21–83 years). The most frequent cause of death was a fall from a ladder ( n = 8; 66%), followed by electrocution ( n = 4; 33%). The falls were associated with deaths from blunt injuries, impalement and laceration. The age range of those who fell was 47–83 years (average 66 years). The three of the four deaths associated with electrocutions involved contact with power lines or live electrical wires; the remaining case involved a sharp metal ladder base cutting through a live power lead. The age range of those who were electrocuted was 21–43 years (average 35 years) – significantly younger than those who had died from falls ( p < 0.05). The increase in mean age of the population with increasing popularity of home maintenance activities may result in more cases of lethal falls involving ladders presenting for forensic assessment.

The epidemiology of emergency presentations for falls from height across Western Victoria, Australia

BACKGROUND

In order to implement intervention strategies to prevent falls from height, epidemiological data are needed. The aim of this study was to map emergency presentations for falls from height in residents aged ≥40yr of the western region of Victoria, Australia.

METHODS

Emergency presentations following a fall from height (≥1m) were obtained from electronic medical records for 2014-2016 inclusive. For each Local Government Area, age-standardised incidence rates (per 10,000 population/year) were calculated.

RESULTS

The age-standardised incidence rate was lowest in the Northern Grampians (3.4 95%CI 0.8-5.9), which has several main industries including health care, agriculture and manufacturing. The highest rates occurred in Corangamite (26.0 95%CI 19.9-32.0), Colac-Otway (23.7 95%CI 18.5-28.8) and Moyne (22.5 95%CI 16.8-28.3), which are sparsely populated (15,000-20,000 people each). Patterns were similar for men and women. Most falls occurred during "leisure" (38.0%), followed by "other work" (15.4%). Men were more likely than women to experience a fall from height while undertaking work activities. Many falls occurred in the home (53.2%).

CONCLUSION

Future research should inform strategies to prevent falls from height in the region. This could include specific locations such as the home or farm, and during leisure activities or work.

Traumatic spinal cord injuries in geriatric population: etiology, management, and complications

Background

The relationship of traumatic spinal cord injury (SCI) and the geriatric population is not emphasized in current literature. Our objective was to evaluate mechanisms of injury, outcomes, and complications of geriatric patients with traumatic SCI.

Methods

Patients with traumatic spinal cord injuries admitted to the inpatient rehabilitation unit of a level I trauma center from 2003 to 2013 were reviewed. Inclusion criteria were ages ≥65 years old and availability of complete medical records. Patient demographics, mechanism of injury, diagnoses, American Spinal Injury Association (ASIA) grade, management (surgical, nonsurgical), complications, and mortality were evaluated.

Results

Seven hundred and fifty-seven SCI patients were identified and 53 met our inclusion criteria, with 35 (66.0%) males and 18 (34.0%) females. The average age was 74-years (range, 65 to 91 years). A proportion of 24.5% were 65-69 years of age, 30.2% were 70-74, 22.6% were 75-79, and 22.6% were 80 or older. Thirty-four (64.2%) underwent surgery. The two most common diagnoses of SCI were fractures (43.4%) and central cord syndrome (28.3%). ASIA grading was: A 5 (9.4%); B 3 (5.7%); C 5 (9.4%); D 40 (75.5%). The most severe SCI (ASIA score A and B) primarily occurred in the younger geriatric populations (ages 65-74), as did the highest rates of major complications or major and minor complications (15.4% and 46.2%, respectively, in the 65-69 group). Surgical management increased with age from 46.2% in the 65-69 group to 83.3% in the 75-79 group but subsequently decreased in the ≥80 group (66.7%).

Conclusions

Fractures and central cord syndrome were the most common diagnoses and typically due to falls. The complication rate in this population is high and due to complex causes. SCI in patients aged 65-69 was associated with increased rate of ASIA score A and increased rate of major complications.

Severe Injuries from Low-height Falls in the Elderly Population

BACKGROUND

Falls from low-height can cause severe injuries in the elderly population. This study was conducted to determine characteristics of injuries from low-height falls.

METHODS

We retrospectively review surveillance data on injured patients who presented to six emergency departments from January 2011 to December 2015. Study subjects were divided into severe group and non-severe group based on severity of injury. The general and clinical characteristics were compared between the two groups and analyzed factors related with severe injuries.

RESULTS

Of 1,190 elderly patients, severe group comprised 82 patients (7%). The severe group was 2 years younger than the non-severe group. In the severe group, 61% was men and 34% in the non-severe group. In the non-severe, the injuries more commonly occurred at residential facilities and indoors than those in the severe group. Paid work during injury occurrence was 15%, and the more patients presented with non-alert consciousness in the severe group. The most common regions of major injury were head and neck in the severe group.

CONCLUSION

Paid work, non-alert consciousness, and major injury to head and neck are relating factors to severe injuries in the elderly population.

Injury patterns and outcomes in late middle age (55-65): The intersecting comorbidity with high-risk activity - A retrospective cohort study

BACKGROUND

Late middle age (LMA), is a watershed between youth and old age, with unique physical and social changes and declines in vitality, but a desire to remain active despite increasing comorbidity. While post-injury outcomes in the elderly are well studied, little is known regarding LMA patients. We analyzed the injured LMA population admitted to a rural, regional Level 1 Trauma Center relative to outcomes for both younger and older patients.

MATERIALS AND METHODS

Our registry was queried retrospectively for patients admitted 7/2008- 12/2015; they were divided into three cohorts: 18-54, 55-65, and >65 years. Demographics, injury details, comorbidities, and outcomes were compiled and compared using ANOVA and Chi-square; p < 0.05 was significant.

RESULTS

During the study period, 10,543 were admitted; 1419 (14%) were LMA who experienced overall injury mechanisms, severities and patterns that mirrored the younger cohort. However comorbidity rates were high (56.4%) and comparable to the elderly. LMA patients had the highest rates of alcohol abuse, morbid obesity, and psychiatric illness (p < 0.0001) and suffered the poorest outcomes: highest complications and hospital charges, and longest ICU and hospital LOS. LMA mortality (4.1%) was 41% higher than younger patients (2.9%; p < 0.02) and similar to the older cohort (4.7%; p = 0.32).

CONCLUSIONS

The LMA population has similar mechanisms and injury patterns to younger patients, while exhibiting comorbidity rates similar to the elderly. High-energy injuries exact a greater toll in LMA with poorer outcomes and greater resource utilization. Targeted outreach for injury prevention, and future studies, are needed to address high-risk behavior, substance abuse, and societal contributors.

Characterization of fall patients: Does age matter?

INTRODUCTION

Evaluating age-specific fall characteristics is important for prevention programs. The aim was to characterize fallers who presented to our trauma center. We hypothesized that fall characteristics and outcomes would vary with age.

METHODS

Data were retrospectively collected from the trauma registry and electronic medical records during January 1st, 2014-December 31st, 2015. Data were analyzed by Chi-square test with Yates' continuity correction and one-way ANOVA with Bonferroni's multiple comparisons test.

RESULTS

There were 1541 fallers, 814 (52.8%) were male. Ages ranged from 11 months to 100years. The admission rate was high at 86%, with an average hospital stay of 5.7days. Patients in the 0-18 and 19-45age groups spent significantly less time in the hospital (p<0.0001). Elderly patients had the highest average injury severity score (p<0.0001). However, the youngest patients required surgery more often (p=0.0004). The overall mortality rate was 3.6% and 52.8% were male. The mortality rate increased with age, from 0% for the 0-18 age group to 6.9% for patients ≥65years of age. Remarkably, fallers in the 19-45 and 46-64age groups predominantly died from ground level falls even though the average fall height in these groups was the highest (p<0.0001). More fallers in the 19-45 and 46-64age groups tested positive for alcohol/drug use (p<0.0001). Middle-aged and elderly patients were more likely to be discharged to a skilled nursing or rehabilitation facility compared to younger patients who were discharged home.

CONCLUSIONS AND PRACTICAL APPLICATIONS

Fall characteristics and outcomes varied with age. Data on age-specific characteristics, outcomes, and risk factors of falls will help in developing targeted interventions and may lead to better approaches to treat patients.

A biomechanical analysis of traumatic brain injury for slips and falls from height

Background

Falls are a common cause of morbidity and mortality in society, particularly among the aged and young. There has been research to describe the epidemiology of these types of events, but to date there has been few correlations of clinical brain injury outcomes and metrics used in biomechanical research; parameters often used to help develop protective devices and environments. The purpose of this research was to examine the kinematic characteristics of falls from standing and higher heights in an effort to understand how clinical brain injury is predicted by biomechanical injury metrics.

Methods

Computer simulations of nine traumatic brain injury events from falling were conducted to determine the biomechanical metrics associated with each injury case.

Results

Many of the impacts were to the occipital region of the head, as would be expected from backward falls or from slipping from ladders. These falls resulted in low rotational acceleration values and high linear accelerations, suggesting linear acceleration may be an important characteristic of this injury mechanism. In addition, even though each case resulted in severe head injury, the HIC15 (Head Injury Criterion) values did not consistently predict injury when the kinematic output was lower than 300 g. This result suggests that HIC15 may have limited value as a predictor for high energy short duration direct impacts to the head. The results supported a relationship between fall height and duration of loss of consciousness, with the higher fall heights producing longer times of unconsciousness.

Conclusion

Linear acceleration may be the metric that should be focused on to develop further strategies to protect against severe TBI for fall cases similar to those in this research. In addition, the HIC15 may not be suitable as a predictive metric for TBI and future development of protective devices for the prevention of head injury should take this into account.

Skeletal fractures resulting from fatal falls: A review of the literature

To investigate what is currently known about skeletal blunt force trauma (BFT) resulting from falls, and how valuable that research is in contributing to forensic anthropology investigations and interpretations of circumstances of death, a comprehensive review of forensic anthropology, forensic pathology and clinical medicine literature was performed. Forensic anthropology literature identified that establishing the type of fall from the analysis of BFT is difficult given the uniqueness of each fall event, the complexities involved with identify BFT and, in particular, the limited available research documenting fracture patterning and morphologies. Comparatively, skeletal BFT resulting from fatal falls is well documented in the forensic pathology and clinical medicine literature. These disciplines cover a wide range of fall types (free falls, falls in juveniles, specific fractures produced from falls, falls down staircases, falls resulting in impalements, and 'other' fall types), provide details on how the nature of the fall influences the skeletal fracturing, and documents the anatomical regions susceptible to fracturing. Whilst these contributions may assist forensic anthropologists, they provide limited details of fracture patterns and morphologies and thus further research investigating the details of skeletal BFT resulting from fatal falls is required.

Danger at every rung: Epidemiology and outcomes of ICU-admitted ladder-related trauma

INTRODUCTION

The incidence of ladder-related falls is increasing, and this represents a disturbing trend, particularly in the context of increased life expectancy and the impending retirement of the populous 'baby-boomer' generation. To date, there have been no critical illness-focused studies reporting on the incidence, severity and outcomes of severe ladder-related injuries requiring ICU management.

METHODS

Major trauma patients admitted to ICU over a 5year period to June 2011 after ladder falls >1m were identified from prospectively collected trauma data at a Level 1 trauma service. Demographic and ICU clinical management data were collected and non-parametric statistical analyses were used to explore the relationships between variables in hospital mortality/survival.

RESULTS

There were 584 ladder fall admissions, including 194 major trauma cases, of whom 29.9% (n=58) fell >1m and were admitted to ICU. Hospital mortality was 26%, and fatal cases were almost entirely older males in domestic falls of ≤3m who died as a result of traumatic brain injury. Non-survivors had lower GCS at the scene (p=0.02), higher AIS head code (p=0.01), higher heart rate and lower mean arterial pressure (p<0.01) in the initial 24h period in ICU, and were ≥55years of age (p=0.05). Only 46% of patients available for follow-up were living at home at 12months without requiring additional care.

CONCLUSIONS

The incidence of ladder falls requiring ICU management is increasing, and severe traumatic brain injury was responsible for the majority of deaths and for poor outcomes in survivors. In-hospital costs attributable to the care of these patients are high, and fewer than half were living independently at home at 12months post-fall. A concerted public health campaign is required to alert the community to the potential consequences of this mechanism of injury. The use of helmets for ladder users in domestic settings, where occupational health and safety regulations are less likely to be applied, is strongly recommended to mitigate the risk of severe brain injury. The benefits of this simple strategy far outweigh any mild inconvenience for the wearer, and may prevent catastrophic injury.

Bicycle helmet use to reduce the impact of head injuries in ladder users

BACKGROUND

The aim of this study was to determine if wearing a bicycle helmet during ladder use could reduce the incidence and severity of head injury in the event of a fall.

METHODS

A headform model with inbuilt accelerometers was used to determine the Head Injury Criterion (HIC) score of head impact by dropping 41 helmeted and unhelmeted headforms from eight heights. These results were compared.

RESULTS

There was a statistically significant difference between averaged HIC scores in helmeted and unhelmeted drops (P < 0.001). Unhelmeted HIC scores ranged from 387 at 0.25 m to 2121 at 0.6 m. Helmeted HIC scores ranged from 29 at 0.25 m to 1199 at 2.5 m. At a height of 0.5 m, the risk of severe brain injury (AIS ≥4) from direct frontal head impact is predicted to reduce from >50% to <5% with helmet use.

CONCLUSION

There was a significant decrease in the HIC scores when helmets are used and it is likely that the benefits would be seen in the clinical setting. These results provide an argument for the use of a bicycle helmets by all ladder users, in particular those over age 50 who are at increased risk of head injuries. We recommend that bicycle helmet use be incorporated into ladder injury prevention strategies.