Geriatric falls: Injury severity is high and disproportionate to mechanism

Objective: Falls are a well-known source of morbidity and mortality in the elderly, Pall-related injury severity in this group, however, is less clear , particularly as it relates to type of fall. Our purpose is to explore the relationship between mechanism of fall and both pattern and severity of in jury in geriatric patients as compared with a younger cohort. Methods: Our trauma registry was queried for all patients evaluated by the trauma sen ice over a 412-year period (1994-1998). Two cohorts were formed on the basis of age greater than 65 or less than or equal to 65 years and c ompared as to mechanism, Injury Severity Score (TSS), Abbreviated Injury Sc ale score, and mortality. Results: Over the study period, 1,512 patients were evaluated, 333 greater than 65 years and 1,179 less than or equal to 65 years of age. Falls were t he injury mechanism in 48% of the older group and 7% of the younger group ( p < 0.05), Falls in the older group constituted 65% of patients with ISS > 15, with 32% of all falls resulting in serious injury (ISS > 15). In contra st, falls in the younger group constituted only 11 % of ISS >15 patients, w ith falls causing serious injury only 15 % of the time (both p < 0.05), Not ably, same-level falls resulted in serious injury 30% of the time in the ol der group versus 4% in the younger group (p < 0.05), and were responsible f or an ISS >15 30-fold more in the older group (31% vs. < 1%; p < 0.05), Abb reviated Injury Scale evaluation revealed more frequent head/neck (47% vs. 22%, chest (23% vs. 9%), and pelvic/ extremity (27% vs, 15%) injuries in th e older group for all falls (all p < 0.05), The mean ISS for same-level fal ls in the older group,vas twice that for the younger group (9.28 vs. 4.64, p < 0.05), whereas there was no difference in mean LSS between multilevel a nd same-level falls within the older group itself (10.12 vs. 9.28, p > 0.05 , The Fall-related death rate was higher in the order group (7% vs. 4%), wi th falls seven times more likely to be the cause of death compared with the younger group (55% vs. 7.5%) (both p < 0.05), Same-level falls as a cause of death was 10 times more common in the elderly (25% vs. 2.5%, p < 0.05), Conclusion: Falls among the elderly, including same-level falls, are a comm on source of both high injury severity and mortality, much more so than in younger patients, A different pattern of injury between older and younger f all patients also exists.