Analysis of Factors Influencing the Injury Severity of Free Fall Patients in an Emergency Department

Kim, Ho; Kim, Sun Pyo; Cho, Soo Hyung; Kim, Seong Jung; Cho, Nam Soo

Abstract

PURPOSE: The aim of this study was to determine the epidemiology and risk factors associated with patients in a level I trauma center following fall injuries, and to define potential avenues for risk prevention.
METHODS
The records of 186 patients admitted to the emergency department of Chosun University Hospital with a history of a fall from January 2004 to August 2006 were examined. Data were collected on each patient's age, sex, date of fall, the causea and height of fall, Galsgow Coma Scale (GCS), Revised Trauma Score (RTS), and previous history. Injuries were reviewed and Injury Severity Score (ISS) were calculated.
RESULTS
Falls constituted 0.86% of total trauma patients. Among the 186 patients, 134 (72.0%) were male and 52(28.0%) were female, and the most common ages og fall patients were the thirties and forties, with a mean age of 41.73 years. The mean RTS was 11.15. Most falls were from a height of less than 6meters, with a mean height of 4.77 meters. One hundred sixty-four falls (88.2%) were accidental and 22 falls (11.8%) were from suicide attempts. The peak times for free falls were from 9 a.m. to 12 noon (n=44, 23.7%) and from 3 p.m to 6 p.m.(42, 22.6%). The most common fall injuries were cranial injuries (73, 39.2%), followed by spinal injuries (61, 32.8%)and extremity injuries (28, 15.1%). The median length of hospital stay was 25days (range 1-685days). The mortality rate was 9.14% (17 of 186). The average ISS was 12.06 (range 1-41), with a survivors' mean ISS of 11.37 and non-survivors' mean ISS of 17.92.
CONCLUSION
The factors that significantly correlate with the Injury Severity for free fall patients are the height of fall, lower GCS or RTS score, intention of suicide, and hardness of impact surface (p<0.05). Patients most at risk can be more accurately identified in the emergency department through the development and implementation of educational programs.