High-Level Falls: Type and Severity of Injuries and Survival Outcome According to Age

Abstract

High-level falls are associated with multiple injuries and are often difficult to evaluate. Age may be an important factor determining the anatomic distribution and severity of injuries and outcome. There is little work published on this subject. Our objective was to evaluate the effect of age on the incidence and severity of specific organ injuries and survival outcome after high-level falls. This was a trauma registry study that included all victims of high-level falls (>15 feet) admitted to a Level I academic trauma center. The incidence of severe trauma (Injury Severity Score > 15), severe body area trauma (head, chest, abdomen, and extremities) with Abbreviated Injury Scale score > 3, specific organ injuries (spine, thoracic aorta, solid and hollow viscus intra-abdominal injuries, and pelvic and lower extremity fractures), and mortality were compared in four age groups: < or =14 years, 15 to 55 years, 56 to 65 years, and >65 years. The study included 1,613 patients. There were 128 patients (7.9%) in the age group < or =14 years, 1,389 (86.1%) in the age group 15 to 55 years, 59 (3.7%) in the age group 56 to 65 years, and 37 (2.3%) in the age group >65 years. The mortality ranged from 5.5% in the pediatric group to 24.3% in the elderly group (p = 0.02). Significantly more patients in the elderly group had an Injury Severity Score > 15 than in the pediatric group (45.2% vs. 15.6%, p = 0.001). The overall incidence of spinal fractures was 24.1% (392 cases) and increased significantly after the age of 15 years. Elderly patients were significantly more likely than pediatric patients to suffer pelvic fractures (21.6% vs. 1.6%, p = 0.0001) and more likely to have fractures of the femur (18.9% vs. 3.9%, p = 0.006). The nature of intracranial injuries and the incidence of solid and hollow viscus injuries were similar in all age groups. Age is an important variable in determining the nature and severity of injuries after high-level falls. Spinal injuries are very common in all age groups older than 14 years.