Law falls: An underappreciated mechanism of injury

Objective: This is a retrospective study designed to evaluate the pattern a nd severity of injuries that result from low falls, defined as fails from l ess than 20 ft, subsequent mortality, and requirements of hospital resource s. Our hypothesis is that many of these injuries, even without cardiopulmon ary instability, are worthy of trauma center care. Methods: The records of all patients entered into the hospital trauma regis try at an urban Level I trauma center during the years 1991 through 1997 wh o suffered low falls and who either died after admission or were hospitaliz ed for at least 3 days were reviewed. Patients suffering isolated hip fract ures were excluded. One hundred seventy-six patients constituted the study population. This group accounts for about 2% of all admissions for falls at our institution. Patterns of injury were examined. Age, mechanism of injur y, Injury Severity Score (ISS), and cardiopulmonary or neurologic instabili ty on admission were documented, Mortality, length of intensive care unit a nd hospital stays, as well as billed hospital charges, were reviewed. Results: The majority of patients (62%) were younger than 50 years. Sixty p atients had ISS > 15 and 116 patients had ISS > 9, Sixty patients had multi system injuries requiring specialty care. Head injuries were found in 81 pa tients (35%), and vertebral fractures or spinal cord injuries were found in 49 patients (22%), including 9 quadriplegics and 5 paraplegics. There were seven patients with intra-abdominal injuries (five spleen and two bowel in juries). There was one patient with a rupture of the thoracic aorta. Sevent een patients had deteriorating neurologic or pulmonary function on arrival, but the majority (90%) were stable. Of the 159 "stable" patients, 48 suffe red head injuries, 7 were quadriplegic, and 3 were paraplegic, All intra-ab dominal injuries were in this group. Overall, 14 of 176 patients (8%) died. Seven deaths were in patients older than 60 years, and seven deaths were i n younger patients (p = 0.04). The majority of deaths (9 of 14) were from h ead trauma. Care in the intensive care unit was required in 92 of 176 patie nts. Nine patients had billed charges exceeding $100,000, Conclusion: Low falls can cause significant injuries, most commonly to the head and spine. Based on mechanism of injury alone, patients injured in low falls might not be taken to trauma centers. We have found, however, that m any of these patients sustain serious multisystem injuries, even though the y are stable initially, Although these patients represent only a fraction o f those who fall, our study would support adjustment of triage guidelines t o recommend transport of such patients, particularly elderly patients, to t rauma centers.