Injury Patterns after Falling down Stairs-High Ratio of Traumatic Brain Injury under Alcohol Influence

Consumer Products Nerve Injuries Among Patients Products Presenting to United States Emergency Departments Between 2012 and 2021: A Nationwide Cohort

Introduction

Nerve injuries and resultant pain are common causes of emergency department (ED) visits in the United States. Injuries often occur either due to activity (ie sports related injury) or due to consumer products such as stairs or bedframes. We investigated the incidence of consumer product-related nerve injuries (CPNIs) in patients who presented to the ED in the United States.

Materials and Methods

The National Electronic Injury Surveillance System was queried to identify patients presenting to US EDs between 2012 and 2021 with CPNIs. The cohort was categorized by age: 1) 0-17-year-olds, 2) 18-64-year-olds, 3) and 65+ year-olds. The primary outcomes were the type of injury and the location of injury.

Results

A total of 14,410 CPNIs were reported. There was an increase in yearly CPNIs (β = 4763, (95% confidence interval 1940-7586); P = 0.004). The majority (11,547/14,410, 80.1%) of injuries were among adults. Elderly females encountered more CPNIs than males (52.5% vs 47.8%, P = 0.002). Stairs were most involved in nerve injuries among adults (8.21%) and children (3.96%) whereas beds or bedframe injuries were most frequent (12.0%) among the elderly. Sciatica was the most common diagnosis (≥60%) followed by radiculopathy (≥20%) in adults >18 years of age. Among adults aged 18 to 29, the upper trunk, lower arm, and wrist was more frequently involved, while these areas were less commonly involved in adults aged 40 to 49. Compared to adults, the pediatric and elderly patients presented with more traumatic spinal cord injuries.

Conclusion

Sciatica, radiculopathy, and traumatic spinal cord injury were the most common diagnoses following CPNIs. Children and the elderly tended to present with more severe CPNIs than the general adult population. Further investigations exploring interventions to lower the burden of CPNIs, improve consumer product safety, and reduce potentially chronic and debilitating injuries are necessary.

Location and accumulation of primary head injuries, and prevalence of secondary injuries among neuropathologically examined medico-legal autopsy cases - A comparative study of falls and assaults

Even though traumatic brain injury (TBI) is a major cause of death globally, detailed data on the location and accumulation of primary head injuries, and prevalence of secondary injuries in distinct injury circumstances such as falls and assaults is limited. This study aimed to highlight the differences in injury patterns between falls and assaults among neuropathologically examined medico-legal autopsy cases. Data were collected on a total of 128 cases from the Forensic Medicine Unit, Finnish Institute for Health and Welfare, between the years 2016 and 2022. All cases had suspected or confirmed acute head injuries and underwent a full neuropathological examination. Background and circumstantial variables, as well as the presence of head and brain injuries, were extracted from the medico-legal autopsy case files. Comparative analyses were conducted between assured falls (n = 26) and assaults (n = 23). Any primary head injury was observed in 57.0 % of the full sample; the most common primary injuries were scalp haemorrhage (47.7 %), subarachnoid haemorrhage (SAH) (24.2 %), and diffuse traumatic axonal injury (13.3 %). Assault cases showed a significantly higher prevalence of scalp haemorrhage (82.6 % vs. 46.2 %, p = 0.016) and SAH (52.2 % vs. 11.5 %, p = 0.004) compared to fall cases. In assault cases, the left hemisphere was clearly more frequently affected than the right one (91.3 % vs. 65.2 %). Of secondary injuries, brain oedema was more common in assaults than falls (47.8 % vs. 7.7 %, p = 0.003). In conclusion, this study highlights differences in head and brain injury patterns between falls and assaults. Scalp haemorrhage and SAH are more common in assaults than falls. Assaults appear to lead to a higher frequency and diversity of injuries, particularly in the left hemisphere.

A retrospective study of the injury patterns seen in fatal falls downstairs

INTRODUCTION

Fatal falls involving stairs are often associated with advanced age, intoxication, acute natural pathology and less commonly - the involvement of a third-party. The injury patterns seen in these cases are often complex and from a medico-legal standpoint, determining third-party involvement based on pathology alone can prove a significant challenge. Classifying the manner of death in such cases, can become particularly complex when the injury pattern appears inconsistent with a simple fall downstairs, or there is an absence of eye-witness testimony.

AIM

To explore the circumstances and injury patterns seen in cases of fatal falls downstairs which were classified as accidental vs. undetermined by the coroners.

STUDY DESIGN

This retrospective study explored the injury patterns present in all cases of fatal falls downstairs referred to the Office of the State Pathologist (OSP) over a 10-year-period (2012-2022) (n = 51).

RESULTS

Fatal falls downstairs which were classified as undetermined were found to have a greater number of craniofacial fractures, spinal fractures and intracranial injuries when compared to accidental falls. Undetermined staircase deaths also displayed more significant fracturing involving the facial skeleton.

CONCLUSION

Ultimately, where there is a question of third-party involvement, the Post-Mortem Examination (PME) findings alone cannot determine the manner of death. The pathologist's examination may identify injuries that are inconsistent with a simple fall downstairs, but it is the coroner who must conduct a thorough investigation into the circumstances of the fatal fall and ultimately determine the classification of the death.

Investigation of injuries sustained from falls down stairs

Interpretation of injuries sustained from fatal falls involving stairs is a challenge encountered by death investigation teams regularly. The high incidence of this occurrence is because stairs are a common entity in society. Without a medical evaluation of an individual's injuries, it is difficult to determine whether a fall from stairs contributed to how the individual died. The purpose of this study is to characterize the injuries of individuals that were sustained from a confirmed fatal fall involving stairs within our jurisdiction (Ontario, Canada) during 2014-2020. In a retrospective cross-sectional observation study, we examined 159 cases using both postmortem imaging and routine autopsy approaches. Our findings showed the head was the most common anatomical region injured. The most common injuries observed in the head included skull fracture(s) (most commonly the temporal, parietal and occipital bones), subarachnoid hemorrhages, and brain contusions. Anatomical regions less commonly injured included the extremities, thorax, and pelvis. This study identified an association between the presence of intracranial hemorrhage and those 65-years-old and younger; brain injury in the absence of pre-existing medical conditions; and brain injury for individuals that had a blood alcohol concentration between 0 and 80mg/100 mL. Extracranial skeletal trauma, as defined by skeletal trauma apart from the head region, was observed in 62% of cases. Extracranial skeletal trauma was also found to be strongly associated with individuals over 65-years-old. Overall, our study affirms that traumatic head injury is the primary cause of death from falls down stairs. Also, we provide information on rare injuries from falls down stairs, and indirectly, identify which body locations appear protected from injury during falls. These findings may aid in the interpretation of whether injuries in this setting are compatible with accidental or non-accidental trauma.

Saturday Night Fever: Interpersonal Violence as a Reason for Presentation in a University Emergency Department

(1) Presentations to a trauma emergency department following a violent confrontation account for a relevant proportion of the overall population. To date, violence (against women) in the domestic setting has been studied in particular. However, representative demographic and preclinical/clinical data outside of this specific subgroup on interpersonal violence are limited; (2) Patient admission records were searched for the occurrence of violent acts between 1 January and 31 December 2019. A total of 290 patients out of over 9000 patients were retrospectively included in the "violence group" (VG). A "typical" traumatologic cohort (presentation due to, among other things, sport-related trauma, falls, or traffic accidents) who had presented during the same period served as comparison group. Then, differences in the type of presentation (pedestrian, ambulance, or trauma room), time of presentation (day of week, time of day), diagnostic (imaging) and therapeutic (wound care, surgery, inpatient admission) measures performed, and discharge diagnosis were examined; (3) A large proportion of the VG were male, and half of the patients were under the influence of alcohol. Significantly more patients in the VG presented via the ambulance service or trauma room and during the weekend and the night. Computed tomography was performed significantly more often in the VG. Surgical wound care in the VG was required significantly more often, with injuries to the head being the most common; (4) The VG represents a relevant cost factor for the healthcare system. Because of the frequent head injuries with concomitant alcohol intoxication, all mental status abnormalities should be attributed to brain injury rather than alcohol intoxication until proven otherwise, to ensure the best possible clinical outcome.

Stair-related falls in the USA: traumatic brain injury and the role of alcohol intoxication

INTRODUCTION

Falls are a leading cause of head injury in the USA. Stair-related fall injuries are common and often more serious than same level falls. Alcohol is a known contributor to unintentional injuries, and often associated with fall-related injuries, specifically falls occurring on stairs. The objective was to examine the association between alcohol use and head injuries (traumatic brain injuries (TBIs) or craniomaxillofacial (CMF) injuries) among persons aged 15-64 presenting to an emergency department (ED) with an injury resulting from a fall on stairs.

METHODS

Using the 2019 National Electronic Injury Surveillance System, US ED records were examined. Injuries due to falling on stairs were retrieved, with the role of alcohol in the outcome of TBI and CMF injuries examined. Prevalence ratios (PR), adjusted for covariates (blood alcohol level screening, patient demographics, drug use, disposition) were obtained from average marginal predictions derived from logistic regression models.

RESULTS

An estimated 687 902 patient visits related to falls on stairs occurred during the study period. Patients who presented with alcohol intoxication had a higher prevalence of TBI (PR 2.7 95% CI 2.3 to 3.1) and CMF injuries (PR 2.5; 95% CI 2.3 to 2.8). PRs were more pronounced among patients with blood alcohol concentration ≥0.1, as was hospital admission.

CONCLUSIONS

Stair-related falls represent a common cause of ED visits for falls in the USA. Alcohol intoxication had a detrimental effect on the prevalence of TBI and CMF. A multimodal treatment approach may be beneficial given the complex interrelationship between the injury type and alcohol.