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Ground Level Falls Are Associated With Significant Mortality in Elderly Patients

Spaniolas, Konstantinos MD; Cheng, Julius D. MD, MPH; Gestring, Mark L. MD; Sangosanya, Ayodele MD; Stassen, Nicole A. MD; Bankey, Paul E. MD

The Journal of Trauma: Injury, Infection, and Critical Care: October 2010 - Volume 69 - Issue 4 - p 821-825
doi: 10.1097/TA.0b013e3181efc6c6
Original Article

Background: Falls from height are considered to be high risk for multisystem injury. Ground-level falls (GLF) are often deemed a low-energy mechanism of injury (MOI) and not a recommended triage criterion for trauma team activation. We hypothesize that in elderly patients, a GLF may represent a high-risk group for injury and concurrent comorbidities that warrant trauma service evaluation and should be triaged appropriately.

Methods: This is a retrospective study based on the National Trauma Data Bank. All patients with MOI consistent with GLF were identified. Demographics, type and severity of injuries, and outcomes were analyzed.

Results: We identified 57,302 patients with GLF. The group had 34% men, with mean age of 68 years ± 17 years and injury severity score of 8 ± 5. Overall mortality was 3.2%. There were 32,320 elderly patients (older than 70 years). The mortality in the elderly was significantly higher than the nonelderly (4.4% vs. 1.6%, p < 0.0001). The elderly were more likely to sustain long-bone fracture (54.5% vs. 35.9%, p < 0.0001), pelvic fracture (7.6% vs. 2.4%, p < 0.0001), and intracranial injury (10.6% vs. 8.7%, p<0.0001). Multivariate analysis showed that Glasgow Coma Scale (GCS) score <15 (odds ratio, 4.98) and older than 70 years (odds ratio, 2.75) were significant predictors of mortality inpatients after GLF.

Conclusions: Patients older than 70 years and with GCS score <15 represent a group with significant inhospital mortality.

From the Division of Acute Care and Trauma surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.

Submitted for publication February 26, 2010.

Accepted for publication June 30, 2010.

Presented as a poster at the 67th Annual Meeting of the American Association for the Surgery of Trauma, September 24–27, 2008, Maui, Hawaii.

The authors have no financial interest to disclose.

Address for reprints: Julius D. Cheng, MD, MPH, 601 Elmwood Avenue, Box Surg, Rochester, NY 14642; email:

© 2010 Lippincott Williams & Wilkins, Inc.