"Insignificant" mechanism of injury: Not to be taken lightly

BACKGROUND: Trauma resources should be spent rationally. The mechanism of t rauma is used extensively to triage patients to appropriate levels of care. We examine the hypothesis that patients with "insignificant" mechanism of trauma may have major injuries that require expert trauma care. STUDY DESIGN: Over 9 months at a high-volume Level I trauma center, a prosp ective study was done on patients who sustained ground-level falls (GLF), l ow-level falls (LLF) from less than 10 feet, or were found down (FD) with n o external evidence of significant trauma, and required evaluation by the t rauma team. Of 301 patients included, 110 (37%) had GLF 95 (31%) LLF, and 9 6 (32%) FD. Our main outcomes measure was significant injuries, defined as visceral or intracranial injuries, long-bone, pelvic, facial, or spinal fra ctures. RESULTS: One hundred ten patients (37%) had significant injuries, 20 (7%) w ere admitted to the ICU, 14 (5%) required an operation, and 4 (1%) died. Th e most common injuries were intracranial and skeletal. Almost all patients were evaluated by CT (95%), but only one-quarter had abnormal findings on i t. LLF age more than 55 years, and the absence of severe intoxication (bloo d alcohol level of less than 200 mg/dL) were independent risk factors for s ignificant injuries. A statistical prediction model showed that, when all r isk factors are present, the probability of significant injuries is 73%; wh en all risk factors are absent, there is still a 16% chance for significant injuries. Patients with significant injuries had more operations, longer h ospital stays, and higher hospitalization costs compared with patients with out significant injuries. CONCLUSIONS: Low-energy trauma may produce significant injuries, predominan tly intracranial and skeletal. Trauma care providers should be cautious abo ut dismissing such patients based on the trivial mechanism of injury. Patie nts with LLF who are older than 55 years and not severely intoxicated have a high likelihood for significant injuries. Resources should be spent ratio nally for patients who do not have these characteristics, because the proba bility of significant injuries among them is low, but not zero. (J Am Coll Surg 2001;192:147-152. (C) 2001 by the American College of Surgeons).