Fall Injuries Research Articles

Vertebral Fracture and Its Outcomes in Emergency Patients of Kowsar Hospital in Sanandaj: An Epidemiological Study

Background: Vertebral fracture, one of the most incidents in human life, is associated with many complications. Due to the importance of this complication, this study was conducted to epidemiologically investigate vertebral fractures and their consequences in the emergency department of Kowsar Hospital in Sanandaj in 2017. Methods: In this retrospective cross-sectional study, 350 patients who visited the emergency department of Kowsar Sanandaj Hospital in 2017 due to vertebral fractures were included. The data was extracted from information collected through phone contact and patients’ medical documents. V Kramer and ETA tests were performed to analyze the hypotheses using SPSS 25 software. Results: Men constituted 61% of the patients. The average age of the patients was 42.18 (6.86) years, and almost 41% of the patients lived in Sanandaj. The most common trauma mechanism was fall injury with 44.8%, 59.55% of which were in the lumbar region. Compression and burst fractures had the highest fracture rates with 47.85 and 21.9 percent, respectively. Conclusion: According to the findings, the fractures were more prevalent in men, young people, and in labor and agricultural occupations, and there is a significant relationship between the consequences of fractures with age, sex, and occupation, which indicates the need for more safety considerations in these people. Therefore, it is necessary to identify and subsequently modulate the risk factors associated with falling injuries to reduce this type of injury.

Nationwide Update on Prevalence of Falls, Injurious Falls, Concerns About Falling, and Fall Prevention in Persons With Multiple Sclerosis.

The aim of the study is to estimate the current nationwide prevalence of falls, injurious falls, concerns about falling, and information on fall prevention among people with multiple sclerosis. This is a cross-sectional national web-based survey that included 965 adult people with multiple sclerosis. Participants self-reported falls and injurious falls experienced in the past 6 months. Participants also provided information on their concerns about falling and information on fall prevention received. A total of 56% reported falling in the past 6 months. The prevalence of falls at the population level ranges between 53% and 59%. Most falls occur inside of participants' homes (68%). About 30% of fallers reported an injurious fall. Most respondents, 87% expressed being concerned about falling and 68% reported they had cut down on activities due to their concerns about falling. Among participants who received information about falling (64%), only 9% received a formal fall prevention course. Despite advances in falls research over the last decades, falling continues to be a highly prevalent problem for people with multiple sclerosis. About one-third of those falls result in injuries. Concerns about falling among fallers and nonfallers affect the performance of daily activities and independence. Few people receive a formal falls prevention education or training.

Traumatic scrotal sac hematoma after a fall injury

Introduction and Importance: Traumatic scrotal sac hematoma is an uncommon medical condition following a fall injury. Symptoms include swelling, pain, and discoloration. Accurate and immediate diagnosis is crucial to avoid complications and prevent testis loss, abscess formation, erectile dysfunction, and infection. This case highlights the importance of prompt evaluation and treatment to prevent complications and ensure optimal patient outcomes. Case Presentation: A 56-year-old man without prior medical history presented to the emergency department with scrotal pain and swelling 10 h after a traumatic event. The patient underwent a series of examinations, including radiological studies, before undergoing scrotal exploration and hematoma evacuation under subarachnoid block anesthesia. As of now, the patient has not experienced any complications that have impacted his quality of life. Clinical Discussion: Scrotal sac hematoma is formed following a blunt trauma when a significant force is transferred during contact with a solid object, impact from sports equipment, road traffic accidents, or falls from a height. If early exploration is delayed, then it can lead to complications like testicular atrophy, abscess formation, and infection. Hence, prompt diagnosis with clinical and radiological evaluation followed by immediate surgical intervention can result in better outcomes. Conclusion: Scrotal sac hematoma from blunt trauma is rare but can cause significant morbidity and psychological distress. Early surgical intervention is often necessary, especially if a testicle has ruptured, to salvage viable testicular tissue and control bleeding, resolve pain faster, shorten hospital stays, and improve the quality of life for patients.

Evaluation of a Fall Prevention Program to Reduce Fall Risk and Fear of Falling Among Community-Dwelling Older Adults and Adults with Disabilities.

The overarching goal of the program evaluation was to determine the reach and impact of the District-funded Safe At Home (SAH) modification program in reducing falls, fall injuries, and fear of falls among community-dwelling older adults and adults with disabilities. The SAH program has served over 6000 adults since 2016, the majority of whom are women (79%) and over age 60 (92%). Letters were mailed in September 2022 to clients (n=492) who had home modifications completed between October 2021-March 2022 inviting them to participate in a brief phone survey about program satisfaction, falls, fall location, and severity. The validated Fall Efficacy Scale (FES) was administered pre (at first visit), post (at last visit), and during the phone survey (within 6 months to 1 year of program completion) to assess fear of falling. The response rate was 55% (n=241). Older adults (n=219) and adults with disabilities (n=22) reported high program satisfaction. Most clients, 79%, did not report a fall since the completion of the home modifications. The majority of falls reported, 76%, occurred inside the home. The average evaluation FES score was 32.5 (SD=22.6, range 10-100), indicating relatively low fear of falling. Higher FES scores were associated with a greater likelihood of reporting a fall (r=0.44, p < 0.001, n=51) and older age (r = 0.17, p < 0.01).FES scores were not related to gender. Evaluation FES scores were significantly lower than the pre-FES scores, indicating a reduction in fear of falling and positive impact of the home modifications (T(107) = 5.14, p < 0.001). The client-centered SAH program demonstrates significant reductions in falls, fear of falling, and high satisfaction among clients. Recommendations include program expansion to offer other evidence-based components to reduce falls and support safe aging in place.

The influence of women’s age and fall history on foot and lower limb kinematics during transition step descent

Falls are a major public health concern, with older women being at the greatest risk to experience a fall. Step descent increases the likelihood of a fall injury, yet the influence of age and fall history on lower extremity kinematics have not been extensively studied. The purpose of this study was to examine lower extremity and foot kinematics of women with and without a fall history during single step descent. Hip, knee, and foot kinematics of young women (n = 15, age = 22.6 ± 3.2 years), older women with no recent falls (n = 15, age = 71.6 ± 4.4 years), and older women with a fall history (n = 15, age = 71.5 ± 5.0 years) as they descended a 17 cm step were examined. Differences in initial contact angles and ROM during landing were examined with between group MANOVA tests. Distal foot initial contact angles were not significant between groups. For range of motion, both older groups went through greater hip extension (p = 0.003, partial η2 = 0.25), but less hip adduction (p = 0.002, partial η2 = 0.27) and less lateral midfoot dorsiflexion (p = 0.001, partial η2 = 0.28) than the younger women. The older fall group had reduced knee flexion (p = 0.004, partial η2 = 0.23) than the younger group, and the older non-fallers slightly plantarflexed at the medial midfoot (p = 0.005, partial η2 = 0.23) while the young women dorsiflexed. Thelanding phase ROMdifferences exhibited by the older adult groupsmayincrease the likelihood of a misstep, which may result in a fall.

Retrospective Analysis of Circumstances of Falls and Related Injuries across Levels of Care in Older Adult Retirement Home Facilities.

Towards developing more effective interventions for fall-related injuries, this study analysed a novel database from six retirement home facilities over a 4-year period comprising 1,877 fallers and 12,445 falls. Falls were characterized based on location, activity, injury site, and type, and the database was stratified across four levels of care: Independent Living, Retirement Care, Assisted Care, and Memory care. Falls most occurred within the bedroom (62.8%), and during unknown (38.1%), walking (20.2%), and transfer tasks (14.6%). Approximately one in three (37%) of all falls resulted in an injury, most commonly involving the upper limb (31.8%), head (26.3%), and lower limb (22.2%), resulting in skin tears (35.3%), aches/pains (29.1%), or bruises (28.0%). While fall location, activity, and injury site were different across levels of care, injury type was not. The data from this study can assist in targeting fall-related injury prevention strategies across levels of care within retirement facilities.

Short physical performance battery is not associated with falls and injurious falls in older persons: longitudinal data of the SCOPE project

Key summary pointsAimOur objective was to study the predictive value of the Short Physical Performance Battery (SPPB) in the cohort of the SCOPE project on falls, injurious falls, and possible difference of prediction between indoors and outdoors falls.FindingsNo association of SPPB and falls was found in models adjusted for age, sex, marital status, number of medications, quality of life, handgrip strength, and muscle mass. While SPPB fails to differentiate between injurious and non-injurious falls (p = 0.48), a lower SPPB score was associated with falls at home (p < 0.01) after 24 months.MessageSBPP was not able to significantly predict the risk of falling as well as experiencing an injurious fall.

Effect of forward moment on recovery motion against tripping.

Investigating the fall recovery motion mechanism is crucial to prevent fall injuries. Among the various parameters of motion and posture, the forward moment can be considered the representative parameter of the magnitude of tripping from a kinematic perspective. The effect of increasing the forward moment on the recovery motion after tripping was investigated in this study. A tripping experiment was performed on a treadmill, and the recovery motion was observed. The forward moment was artificially increased using several approaches, such as pulling the torso, increasing gait speed, and increasing body mass. Factor analysis was performed to establish the relationship between the recovery motion parameters and forward moment. The distribution of the factor scores implied the uniqueness of the recovery motion of the pull condition. Although the forward moment temporarily increased, it was compensated quickly. The other conditions and factors indicated qualitative similarity of the recovery motion among the different conditions. This study demonstrates that the recovery motion after tripping is robust against an increase in forward moment, regardless of the method used to increase the forward moment. The investigation of reaction motion pattern enables validation of the recovery motion and falling posture estimation. Such fall simulations will facilitate the development of a method of fall prevention and mitigation.

Characteristics and demography of low energy fall injuries in patients > 60 years of age: a population-based analysis over a decade with focus on undertriage

BackgroundAn increasing group of elderly patients is admitted after low energy falls. Several studies have shown that this patient group tends to be severely injured and is often undertriaged.MethodsPatients > 60 years with low energy fall (< 1 m) as mechanism of injury were identified from the Stavanger University Hospital trauma registry. The study period was between 01.01.11 and 31.12.20. Patient and injury variables as well as clinical outcome were described. Undertriage was defined as patients with a major trauma, i.e., Injury Severity Score (ISS) > 15, without trauma team activation. Statistical analysis was performed using the Chi-squared test for categorical variables and the Mann–Whitney U test for continuous variables.ResultsOver the 10-year study period, 388 patients > 60 years with low energy fall as mechanism of injury were identified. Median age was 78 years (IQR 68–86), and 53% were males. The location of major injury was head injury in 41% of the patients, lower extremities in 19%, and thoracic injuries in 10%. Thirty-day mortality was 13%. Fifty percent were discharged to home, 31% to nursing home, 9% in hospital mortality, and the remaining 10% were transferred to other hospitals or rehabilitation facilities. Ninety patients had major trauma, and the undertriage was 48% (95% confidence interval, 38 to 58%).ConclusionsPatients aged > 60 years with low energy falls are dominated by head injuries, and the 30-day mortality is 13%. Patients with major trauma are undertriaged in half the cases mandating increased awareness of this patient group.

Bayesian semi-parametric inference for clustered recurrent events with zero inflation and a terminal event.

Recurrent events are common in clinical studies and are often subject to terminal events. In pragmatic trials, participants are often nested in clinics and can be susceptible or structurally unsusceptible to the recurrent events. We develop a Bayesian shared random effects model to accommodate this complex data structure. To achieve robustness, we consider the Dirichlet processes to model the residual of the accelerated failure time model for the survival process as well as the cluster-specific shared frailty distribution, along with an efficient sampling algorithm for posterior inference. Our method is applied to a recent cluster randomized trial on fall injury prevention.

IOT Based Smart Solution for Preventing Fall Injuries at Workplace

In India fall injuries are increasing rapidly at workplace not only in the industrial sector even though construction and private sector too. Fall injury is the highest cause of death/ fatal/severe injuries. The severity of working at height incident depending upon the nature of job, height of application, uneven/cluttered surface etc.In this research paper a unique solution has been studied to bring revolutionary change in personal protective equipment which is used while working at height. There are many technologies are available, in chemical industry if any parameter deviate automatically machine will be shut-down and safe operating protocols will be activated but in conventional personal protective equipment it is hardly say there is still area of research where the technological improvement is needed to bring the robust safety system. Air bags are a very good example to correlate the smart PPE, if any passenger vehicle have air bag system collision with other vehicle automatically within milli second the airbag will be activated which saves the life of driver and passenger as well. Similarly Smart PPE has unique provision if PPE compliance is deviated at workplace immediately the violation shall be captured, and warning alert shall be given to user to remind them to compliance. This will help us to improve workplace safety. It is an error proof system that neither required manual surveillance nor manual recording of violations. In this research paper IOT internet of thing based smart safety harness has been studied and the workplace deviation were compared earlier with manual monitoring data to analyze the human error with respect to compliance of personal protective equipment

Alcohol and Substance Use Among the Working Age Population: A Nationwide Study of Fall-Related Emergency Department Visits.

Prior studies have linked fall-related emergency department (ED) visits among older adults to alcohol use. Characteristics related to falls in the working age population (WAP; 15-64 years) may vary with alcohol and substance use. This study aimed to identify factors associated with fall-related ED visits related to alcohol and substance use in the WAP. Using nationally representative 2019-2020 National Hospital Ambulatory Medical Care Survey data, fall-related ED visits within 72 hours were stratified by indication of alcohol use, substance use, and concurrent alcohol and substance use. Descriptive statistics accounting for the survey's complex design were used along with multivariable logistic regression to identify associated factors. Between 2019 and 2020, an estimated 10,800,000 fall-related ED visits occurred among the WAP, with 51.7% related to alcohol use, substance use, or both. Multivariable logistic regression analysis revealed that the WAP with fall-injury ED visits were associated with alcohol use (adjusted odds ratio [AOR] = 2.3, 95% CI [1.0, 5.9]) or concurrent alcohol and substance use (AOR = 8.5, 95% CI [1.6, 43.0]), and individuals with alcohol and substance use with a depression diagnosis are twice as likely to visit EDs with fall injuries. Individuals with alcohol and substance use with depression were twice as likely to visit EDs for fall injuries. Higher fall-related ED visits in the WAP were attributed to alcohol and substance use. Identified factors could improve injury prevention and timely intervention among the WAP in the United States.

Examining the joint coordination during dynamic balance learning using vector coding and statistical parametric mapping analyses

We aimed to examine the changes in balance performance, kinematic variables, and joint coordination of the lower extremities during the Y-balance learning task. Twenty female university students completed five consecutive blocks of Y-balance learning from days 3 to 7 (135 trials). Pre-tests and tests were performed on days 1 and 9. Maximum reach distance, peak joint angle, and joint coordination in the anterior (AL), posterolateral (PL), and posteromedial (PM) directions were measured to determine the efficacy of Y-balance performance. A repeated measures ANOVA was performed for the maximum reach distance across learning blocks to confirm whether learning had occurred. Our results indicated that the maximum reach distance on day 5 was longer than that on other learning days. The maximum reach distance significantly increased in the PL and PM directions after learning. The hip flexion (PL/PM), abduction (PM), internal rotation (PM), and external rotation (PL) angles increased after learning. The knee joint flexion angle increased in both AL and PL directions. Only the ankle dorsiflexion angle increased in the AL direction. Joint coordination indicated that the knee and hip joints performed simultaneously during internal rotation. Ankle-knee joint coordination was performed using dorsiflexion and flexion strategies. Statistical parametric mapping analysis indicated significant differences in the ankle sagittal plane in the AL direction, hip horizontal and hip/knee sagittal planes in the PL direction, and hip/knee sagittal and hip frontal/horizontal planes in the PM direction. These data suggest that the dynamic balance ability of the novice participants improved in relation to changes in coordination patterns after learning. The results of this study can be applied to other populations to improve their dynamic balance and prevent fall injuries.

Epidemiology of work-related fall injuries resulting in hospitalisation: individual and work risk factors and severity

ObjectivesInjuries at work are common and costly for individuals and employers. A common mechanism of workplace injury is through falls, but there have been few epidemiological studies of risk factors....

Improved accuracy and efficiency of primary care fall risk screening of older adults using a machine learning approach.

While many falls are preventable, they remain a leading cause of injury and death in older adults. Primary care clinics largely rely on screening questionnaires to identify people at risk of falls. Limitations of standard fall risk screening questionnaires include suboptimal accuracy, missing data, and non-standard formats, which hinder early identification of risk and prevention of fall injury. We used machine learning methods to develop and evaluate electronic health record (EHR)-based tools to identify older adults at risk of fall-related injuries in a primary care population and compared this approach to standard fall screening questionnaires. Using patient-level clinical data from an integrated healthcare system consisting of 16-member institutions, we conducted a case-control study to develop and evaluate prediction models for fall-related injuries in older adults. Questionnaire-derived prediction with three questions from a commonly used fall risk screening tool was evaluated. We then developed four temporal machine learning models using routinely available longitudinal EHR data to predict the future risk of fall injury. We also developed a fall injury-prevention clinical decision support (CDS) implementation prototype to link preventative interventions to patient-specific fall injury risk factors. Questionnaire-based risk screening achieved area under the receiver operating characteristic curve (AUC) up to 0.59 with 23% to 33% similarity for each pair of three fall injury screening questions. EHR-based machine learning risk screening showed significantly improved performance (best AUROC = 0.76), with similar prediction performance between 6-month and one-year prediction models. The current method of questionnaire-based fall risk screening of older adults is suboptimal with redundant items, inadequate precision, and no linkage to prevention. A machine learning fall injury prediction method can accurately predict risk with superior sensitivity while freeing up clinical time for initiating personalized fall prevention interventions. The developed algorithm and data science pipeline can impact routine primary care fall prevention practice.

Factors Associated with Uptake of No-Cost Safety Modifications to Home Access Steps: Implications for Equity and Policy

(1) Background: Fall injuries in the home present a major health burden internationally for all age groups. One effective intervention to prevent falls is home modification, but safety is only increased if opportunities to install safety modifications are taken up. This study sought to identify factors that may lead to a higher uptake of no-cost home modifications when these are offered to people living in the community. (2) Methods: We studied 1283 houses in the New Zealand cities of New Plymouth and Wellington. Using logistic regression, we modelled the odds of uptake according to the number of access steps, the provider who was undertaking the modifications, occupant ethnicity, prior fall injury history, and age group. (3) Results: Homes with older residents (age 65+) had higher uptake rates (35% vs. 27% for other homes). Larger numbers of access steps were associated with higher uptake rates. There was indicative evidence that homes with Indigenous Māori occupants had a higher uptake of the modifications for one of the two providers, but not the other. (4) Conclusions: No-cost home safety modifications offered via cold calling are likely to have relatively low uptake rates but the households that do consent to the modifications may be those who are more likely to benefit from the concomitant increased safety.

Validation of the Saga Fall Injury Risk Model.

Background: Predicting fall injuries can mitigate the sequelae of falls and potentially utilize medical resources effectively. This study aimed to externally validate the accuracy of the Saga Fall Injury Risk Model (SFIRM), consisting of six factors including age, sex, emergency transport, medical referral letter, Bedriddenness Rank, and history of falls, assessed upon admission. Methods: This was a two-center, prospective, observational study. We included inpatients aged 20 years or older in two hospitals, an acute and a chronic care hospital, from October 2018 to September 2019. The predictive performance of the model was evaluated by calculating the area under the curve (AUC), 95% confidence interval (CI), and shrinkage coefficient of the entire study population. The minimum sample size of this study was 2,235 cases. Results: A total of 3,549 patients, with a median age of 78 years, were included in the analysis, and men accounted for 47.9% of all the patients. Among these, 35 (0.99%) had fall injuries. The performance of the SFIRM, as measured by the AUC, was 0.721 (95% CI: 0.662-0.781). The observed fall incidence closely aligned with the predicted incidence calculated using the SFIRM, with a shrinkage coefficient of 0.867. Conclusions: The external validation of the SFIRM in this two-center, prospective study showed good discrimination and calibration. This model can be easily applied upon admission and is valuable for fall injury prediction.

Pattern of fall and its determinants among elderly patients attending the general outpatient clinic of a tertiary hospital in northern Nigeria: a cross-sectional study.

falls in the elderly are a neglected health problem in many societies, particularly in the developing world. Many health and social service providers are unprepared to prevent and manage falls and related injuries as they lack sufficient knowledge to identify their predisposing factors. For this reason, this study aims to identify the pattern of falls and its determinants among the elderly in northern Nigeria. a cross-sectional study was conducted among 300 elderly patients, selected by systematic random sampling. An interviewer-administered questionnaire was used. Data was analyzed using SPSS version 20. Variables were summarised using percentages and measures of central tendency/dispersion. The chi-square test was used in assessing the significance of associations between categorical variables. A p-value of <0.05 was considered statistically significant. Binary logistic regression analysis was conducted to identify determinants of falls. the prevalence of falls and fall injuries was 41.4% and 25.4% respectively. The commonest pattern of fall injuries was swellings and pain (31.1%). Tripping was the commonest 60 (49.2%) cause of fall. Age (p<0.026, AOR=4.424, CI=1.192-16.424), presence of dizziness (p<0.015, AOR=0.334, CI=0.138-0.810), use of shoes with uneven (P<0.021, AOR=0.337, CI=0.133-0.851)/slippery soles (p<0.038, AOR=0.392 CI=0.162-0.948), having slippery mats (P<0.001, AOR=0.086, CI=0.039-0.192), wires/cords exposed (p=0.005, AOR=0.306 CI=0.132-0.705) on the pathways were the determinants. the high prevalence of falls and fall injuries signifies its importance in health care. This implies that physicians should be proactive in asking, assessing, and assisting the elderly to provide targeted interventions to potentially prevent falls.

Neurotrauma from fall accidents in Ethiopia

BackgroundEthiopia is a fast-growing economy with rapid urbanization and poor occupational safety measures. Fall injuries are common and frequently result in traumatic brain injury (TBI) or spinal cord injury (SCI). MethodsWe prospectively included fall victims who were hospital-treated for neurotrauma or forensically examined in 2017 in Addis Ababa, Ethiopia. We registered sociodemographic factors, fall types, injuries, treatment, and outcome. ResultsWe included 117 treated and 51 deceased patients (median age 27 vs. 40 years). Most patients were injured at construction sites (39.9%) and only one in three used protective equipment. TBI (64.7%) and SCI (27.5%) were the most common causes of death among the deceased patients, of which most died at the accident site (90.2%). Many patients suffered significant prehospital time delays (median 24 h). Among treated patients, SCI was more frequent than TBI (50.4% vs. 39.3%), and 10.3% of the patients had both SCI and TBI. Most SCIs were complete (49.3%), whereas most TBIs were mild (55.2%). Less than half of TBI patients and less than one in five SCI patients were operated. There were twice as many deaths among TBI patients as SCI patients. Among those discharged alive, at a median of 33 weeks, 50% of TBI patients had a good recovery whereas 35.5% of SCI patients had complete injuries. ConclusionFalls at construction sites with inadequate safety measures were common causes of SCI and TBI resulting in severe disability and death. These results support further development of prevention strategies and neurotrauma care in Ethiopia.

Survey on Sensor based Fall Assistance System for Elderly

Falling is one of the main factors causing injuries to the elderly. However, there is a lack of comprehensive review surveys in this field. This paper systematically summarizes the relevant studies in recent years. First, considering the duration of fall prevention, this paper divides fall prevention into fall injury prevention and fall behavior prevention; then in order to comprehensively study fall detection and prediction, this paper divides relevant studies into environmental sensors and wearable sensors according to the different used sensors. According to current research, this paper also proposes a full-process architecture for fall assistance, which integrates multiple sensors and algorithms. Finally, the trends and challenges of fall-related research from four aspects are summarized.