Spinal injuries after falls from hunting tree stands

Tree Stand-Related Injuries in Nonadmitted and Admitted Patients at a Level 2 Trauma Center in Michigan: 2015-2019

INTRODUCTION

Tree stand-related injuries (TSRI) are more common than firearm-related injuries in hunters. Most previous studies on the topic used trauma databases that only include admitted patients. This study characterizes injury patterns found in nonadmitted and admitted TSRI patients presenting to a level 2 Michigan trauma center. TSRI prevention interventions are also discussed.

METHODS

Cases were obtained through a retrospective chart review of the Henry Ford Allegiance Health trauma registry and EPSi cost-accounting database from 2015 to 2019. Keywords searched included fall, hunter, tree, tree stand, treestand, ICD 9 diagnosis (E884.9_Other accidental fall from one level to another), and ICD 10 diagnosis (W14.XXXA_Fall from tree, initial encounter). We analyzed age, sex, body mass index, injury severity score, disposition, alcohol use, injuries sustained, reported height of fall, and narrative of fall.

RESULTS

Thirty-three patients were identified. Patient age was 45±13 y (mean±SD). All patients were male. Injury severity score for nonadmitted patients was 2±1 vs 13±11 in admitted patients. Thirty-three percent of cases were nonadmitted; 67% were admitted. The most common injuries sustained were spinal (33%) and lower extremity fractures (15%). The average yearly TSRI case rate was 5.73 per 10,000 hunters in the study area.

CONCLUSIONS

Our study found that spinal and lower extremity fractures were the most common injuries sustained. One-third of our patients were nonadmitted and therefore not included in the Henry Ford Allegiance Health trauma registry. Some nonadmitted patients had significant injuries requiring specialist consultation, orthopedic braces, or outpatient surgery.

Common Injuries Associated with Falls from Tree Stands in Iowa

INTRODUCTION

Tree stand falls are a common injury among hunters. This study was designed to identify specific injury patterns and local and regional factors affecting access to and care for this unique trauma cohort in Iowa.

METHODS

The University of Iowa trauma registry was retrospectively queried from 2004 to 2014 for patients with a mechanism of injury of fall from tree stands. Data are presented as mean±SD, median, and range, or raw number and percentages as appropriate. Correlation analyses were performed using the Spearman coefficient.

RESULTS

Fifty-three patients were identified. Age was 44±14 (17-78) y. Median fall height was 4.6 m (15 ft), ranging from 1.5 to 12 m (5 to 40 ft). Transport times varied from <1 h to >7 h. Hypothermia was observed in 6 patients (11%). Two patients (4%) tested positive for alcohol. Three patients (6%) tested positive for drugs. Soft tissue injuries (32 [60%]; ie, lacerations and abrasions) were the most common, followed by 30 spine fractures (57%, including 11 lumbar and 10 thoracic fractures), 16 other bone fractures (30%), and 11 rib fractures (21%). Twenty-two patients underwent surgery. Median hospital length of stay was 4 d, ranging from 0 to 20 d.

CONCLUSIONS

Tree stand falls lead to significant injuries. Hypothermia represents a significant risk for these patients, and remote location resulted in long transportation time. Improper use or poor condition of safety equipment contributed to falls and injuries in a few of our patients.

Frequency of complications of falling from the walnut tree, as an occupational-seasonal injury

BACKGROUND

Falling from a tree is one of the major causes of serious injuries in farmers but it can be prevented. Walnut is one of the most important agricultural products in Iran and falling from walnut trees is common during the season of harvest. The aim of this study was to determine the frequency of complications due to falling from walnut tree in patients referred to the emergency department of Imam Ali Hospital in Bojnurd City, Iran.

METHODS

A descriptive cross sectional study was conducted on 127 patients with injuries due to falling from the walnut tree in Bojnurd City, Iran, in the walnut harvest season of August 2013 to November 2014. The tools used for data collection in this study included a demographic information form, checklists of information about the injury and the follow-up checklist of treatment. Data were analyzed using descriptive statistics by the SPSS software version 16.

RESULTS

From a total of 127 injured patients, 120 cases (94.4%) were males with a mean age of 36.49 ± 15.65 years. Five patients died on the day of admission. Eighty two patients (64.56%) were admitted in hospital wards. The most common type of injuries were trunk injuries (26.19%), followed by spinal cord injuries (18.1%). Also, 7 patients suffered from complete spinal cord injury.

CONCLUSIONS

Injuries caused by falling from walnut trees are seasonal and impose large financial burden on our health system. In most cases, young men suffer from varying degrees of disability and experience financial problems. It is very important to train farmers and workers, so as to prevent such injuries.

Fall-induced spinal cord injury: External causes and implications for prevention

OBJECTIVE

To document the demographic and clinical profile of persons who sustained spinal cord injury (SCI) as a result of accidental falls and to determine the usual circumstances surrounding the fall-induced SCI.

DESIGN

Cohort study.

SETTING

21 SCI Model Systems centers throughout the United States.

PARTICIPANTS

6,408 individuals with traumatic SCI between 2005 and 2014 were recruited from the National SCI Database. 1,877 (29%) of them were injuries caused by falls.

INTERVENTIONS

Not applicable.

OUTCOMES MEASURES

External causes of injury documented by the International Classification of Diseases, 10(th) revision, Clinical Modification (ICD-10-CM).

RESULTS

Falls on the same level from slipping, tripping, and stumbling were the most common cause of fall-induced SCI (20%), followed by falls from building (16%), stairs and steps (16%), and ladder (9%). People who were 61 years of age and older had the highest frequency of falls on the same level, while those aged 16-45 years had a higher percentage of falls from buildings, usually work-related. The mechanisms of falls also varied by sex and race. Associated injury and vertebral injury occurred frequently among falls from buildings and ladders. High falls were more likely to be work-related and result in thoracic and complete injury, while low falls were more commonly associated with cervical and motor functionally incomplete injury.

CONCLUSION

The study findings of different mechanisms of falls by age, sex, race and medical consequences provide an insight for future interventions aimed at high risk persons, activities, and environmental factors for preventing or reducing fall-induced SCI.

Alcohol intoxication and its effects on traumatic spinal cord injury outcomes

There are sparse data regarding the impact of alcohol on in-hospital complications associated with traumatic spinal cord injuries (TSCIs). We set out to quantify the impact of alcohol on TSCI outcomes and its influence on health care cost and utilization. The National Trauma Data Bank (NTDB) Research Data Set version 7.2 (2000-2006) was utilized to gather data between 2007 and 2009. We extracted cases of TSCI (International Classification of Diseases, Ninth Revision, Clinical Modification codes 806.xx) without concurrent traumatic brain injury. Outcomes of interest were mortality, length of stay (LOS), intensive care unit (ICU) days, ventilator days, and complications. Continuous outcomes such as LOS, ICU days, and ventilator days were analyzed using linear regression. Risk-adjusted analysis of risk factors for mortality and complication rates were performed using multiple logistic regression. Of the 10,611 persons identified in the NTDB, alcohol was present in approximately one fifth of all cases (20.76%). A majority of TSCI patients were young (mean age, 39 years) Caucasian (65.07%) males (75.93%). Blunt injury was the most common mechanism of injury. The presence of alcohol did not significantly affect mortality or neurological complications. Alcohol in the blood was associated with extended LOS, longer ICU stays, more days spent ventilated, and increased risk of all-type complications. Further, there was a statistically significant association with the presence alcohol and increased risk for pulmonary, pneumonia, deep vein thrombosis and pulmonary embolism, urinary tract infection, and ulcer/skin complications. Alcohol intoxication is associated with increased in-hospital morbidity. The significant association with in-hospital complications increases health resource utilization after spinal cord injury.

Epidemiology of Hunting Stand Injuries Presenting to US Emergency Departments, 2008-2013

OBJECTIVE

To determine the epidemiology of injuries from hunting stands presenting to US emergency departments (EDs).

METHODS

The National Electronic Injury Surveillance System (NEISS) database was queried for ED visits for the period 2008 through 2013 for hunting stand injuries and analyzed for age, diagnosis, sex, race, anatomic location of the injury, the use of alcohol, and association with a gunshot wound.

RESULTS

There were an estimated 38,308 visits with an average age of 40.0 years (range, 1-83 years). The patients were predominantly male (93.3%), white (99.1%), and seen at small- or medium-size hospitals (80.6%). Disposition from the ED was admission in 20.1% and released in 79.9%. A fall occurred in 80.3%, a gunshot wound in 0.4%, and alcohol was involved in 0.6%. The most common diagnoses were a fracture (34.7%), contusion or abrasion (24.0%), strain or sprain (16.8%), laceration (7.7%), and internal organ injury (5.4%). Those injured in a fall were more frequently admitted (23.0% vs. 8.7%) and more likely to have a fracture (37.9% vs. 9.1%). Those with a fracture were older (44.6% vs. 37.9%). Those with internal organ injuries were more frequently admitted (44.8% vs 18.6%).

CONCLUSIONS

This study has characterized the epidemiology of hunting stand injuries with most occurring from falls. A fracture was the most common injury with a very low alcohol intoxication rate. These baseline data can now be used to compare other studies of hunting stand injuries and guide prevention strategies, such as education regarding the need for safety measures to prevent falls.

Severe hypothermia secondary to spinal cord injury without radiographic abnormality

Case

A 64-year-old female was found lying by a river. She was unconscious and her lower body was under water. The patient was transported to the emergency room of our hospital. On arrival, her rectal temperature was 24.6°C. We immediately started rewarming and artificial respiration. Five days after admission, rewarming was completed and she became conscious and could communicate. Initially, she had been injured and examination showed paraplegia. Magnetic resonance imaging of her cervical spine showed no findings indicating bony or ligament injury, but there was a T2 high intensity area at C5/6 and C6/7 levels. The patient was diagnosed with spinal cord injury without radiological abnormality.

Outcome

At 5 months post-injury, the patient was able to walk without crutches.

Conclusion

Spinal cord injury might be missed if there are no radiographic abnormalities. Spinal cord injury without radiological abnormality should be considered as a differential diagnosis of accidental hypothermia.

Hunting stand-related injuries in orthopedics

Hunting remains an extremely popular recreational activity, with nearly 15 million Americans receiving a hunting license annually. Precautions have helped decrease accidents, but hunting-related injuries remain relatively common. The majority of severe, hunting-related accidents involve either a fall from a hunting platform or an accidental shooting. Both of these mechanisms frequently result in orthopedic injuries, many of which require operative care. Although firearms-associated injury has seemingly decreased, hunting platform falls and their sequelae are increasing. Understanding the mechanisms of these injuries and increasing awareness of them may minimize their morbidity and mortality or help prevent them altogether.

Injuries from firearms in hunting activities

BACKGROUND

Recreational hunting is a very popular sport, and frequently involves firearms. Few studies address the pattern of firearm injuries occurring with hunting and how they differ from firearm injuries not associated with hunting.

PURPOSE

A nation wide database will provide an overall perspective of the scope of the problem and types of injuries.

METHODS

Our data were obtained from the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2008 (ICPSR 30543). It was statistically analyzed for demographic and injury patterns using SUDAAN 10™ software. A p < 0.05 was considered to be statistically significant.

RESULTS

There were 1,841,269 ED visits for firearm related injuries 1993-2008; 35,970 were involved in hunting (1.95%). Hunters were older than non-hunters (34.5 vs. 26.7 years, p < 0.0001). Handguns were involved in 48% of the non-hunters and 5.3% of the hunters (p < 0.0001). The injury was unintentional in 99.4% of hunters; for non-hunters 32.1% were unintentional and 60.7% assaults. The majority of the hunting injuries presented to small hospitals (65.9%) while the majority of non-hunting injuries presented to the large (27.0%) and very large (35.0%) hospitals. Hunters were nearly all Caucasian (92%). In hunters, 57% were shot compared to 77% in non-hunters. The most common diagnosis in hunters was a laceration (42%) compared to a puncture in non-hunters (41%). The head and neck accounted for nearly one-half of the injuries in hunters (47%); for non-hunters it was the head and neck (29%) and the leg/foot (24%). Mortality was 0.6% for hunters and 5.3% for non-hunters. The use of alcohol and being involved in antisocial behaviours was much higher in the non-hunters. The estimated incidence of a firearm injury associated with hunting activities was 9 per 1 million hunting days.

CONCLUSION

Hunters injured by firearms were nearly all Caucasian, older than non-hunters, did not involve handguns, presented to small hospitals, often sustained unintentional injuries and were not shot; most commonly injured in the head and neck, and had an overall mortality of 0.6%. These data can be a reference for future studies regarding hunting injuries associated with firearms.

Pattern of spine fractures after falling from walnut trees

OBJECTIVES

Different mechanisms are introduced for various kinds of spine fractures. Falls from walnut trees are a major cause of spine fracture, with a high rate of mortality and significant deficits in young male workers. The aim of this study was to define the rate of cervical fractures and pattern of fractures in falls from walnut trees and to compare with other types of falls in the literature, which seem to have different mechanisms.

METHODS

This was a prospective study conducted at harvest season, from September 2011 to October 2011. Cases of falls from walnut trees referred to the emergency ward were recorded. Spine fractures were analyzed to find the pattern of fractures in falling from trees.

RESULTS

Fifty cases of falling from a walnut tree were referred to the emergency ward. Fractures were detected in 7 cases, including 5 cervical fracture dislocations (10%) and 2 thoracolumbar fractures (4%). The mean age was 25 ± 0.4. Complete spinal cord injury was found at 8 cases, and the mortality rate was 10%.

CONCLUSIONS

The pattern of fractures was unique to falls from walnut trees, mainly consisting of cervical fractures with quadriplegia and a poor prognosis, and in a young group of workers, which puts a large economic burden on society.

Injury pattern due to falls from hunting stands

Hunting is a historically constructed cultural act and continues to be a passion and a popular recreational pastime worldwide. Along with a high population density in Europe and a large volume of hunters hunting injuries such as falls from hunting stands continue to occur regularly and are a significant cause of morbidity among hunters. The purpose of this study was to review typical injury patterns after falls from hunting stands in Germany between 2000–2009 using the German agricultural statutory accident insurance database and to compare these findings to other causes of hunting accidents. The most common injury pattern after falls from hunting stands in Germany in the period of 2000–2009 are closed fractures. However, data collection is incomplete. Thus a more precise data collection would help to be able to better analyze accident mechanisms in order to be able to prevent further accidents.

Deer stand fatalities in Kentucky: two cases of reverse suspension and blunt force trauma

Hunting many types of wild game is an avidly pursued outdoor activity that attracts all ages and both genders at various times of the year. Deer hunting is a popular sport in many regions of North America. A variety of weapons are used in the hunting, trapping, and killing of game. As a variety of different modalities are used, myriad types of injuries unique to the type of hunting can occur. Most deer hunting-related fatalities identified at the Office of the Chief Medical Examiner in Kentucky are accidental firearm injuries. Less commonly encountered are fatalities resulting from elevation of the hunter in a tree stand, often associated with poor design or construction of the perch. We present 2 tree stand-related deaths. One victim died of positional asphyxia due to reverse suspension from a hunting tree stand. The second victim died of multiple blunt force injuries sustained in a 20-foot fall from a tree stand. We summarize the features of morbidity and mortality related to deer hunting based on investigations by the Office of the Chief Medical Examiner.

Tree Stands, Not Guns, are the Midwestern Hunter's Most Dangerous Weapon

Although the prevailing stereotype is that most hunting injuries are gunshot wounds inflicted by intoxicated hunting buddies, our experience led us to hypothesize that falls comprise a significant proportion of hunting related injuries. Trauma databases of two Level I trauma centers in central Ohio were queried for all hunting related injuries during a 10-year period. One hundred and thirty patients were identified (90% male, mean age 41.0 years, range 17-76). Fifty per cent of injuries resulted from falls, whereas gunshot wounds accounted for 29 per cent. Most hunters were hunting deer and 92 per cent of falls were from tree stands. Alcohol was involved in only 2.3 per cent, and drugs of abuse in 4.6 per cent. Of gunshots, 58 per cent were self-inflicted, and 42 per cent were shot by another hunter. Tree stand falls were highly morbid, with 59 per cent of fall victims suffering spinal fractures, 47 per cent lower extremity fractures, 18 per cent upper extremity fractures, and 18 per cent closed head injuries. Surgery was required for 81 per cent of fall-related injuries, and 8.2 per cent of fall victims had permanent neurological deficits. In contrast to prevailing beliefs, in our geographic area tree-stand falls are the most common mechanism of hunting related injury requiring admission to a Level 1 trauma center.

Epidemiology of tree stand-related injuries in the United States from 2000 to 2007

BACKGROUND

: Tree stands have remained popular among hunters because of the increased vantage point for the hunter. Although stand styles vary, the typical stand is very minimalistic in design, comprising a seat and an area for the hunter to place his feet. Although there have been studies using state trauma registry data, to date, there has not been a study on the epidemiology of tree stand-related injuries in the national population.

METHODS

: The 2000 to 2007 National Electronic Surveillance System provided information among individuals aged 16 years and older regarding tree stand-related injuries that required emergency room attention in the United States. Hunter population estimates from the U.S. Fish and Wildlife Services were used to estimates injury rates by sex, age, race, month, and year.

RESULTS

: The rate of tree stand-related injuries remained relatively stable from 2000 to 2007. Rates were higher for men compared with women (48.0 vs. 24.7 per 100,000 hunters, respectively) and highest among those 15 to 24 (55.7 per 100,000) and 25 to 34 (61.0 per 100,000).

CONCLUSIONS

: Although a majority of hunters are older, the highest rates occurred among the younger ones. Hunters using and manufacturers of tree stands must be aware of the safety precautions during use of the stands. Improvements in the safety design of the stands as well as knowledge to the proper use of stands can help to minimize the burden of injury in the hunter population related to tree stands.

Injuries due to falls from hunters' tree stands in Pennsylvania

BACKGROUND

People who hunt deer from elevated tree stands may improve the chances of a successful hunt but also risk serious injury from a fall to the ground.

PURPOSE

The objective of the current investigation is to estimate the rates of injuries from falls from tree stands using a population-based study design.

METHODS

Annual and age-specific rates were calculated using injury data collected from 1987 to 2006 from all accredited Pennsylvania trauma centers and hunting license sales and game-take mail surveys from the Pennsylvania Game Commission.

RESULTS

From 1987 through 2006, 2.73 people (n=499) per 100,000 licensed deer hunters were injured from falls from tree stands; seven people died. Rates increased from 0.59 in 1987 to 7.08 in 2006 (p<0.001). Rates increased with age (p<0.001) and were highest among hunters aged 40-49 years. The case-fatality rate was 1.4%.

CONCLUSIONS

Falls from tree stands associated with deer hunting are an increasing and important cause of injuries, especially for older hunters. Surveillance for tree stand-related injuries should be enhanced and preventive initiatives developed and tested.