Les polytraumatismes sont plus graves après chute d’une grande hauteur qu’après accident de la voie publique

Abstract

Aims. – To compare specific features and prognosis of polytrauma victims requiring urgent laparotomy, after a free fall from a height (FFH) or a motor vehicle accident (MVA). Patients and methods. – Urgent laparotomy was performed only in case of massive hemoperitoneum associated with hemodynamic instability. Injury severity score (ISS) and hospital mortality rate were used to determine the severity of trauma. Results. – Two hundred and four patients underwent urgent laparotomy for blunt abdominal trauma: 79 after FFH (intentional defenestration: 65, accident: 14), and 125 after a MVA. Mean ISS was higher after FFH (39 ± 11) than MVA (35 ± 12) ( P< 0.05). Spine injury and pelvic fractures were more frequent and more severe in FFH patients, with a high incidence of retroperitoneal hemorrhage. Juxta-hepatic veins and inferior vena cava tears usually occurred after FFH. Hospital mortality was 48% (38/79) after FFH and 30% (37/125) after MVA ( P< 0.01). Predominant cause of death was associated injuries. The height of the fall was not a prognostic factor, unlike the quality of the landing surface: the mortality dropped from 59% (34/58) when patient fell onto a hard ground, to 19% (4/21) in case of soft landing surface ( P< 0.05). Conclusion. – Blunt abdominal trauma requiring urgent laparotomy is more severe after FFH than after MVA. The usual cause of death is associated injuries in both groups. Quality of the landing surface is a discriminating factor for mortality after FFH.