Jurnal Trauma
Jurnal Trauma
Jurnal Trauma
Objective: Falls are a well-known anism in 48% of the older group and 7% group (9.28 vs. 4.64, p < 0.05), whereas
source of morbidity and mortality in the of the younger group (p < 0.05). Falls in there was no difference in mean ISS be-
elderly. Fall-related injury severity in this the older group constituted 65% of pa- tween multilevel and same-level falls
group, however, is less clear, particularly tients with ISS >15, with 32% of all falls within the older group itself (10.12 vs.
as it relates to type of fall. Our purpose is resulting in serious injury (ISS >15). In 9.28, p > 0.05). The fall-related death rate
to explore the relationship between mech- contrast, falls in the younger group con- was higher in the older group (7% vs.
anism of fall and both pattern and severity stituted only 11% of ISS >15 patients, 4%), with falls seven times more likely to
of injury in geriatric patients as compared with falls causing serious injury only 15% be the cause of death compared with the
with a younger cohort. of the time (both p < 0.05). Notably, same- younger group (55% vs. 7.5%) (both p <
Methods: Our trauma registry was level falls resulted in serious injury 30% 0.05). Same-level falls as a cause of death
queried for all patients evaluated by the of the time in the older group versus 4% was 10 times more common in the elderly
trauma service over a 412-year period in the younger group (p < 0.05), and were (25% vs. 2.5%, p < 0.05).
(1994 –1998). Two cohorts were formed on responsible for an ISS >15 30-fold more Conclusion: Falls among the elderly,
the basis of age greater than 65 or less in the older group (31% vs. <1%; p < including same-level falls, are a common
than or equal to 65 years and compared as 0.05). Abbreviated Injury Scale evaluation source of both high injury severity and
to mechanism, Injury Severity Score revealed more frequent head/neck (47% mortality, much more so than in younger
(ISS), Abbreviated Injury Scale score, and vs. 22%), chest (23% vs. 9%), and pelvic/ patients. A different pattern of injury be-
mortality. extremity (27% vs. 15%) injuries in the tween older and younger fall patients also
Results: Over the study period, 1,512 older group for all falls (all p < 0.05). The exists.
patients were evaluated, 333 greater than mean ISS for same-level falls in the older Key Words: Falls, Geriatric trauma,
65 years and 1,179 less than or equal to 65 group was twice that for the younger Injury Severity Score.
years of age. Falls were the injury mech-
J Trauma. 2001;50:116 –119.
A
s the population of the United States ages, the ramifi- Falls constitute the most common mechanism of injury
cations of providing health care for this sector become in the geriatric population, with an annual incidence of 30%
increasingly important. It is expected that by the year in those over 65 rising to 50% in those over 80 years of age.4
2030 the U.S. population over the age of 65 will represent In our own state, recent data from the State of Connecticut
25% of the total population, roughly double the current Committee on Trauma regarding geriatric injury corroborate
proportion.1,2 Trauma affecting this age group thus takes on this finding, with 64% of injuries to patients 70 years old or
similar importance. Trauma remains the seventh leading older occurring as the result of falls.5 Although multilevel
cause of death in patients over 65 years of age. Moreover, it falls do occur, same-level falls predominate. The morbidity of
is well established that the elderly, although injured less these falls is significant; nearly 40% of all nursing home
often, are more likely to die from their injuries than are their admissions are in some way related to falls.6
younger counterparts. With geriatric trauma accounting for a Outcome after trauma in this age group has been studied
disproportionate one third of all trauma-related expenses cur- extensively, both short and long term. The majority of the
rently, it can be expected that the cost of caring for the injured literature supports aggressive care of the injured elderly,
elderly will rise dramatically.3
including those over age 75 and with multiple injuries.7–16
Overall mortality from falls has declined over the last 30
years, primarily as a result of improved trauma
Submitted for publication December 15, 1999. management.17
Accepted for publication September 23, 2000.
Copyright © 2001 by Lippincott Williams & Wilkins, Inc.
Much has been reported regarding geriatric falls includ-
From the Department of Surgery, Hospital of Saint Raphael, New ing patient profile, environmental factors, frequency rates,
Haven, Connecticut. and preventive measures.17–23 Risk factors predisposing this
Poster presentation at the 12th Annual Meeting of the Eastern Associ- sector of the population have been well described previously
ation for the Surgery of Trauma, January 13–16, 1999, Orlando, Florida.
Address for reprints: John Bonadies, MD, Department of Surgery,
in both the community and nursing home settings.5 No pub-
Hospital of Saint Raphael, 1450 Chapel Street, New Haven, CT 06511; lished study, however, addresses the association between falls
email: [email protected]. of all types, injury severity, and pattern of injury, specifically
Table 3 AIS Pattern for All Falls Table 4 Fall Related Deaths
Older Younger Body
AIS Region p Value Patient No. Cause of Death ISS
(n ⫽ 159) (n ⫽ 83) RegionAIS
same-level fall death rate. Interestingly, the condition that 11. Horst HM, Obeid FN, Sorensen VJ, Bivins BA. Factors influencing
rendered him susceptible to severe injury equated his physi- survival of elderly trauma patients. Crit Care Med. 1986;14:681–
684.
ologic status to that of an elderly person.
12. Knudson MM, Lieberman J, Morris JA, Cushing BM, Stubbs HA.
Clearly, the “graying of America” has huge implications Mortality factors in geriatric blunt trauma patients. Arch Surg. 1994;
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for injured patients in particular. This article highlights how 13. Morris JA, Mackenzie EJ, Edelstein SL. The effect of preexisting
simple and commonplace mechanisms often result in devas- conditions on mortality in trauma patients. JAMA. 1990;263:1942–1946.
14. Oreskovich MR, Howard JD, Copass MK, Carrico CJ. Geriatric
tating injury and death in the geriatric patient. A high index
trauma: injury patterns and outcome. J Trauma. 1984;24:565–569.
of suspicion for potential serious injury even after simple 15. Osler T, Hales K, Baack B, et al. Trauma in the elderly. Am J Surg.
same-level falls is necessary to diagnose and treat geriatric 1988;156:537–543.
patients in a timely fashion. Efforts at preventing falls clearly 16. Van der Sluis CK, Klasen HJ, Eisma WH, ten Duis HJ. Major
need to include strategies to decrease both same-level and trauma in young and old: what is the difference? J Trauma. 1996;
40:78 – 82.
multilevel falls.
17. Riggs JE. Mortality from accidental falls among the elderly in the
Unite States, 1962–1988: demonstrating the impact of improved
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