Fall-related Injuries Research Articles

Co-use of cannabis and alcohol among adults and the burden of traumatic brain injury from fall-related events

ABSTRACT Background Co-use of cannabis and alcohol is an emerging trend that can exacerbate injury outcomes. While research has focused on younger age groups, there is a need to examine consequences associated with co-use among adults populations. Falls represent a leading cause of injury among older adults. Coupled with substance use, injuries associated with falls may be more severe. Objectives To examine the burden of fall-related head injury among adults who co-use cannabis and alcohol. Methods Emergency department data from the 2019–2022 National Electronic Injury Surveillance System were analyzed for fall-related head injuries associated with co-use of cannabis and alcohol among middle-aged and older adults aged 55–75. Results An annualized estimate of 545,276 fall-related injuries occurred. Patients who presented with co-use of cannabis and alcohol had the highest prevalence of TBI (PR 1.75; 95% CI 1.25–2.25) and CMF injuries (PR 1.70; 95% CI 1.38–2.03) when contrasted to the alcohol-only or cannabis-only groups. Conclusions Results highlight the burden of co-use of cannabis and alcohol on fall-related head injuries. Healthcare providers, policymakers, patients, and caregivers should be aware of these risks and prioritize targeted interventions to mitigate the impact on the health and safety of older individuals.

Role of the upper limb in limiting head impact during laboratory-induced falls in at fall-risk older adults.

Fall-related head impact is the leading cause of traumatic brain injury in older adults. There is limited understanding of factors related to fall-related head impact. This investigation examined characteristics of upper limb movements during standing-height falls and examined their association with fall-related head impact in older adults at risk for falls. Older adults (n=29) at risk for fall-related injuries underwent experimentally induced falls in multiple directions (backwards and sideways). To characterize the upper limb movements and their association with head impact, a standardized analysis tool was used to analyze a total of 164 video-recorded falls. The association between upper limb movements (and their characteristics) and head impact was analyzed through logistic regression. Nearly 80% of falls involved upper limb movements. Absence of upper limb movements significantly increased head impact odds by approximately 4-fold. The odds of head impact were reduced in falls with energy absorption at the forearm (0.013-fold) and upper arm (0.018-fold), compared to falls without upper limb energy absorption. Backwards falls showed significantly higher odds of head impact (more than 4-fold). Upper limb movements are common during fall descent and are associated with lower odds of experiencing head impact. Energy absorption with the upper limb seems to be an important protective mechanism. Future work should explore if these movements can be augmented with targeted training.

Does Equestrian Helmet Type Affect Head Injury? A Study on Equestrian Helmet Use Among Collegiate Athletes.

To characterize helmet use, head injury risk, and to examine rider-related factors that influence these variables. Cross-sectional study. The University of Alabama at Birmingham Equestrian Sports Medicine Collaborative. In total, 357 equestrians competing at the collegiate level participated in this study. χ2 tests were used to evaluate potential associations between a rider's experience level, riding style, and use of helmet designed with MIPS with number of falls, past head injuries, and helmet use frequency. Data regarding helmet use and equestrian-related injuries were collected. χ2 analysis was used to determine potential associations. More than 50% of athletes reported falling off a horse during the course of 1 year. Head injuries occurred with high frequency. Concussion was the most frequently reported type. More than 50% of athletes with self-reported concussion denied receiving medical treatment. The risk of head injury was similar across helmet brands, and between helmets with Multi-Directional Impact Protection System (MIPS) and those without. Riders with the most experience were less likely to report sustaining a head injury than those with less experience. Contrary to current safety guidelines, 78% of equestrians said that they would not replace their helmet after every fall. Collegiate equestrians have a high risk of fall-related traumatic head injury. Despite this risk, they report helmet use practices that are not in line with current recommendations regarding helmet replacement. This suggests thatmany of the athletes are using protective equipment that does not adequately protect against head injury. Neither helmet brand nor liner type was associated with lower rate of head injury.

Increased risk of falls in older adults with hearing loss and slow gait: results from the Otassha Study.

Age-related hearing loss (ARHL) and impaired gait both independently heighten the risk of accidental falls among older adults. However, the combined impact of these factors remains unclear. We analyzed the data of 786 community-dwelling Japanese older adults. Hearing was evaluated at frequencies of 1.0 and 4.0kHz, with participants categorized into ARHL (> 25dB) and non-ARHL groups. Gait was also assessed, defining slow gait (SG) as speeds one standard deviation below the age- and sex-specific mean. Participants were divided into four groups based on their ARHL and SG statuses and were monitored annually for 8years to track falls and related injuries. Throughout the follow-up, incidents included 328 single falls (9.6/100 person-years), 117 multiple falls (2.8/100 person-years), 249 minor injuries from falls (6.7/100 person-years), and 55 fractures due to falls (1.3/100 person-years). Cox proportional hazard regression models showed that participants without ARHL but with SG faced a significantly increased risk of frequent falls. Furthermore, ARHL combined with SG significantly raised the risk of both single and frequent falls, and increased the incidence of both minor and severe fall-related injuries, including fractures. In contrast, no significant association was found between ARHL alone and fall-related incidents. These findings suggest that the previously reported risk associated with hearing loss in fall incidents predominantly relates to gait impairment. The co-occurrence of ARHL and SG significantly escalates the risk of falls and related injuries, highlighting the critical need for routine gait monitoring.

Clinical characteristics and influencing factors of serious fall injuries among older inpatients: A secondary analysis of multicenter cross-sectional administrative data

BackgroundInpatient falls are common adverse events in hospitals, particularly among older adults. However, current research on falls in the older population is limited by small sample sizes and reliance on single-center designs without distinguishing the different levels of fall injuries. ObjectiveTo examine the circumstances of falls in older inpatients and investigate the factors influencing serious fall injuries. DesignA secondary analysis of multicenter cross-sectional administrative data from the China National Database of Nursing Quality (CNDNQ). Setting(s)67 hospitals in Hunan, China. Participants5143 fall incidents from 5048 older inpatients were included from January 2019 to December 2022. MethodsDescriptive statistics (means, standard deviations, frequencies, and percentages) were used to describe fall characteristics. Given the multilevel data structure, a Generalized Linear Mixed Model (GLMM) with a Logistic link function was employed, treating hospitals and wards as random effects. Univariate and multivariate analyses were conducted. ResultsThe prevalences of fall-related injuries and serious fall injuries in this study were 63.3 % and 25.0 %, respectively. Nurse-to-patient ratio at the time of fall ≤0.04 (aOR = 1.522, 95 % CI: 1.297–1.785), female gender (aOR = 1.304, 95 % CI: 1.137–1.497), a lengthy hospital stay (aOR = 1.009, 95 % CI: 1.001–1.018) were associated with an increased risk of serious fall injuries. Surgical (aOR = 0.655, 95 % CI: 0.482–0.889) and orthopedic wards (aOR = 0.649, 95 % CI: 0.449–0.939) exhibited lower risks of serious fall injuries than internal medicine wards. The time period from 8:00 to 15:59 was associated with a higher risk of serious fall injuries compared to the period from 0:00 to 7:59 (aOR = 1.416, 95 % CI: 1.171–1.713). Compared to lying, standing (aOR = 2.594, 95 % CI: 1.733–3.883), getting in/out of bed (aOR = 1.403, 95 % CI: 1.009–1.951), walking or rehabilitating (aOR = 3.039, 95 % CI: 2.194–4.208), toileting (aOR = 1.411, 95 % CI: 1.038–1.917), and showering (aOR = 2.170, 95 % CI: 1.391–3.385) were associated with an increased risk of serious fall injuries. ConclusionsFall-related injuries and serious fall injuries are highly prevalent among older inpatients. The study provides insights for targeted fall prevention strategies, improving nursing management and patient safety. RegistrationNot registered.

Mortality and causes of death of traumatic spinal cord injury in Finland.

Prospective cohort study. To study the mortality rates of TSCI patients compared to matched controls and to examine possible TSCI-related mortality risk factors and causes of death. Oulu and Tampere University Hospital, Finland. All consecutive patients with a new TSCI were included in a prospective study (n = 344, 2012-16). All patients were followed until death or the end of 2019. Patients were compared to a control group formed by randomly choosing gender, age, municipality, and calendar time-matched controls (5 controls/TSCI patient). Standardized mortality ratios (SMR) were calculated using general population mortality rates. Mortality information was extracted from the Statistics of Finland (Helsinki, Finland). TSCI patients had an increased mortality (SMR = 2.9) compared with the Finnish population. During the observation period, 26% of TSCI patients and 12% of the matched controls died. Of the TSCI patient deaths, 51% occurred within the first two years postinjury. Increased age, severity of TSCI (as per International SCI Core Data Set) and fall were related to mortality (p < 0.05). The two most common etiologies of death were: circulatory (30%), and pulmonary diseases (28%). Pneumonia was the single most frequent disease leading to death among TSCI patients. During the first years after injury, the mortality of the patients with TSCI is double compared to the controls. Most deaths occur within two years postinjury. Elderly patients with more severe fall-related injury have the highest mortality risk. Circulatory diseases and pulmonary diseases, especially pneumonia, are the foremost causes of death after TSCI.

Evaluating the Risk of Traumatic Brain Injury in Adults Following a Fall With Concomitant Use of Anti-Coagulation: A Retrospective Cohort Study.

Introduction Falls and fractures are major health challenges for older adults in England. Despite the advantages of anticoagulants, their use in the elderly is often restricted due to concerns about fall-related injuries. However, there is a lack of clear data on the risk of discontinuing anticoagulation therapy solely due to fall risk. NICE guidelines (2021) advise that anticoagulation should not be withheld solely based on age or fall risk. This study aims to assess the incidence of significant brain injuries or intracranial haemorrhages in patients on anticoagulant therapy, also comparing the independent risk factors for traumatic brain injury. Objective This study aims to assess the incidence of TBI following falls in patients on anticoagulant therapy, comparing outcomes between those using DOACs and Vitamin K antagonists. Methods A retrospective cohort study was conducted at Queen Alexandra Hospital, University Hospitals Portsmouth NHS Trust, from November 2023 to May 2024. Data were collected from 3,468 CT head scans performed on patients with a history of falls, including 801 on anticoagulation therapy. Results Of the 801 patients on anticoagulation, 763 (95.2%) were aged 65 or older, with a mean age of 83.1 years. Acute hemorrhage was detected in 3.1% (25/801) of patients. Patients on Warfarin and Dabigatran had significantly higher TBI risk compared to those on Apixaban (6.7%, p=0.02; and 7.6%, p=0.01, respectively), while Edoxaban and Rivaroxaban showed no significant difference. Also, older age (≥65 years) and higher frailty scores (CFS 6 and 7) were associated with increased TBI risk (p<0.05). All patients with acute hemorrhage received conservative management, and two patients experienced mortality within six months. Discussion The study indicates that the risk of TBI following falls in anticoagulated patients is 3.1% relatively low, aligning with existing literature. This underscores the need for careful consideration before discontinuing anticoagulation therapy solely based on fall risk. Hence, discontinuation of anticoagulation should be a patient-specific decision that carefully considers the balance between the risk of traumatic brain injury (TBI) and the benefits of anticoagulation therapy. Factors such as age, frailty, and the type of anticoagulant should all be taken into account. Clinical judgment and selective CT imaging can help balance patient safety with healthcare costs. Conclusion The incidence of adverse outcomes following head injury in patients on anticoagulant therapy is 3.1% and relatively low. Careful decision-making regarding the discontinuation of anticoagulation therapy, informed by patient background and presentation and selective CT imaging, is essential to manage risks effectively and optimize healthcare resource utilization.

Comparative Analysis of Fall Detection Using Artificial Neural Networks (ANN) and K-Nearest Neighbors (KNN) Algorithms

Fall detection is a critical area of research due to its implications for public health, particularly among older adults more vulnerable to fall-related injuries. This study explores the application of pervasive computing and machine learning algorithms in detecting falls using accelerometer and gyroscope sensors. Leveraging a dataset obtained from smartphone sensors, the study employs data processing techniques and classification algorithms, including K-Nearest Neighbors (KNN) and Artificial Neural Networks (ANN), to differentiate fall events from other activities. Evaluation metrics such as accuracy, precision, recall, and F1-score are utilized to assess the performance of the models. The results demonstrate the effectiveness of both the ANN and KNN models in accurately predicting fall detection with high precision and recall scores. The study highlights the potential of pervasive computing systems and machine learning methods to enhance fall detection capabilities, contributing to the development of proactive measures for ensuring the safety and well-being of individuals at risk of falls. Future research directions include exploring alternative algorithms and sensor modalities to improve fall detection systems further.

Fall risk factors and prevention among older adults in primary care in Belgium, 2019-2021

Abstract Background Falls are a major public health problem and ageing populations further increase the burden of fall-induced injuries. Falling among older persons is a multifactorial health condition needing multifactorial care. General practitioners (GPs) are well placed to implement a multifactorial management. A surveillance study of accidental falls studied characteristics of falls, risk groups and fall risk factors as well as fall prevention by GPs. Methods A 3-year retrospective population-based study by the Belgian network of Sentinel General Practitioners (SGP) on all patients aged ≥ 65 years consulting their GP for new fall-related injuries. Descriptive statistics were used to characterize falls, fallers, fall risks and preventive measures. Logistic regression analyses were performed to identify factors associated with a multifactorial fall risk profile. Results During 2019-21, 1138 accidental falls were registered. Medical and/or nursing intervention was required for 24% and 22% had a severe injury. During consult, 30% was referred to hospital. 61% of patients showed at least one of the four most prevalent fall risks, i.e. deficits of mobility or balance, polypharmacy, cognitive impairment or psychotropic medication. A multifactorial fall risk profile was observed in 45% of fallers and was associated with recurrent falling (p &amp;lt; 0.001), fall location (p &amp;lt; 0.05), activity when falling (p &amp;lt; 0.01) and pandemic year 2020 (p &amp;lt; 0.05). Addressing surrounding and walking problems were the most frequently delivered preventive measures. For 28% of patients, other primary care providers (mainly nurse and physiotherapist) were involved in preventive care. Conclusions This study highlights the importance of identifying fall risk factors among fallers in primary care. Preventive fall measures, taken in about one in four general practice patients in collaboration with other healthcare providers, are crucial for preventing accidental falls in older persons in Belgium. Key messages • A multifactorial management of fall risk factors by GPs is crucial for preventing accidental falls in older primary care patients. • Strengthening collaboration between primary healthcare professionals is needed for improving fall prevention in Belgium.

Анализ взаимосвязи между частотой возникновения падений пациентов и уровнем культуры безопасности в медицинской организации

The problem of patient falls in healthcare organizations is a pressing concern for modern healthcare. Falls can lead to serious consequences, including significant limitations in physical activity, the development of anxiety disorders, and depression. Additionally, fall-related injuries are associated with high costs for treatment and rehabilitation. Special comprehensive programs are implemented in healthcare organizations to prevent falls, but the success of their implementation largely depends on the level of safety culture among healthcare personnel. The aim of this study is to investigate the relationship between the level of safety culture among healthcare personnel and the frequency of patient falls. Methods. The study was conducted in the multidisciplinary clinic JSC «Medicina» in Moscow from 2014 to 2020. The safety culture was assessed using the SOPS Hospital Survey 1.0 (HSPSC). The frequency of falls was evaluated based on online forms filled out by staff. Results. The study assessed the dynamics of the fall frequency per 1,000 bed-days in the hospital. Falls were categorized according to the severity of associated injuries. A correlation was found between the fall frequency and safety culture composites, such as «teamwork» –0.826 (p=0.022), «learning from errors» –0.747 (p=0.049), «executive actions in support of patient safety» –0.760 (p=0.047), «overall impression on patient safety» –0.821 (p=0.024), «frequency of reported incidents» 0.782 (p=0.038), «openness of communication» –0.846 (p=0.017), «unit collaboration» –0.867 (p=0.012), «shift handoffs and patient transfers» –0.791 (p=0.034), «non-punitive response to errors» 0.838 (p=0.019), and «average level of safety culture across all composites» –0.809 (p=0.027) (table 1). Conclusion. The study confirms the importance of assessing safety culture as part of a comprehensive approach to prevent patient falls in hospitals. The level of safety culture among healthcare personnel is inversely correlated with the frequency of patient falls. An increase in the level of safety culture is associated with a decrease in fall frequency and a reduction in the number of associated injuries. Additionally, the level of safety culture may potentially serve as an integral indicator of the effectiveness of programs aimed at preventing adverse events related to medical care. The study’s findings are relevant for a wide range of readers interested in issues related to healthcare safety.

Cognitive functions explain discrete parameters of normal walking and dual-task walking, but not postural sway in quiet stance among physically active older people.

Postural control is dependent on the central nervous system's accurate interpretation of sensory information to formulate and execute adequate motor actions. Research has shown that cognitive functions are associated with both postural control and fall risk, but specific associations are not established. The aim of this study was to explore how specific components of everyday postural control tasks are associated with both general and specific cognitive functions. Forty-six community-dwelling older adults reported their age, sex, physical activity level, falls and fall-related concerns. The following cognitive aspects were assessed: global cognition, executive functions, processing speed and intraindividual variability. Postural control was quantified by measuring postural sway in quiet stance, walking at a self-selected pace, and walking while performing a concurrent arithmetical task. Separate orthogonal projections of latent structures models were generated for each postural control outcome using descriptive and cognitive variables as explanatory variables. Longer step length and faster gait speed were related to faster processing speed and less intraindividual variability in the choice reaction test. Moreover, longer step length was also related to less fall-related concerns and less severe fall-related injuries, while faster gait speed was also related to female sex and poorer global cognition. Lower dual-task cost for gait speed was explained by the executive function inhibition and faster processing speed. Postural sway in quiet stance was not explained by cognitive functions. Cognitive functions explained gait speed and step length during normal walking, as well as the decrease of gait speed while performing a concurrent cognitive task. The results suggest that different cognitive processes are important for different postural control aspects. Postural sway in quiet stance, step time and gait variability seem to depend more on physical and automatic processes rather than higher cognitive functions among physically active older people. The relationships between cognitive functions and postural control likely vary depending on the specific tasks and the characteristics of different populations.

Falls and fall-related injuries: prevalence, characteristics, and treatment among participants of the Geelong Osteoporosis Study.

Falls are a significant public health challenge, especially among older adults. In Australia, falls and related injuries incur an annual cost of $2.3 billion. However, there is a scarcity of prevalence data on falls among population-based groups. This study aimed to report the characteristics, circumstances, and treatment for falls and fall-related injuries in a population-based sample of Australian men and women. Participants from the Geelong Osteoporosis Study provided cross-sectional data: baseline for men (2001-2006) and 10-year follow-up for women (2004-2008). Falls over the previous 12 months were self-reported by 2,631 participants aged 20-97 years (1,533 men and 1,098 women). The study described the timing, location, cause, and treatment of falls. Fall prevalence was standardized to the 2006 Australian population. Data collection included self-reported prior fractures, medication, disease conditions, anthropometry, and biochemical tests. Binary logistic regression identified factors linked to fall-related injuries. Fall rates by age group: 20-29 (24.4%), 30-39 (21.5%), 40-49 (18.7%), 50-59 (24.9%), 60-69 (25.0%), 70-79 (34.6%), 80+ (40.5%). The age-standardized prevalence of falls was 25.0% (95% CI: 23.4-26.7%). In adults ≥65 years, the age-standardized prevalence of falls was 32.4% (95% CI: 29.3-35.5%). Fallers were typically older, less mobile, had higher BMI and cholesterol levels, and were more likely to have musculoskeletal conditions, cancer, and polypharmacy. Men had a higher fall risk, but fewer fall-related fractures compared to women. Most falls occurred outdoors (62.1%), were due to extrinsic cause (58.5%), and were on the same level (78.5%). Factors associated with fall-related injuries included being female, elevated falls and falls outside the home. Nearly half (45.7%) of those injured sought medical attention, primarily from general practitioners (25.7%) and emergency departments (12.6%). Falls are common, occurring in approximately one quarter of adults in this study, with a greater prevalence among those ≥65 years. Women experienced fewer multiple falls than men. Many participants sought medical attention, primarily from general practitioners. This research identifies fall characteristics and circumstances, informing targeted prevention strategies to reduce occurrences and alleviate burdens on healthcare systems and individuals.

Programmatic and Organizational Barriers and Facilitators to Addressing High-Risk Issues in Supportive Housing and Housing First Programs.

Risk management is an important component of service delivery in supportive housing and Housing First programs. However, there is no evidence on the implementation of risk management approaches in these settings. This qualitative study examined what service providers working in supportive housing and Housing First programs in Canada identify as the programmatic and organizational factors that affect the prevention and management of high-risk behaviours and challenges (e.g., overdose, suicide attempts, non-suicidal self-injury, falls and fall-related injuries, fire-setting, hoarding, apartment takeovers, violence, property damage, drug selling) in their programs. In-depth interviews were completed with a purposive sample of 32 service providers. Data were analyzed using an integrative approach that incorporated techniques from qualitative description and thematic analysis. Four thematic factors, which were comprised of various barriers and facilitators, that affected management of high-risk issues in supportive housing and Housing First programs were identified: [1] flexibility in addressing risk issues; [2] early identification of risk issues; [3] built environment and housing location; and [4] resource availability. Overall, the findings underscore how service providers aim to identify high-risk issues promptly, beginning as early as referral, and that their capacity to effectively do this and intervene accordingly is dynamically shaped by various aspects of the program model, environment, and availability of internal and external resources. Yet, the findings also highlight how risk management approaches may conflict with other programmatic goals and values, and the importance of considering these collectively. Systems-level changes to strengthen programs' capacity to prevent risk and implications for future research are discussed.

Strategies for implementation of a transmural fall-prevention care pathway for older adults with fall-related injuries at the emergency department

BackgroundAlthough indicated, referrals for multifactorial fall risk assessments in older adults with fall related injuries presenting at the emergency department (ED) are not standard. The implementation of a transmural fall-prevention care pathway (TFCP) could bridge this gap by guiding patients to multifactorial fall risk assessments and personalised multidomain interventions in primary care. This study aims to develop and evaluate implementation strategies for a TFCP.MethodsIn this mixed-methods implementation study, strategies were developed using the Consolidated Framework for Implementation Research Expert Recommendations for Implementing Change Matching Tool. These were evaluated with patients, involved healthcare professionals, and other stakeholders using the Reach, Adoption, Implementation, and Maintenance of the RE-AIM framework in two cycles. Patients of the TFCP consisted of frail community dwelling individuals aged 65 and over presenting at the ED with fall related injuries.ResultsDuring the first implementation phase, strategies were focussed on assessing readiness, adaptability, local champions, incentives and education for all involved healthcare professions in the TFCP. Only 34.4% of eligible patients were informed of the TFCP at the ED, 30.6% agreed to a fall risk assessment and 8.3% patients received the fall risk assessment. In the second phase, this improved to 67.1%, 64.6%, and 35.4%, respectively. Strategies in this phase focussed on adaptability, obtaining sustainable financial resources, local champions, assessing readiness, and education. The implementation was facilitated by strategies related to awareness, champion recruitment, educational meetings, adaptability of TFCP elements and evaluations of facilitators and barriers.ConclusionThe study outlined strategies for implementing TFCPs in EDs. Strategies included increasing awareness, utilising local champions, educational initiatives, adaptability of the TFCP, and continuous monitoring of facilitators and barriers. These insights can serve as a blueprint for enhancing fall prevention efforts for older adults in emergency department settings.

Person-focused interventions for fall risk assessment, fall prevention and fall injury prevention in long-term care facilities: a scoping review

ObjectiveFalls are a significant concern in long-term care facilities (LTCFs) as fall-related injuries can result in functional impairment, disability and death. Older adults living in LTCFs are at greater risk...

Magnitude, mechanism and outcome of pediatric trauma at university of gondar comprehensive specialized hospital, 2023

IntroductionTrauma is the leading cause of mortality among children older than one year. In fact, injuries alone account for a greater number of deaths in children than all other causes combined. Among children under the age of 19, accidental injuries contribute to 65 % of all injury-related deaths. Limited research on childhood trauma in Ethiopia makes it difficult to fully understand its processes, patterns, and effects. In this research, we thoroughly examine the mechanisms, patterns, and outcomes of pediatric trauma cases at the University of Gondar Comprehensive Specialized Hospital, located in Northwest Ethiopia, in the year 2023. MethodsThis cross-sectional study was conducted on a randomly selected sample of 405 pediatric patients who visited the University of Gondar Comprehensive Specialized Hospital between January 1, 2023, and December 30, 2023. Data were extracted from each medical chart using a structured checklist. The collected data were entered into Epi-data 3.1 for cleaning and analyzed using SPSS version 25. The results were reported using tables and text. ResultsA total of 405 patients, consisting of 265 males (65.4 %) and 140 females (34.6 %), were included in this study. The patients had a mean age of 7.1 years and a standard deviation of 4.3. The majority of the patients, 303 (74 %), were under the age of 10. More than half of the trauma cases, 222 (54.8 %), occurred in children from rural areas. Fall-down accidents accounted for 187 (46.2 %) of the cases. The second most common cause of trauma was road traffic incidents with collisions, accounting for 53 (13.1 %) cases. In terms of anatomical location, face and head trauma were the most common, accounting for 165 (40.7 %) cases. This was followed by extremity trauma (upper and lower extremities) in 159 (39.3 %) cases and abdomen and pelvic trauma in 103 (25.4 %) cases. The majority of children, specifically 373 (92.1 %), were discharged with improvement. ConclusionPediatric trauma continues to be a significant issue of public health importance. It is predominantly observed in boys residing in rural areas, with fall-related injuries being the most prevalent cause. Moreover, a majority of the affected individuals experience trauma to the head and face. Therefore, it is imperative to emphasize the necessity of educating the general population about the potential risks associated with pediatric trauma, especially concerning incidents involving falls and motor vehicle collisions. Educating children about the potential hazards linked to activities like climbing trees, crossing roads, and interacting with animals is of utmost importance.

The role of physical activity in falls prevention among older, actively treated cancer populations.

224 Background: Older cancer populations are at higher risks of falls and fall-related injuries undergoing formidable antineoplastic treatment, conditioned to greater physical and functional compromise. While passive risk surveillance and fall prevention strategies often render ineffective, emerging evidence has indicated the benefits of physical activity in reducing risk of falls. This study aimed to explore patient’s awareness and doctor’s advice regarding physical activity in relation to falls among older patients (&gt; 65) under active cancer treatment. Methods: This cross-sectional study was based on the public database from Medicare Health Outcome Survey (MHOS), which derived comprehensive patient-reported outcomes evaluating quality of care provided by Medicare health programs in the United States. Main exposures, including patient’s proactive consultation and doctor’s advice on promoting physical activity, were explored among beneficiaries sampled from 2018 to 2022 diagnosed with cancer and reported undergoing active treatment. Multivariable-adjusted logistic regressions were performed to calculate the risks of falls (Odds ratio, OR) associated with physical activity variables using the latest cohort (2022). Results: Among the total of 14937 (2018), 16927 (2019), 23027 (2020), 23512 (2021), and 21683 (2022) Medicare beneficiaries identified undergoing active cancer treatment, fall incidence sustained at around 30% (median: 30.54%, range 30.17% – 31.26%) of the target population. However, slightly over half of the target populations (median 56.81%, range 53.04% - 56.98%) had proactive consultations regarding physical activity, and even fewer reported receiving doctor’s advice to increase physical activity (median 51.35%, range 48.06% - 52.26%), without significant growth over the 5-year period. In addition, a 21.4% reduction in fall risk (OR=0.786, 95%CI=0.714-0.865) was noted among patients who had physical activity consultations with health professionals. Similarly, a 21.6% risk reduction (OR=0.784, 95%CI=0.713-0.863) was observed among those reported receiving doctor’s advice to increase physical activity level. Notably, the risk of falls associated with these physical variables remained significantly lower in lung (OR=0.667, 95%CI=0.45-0.948), colorectal (OR=0.642, 95%CI=0.436-0.944), and prostate cancer (OR=0.663, 95%CI=0.546-0.804) populations. Conclusions: The study showed an overall lower risk of falls among older cancer patients involved with physical activity, specifically those among lung, colorectal, and prostate cancer subpopulations. Future prospective trials are warranted to provide clinical validations and hence enhance public recognition as to promote the importance of physical activity in minimizing fall risks among older, actively treated cancer patients.

Inferior vena cava collapsibility index and trauma severity in elderly fall injuries.

Falls are a serious cause of morbidity and mortality among older people. One of the underlying causes of falls is dehydration. Therefore, ultrasonography has become an essential tool for evaluating volume status in the emergency department. However, the effect of volume status on falls in older people has not been evaluated before. The aim of this study was to determine the relationship between the inferior vena cava collapsibility index and the injury severity score in older patients who presented with fall-related injuries to the emergency department. A total of 66 patients were included in the study. The injury severity score was used as the trauma severity score, and the Edmonton Frail Scale was used as the frailty scale. Volume status was evaluated with inferior vena cava collapsibility index. The primary outcome measure was defined as the correlation between inferior vena cava collapsibility index and injury severity score. Secondary outcome measures were defined as the effect of inferior vena cava collapsibility index and injury severity score on hospitalization and mortality. There was no significant correlation between injury severity score and inferior vena cava collapsibility index (p=0.342). Neither inferior vena cava collapsibility index nor injury severity score was an indicator of the mortality of these patients. However, injury severity score was an indicator of hospitalization. The mean Edmonton Frail Scale score was an indicator of mortality among older people who experienced falls (p=0.002). Inferior vena cava collapsibility index cannot be used to predict trauma severity in older patients who have experienced falls admitted to the emergency department.

Study protocol: process and outcome evaluation of the Walk with Ease program for fall prevention

BackgroundFalls are the leading cause of injury related morbidity and mortality in older adults. Primary and secondary prevention strategies that address modifiable risk factors are critically important to reduce the number of falls and fall related injuries. A number of evidence-based fall prevention programs are available, but few offer potential for broad dissemination and public health impact due to implementation barriers, such as a need for trained program leaders and clinicians.MethodsThe study will use a randomized controlled trial design to evaluate incorporating physical therapy exercises (primary prevention strategy) within an existing intervention called Walk with Ease. While Walk with Ease has an established evidence-base related to the management of arthritis pain and symptoms, the present study will determine the potential to also reduce falls and fall risk in community-dwelling older adults. The integrated process and outcome evaluation will determine the relative effectiveness of individually-prescribed exercises (compared to standardized exercises) as well as the potential of ‘habit training’ resources (relative to generic behavior prompts) to improve compliance with exercises in this population.DiscussionThe study, conducted through a local clinical-community partnership will advance both the science and practice of community-based fall prevention programming, while also informing implementation strategies needed to promote broader dissemination.Trial registrationClinicalTrials.gov, NCT05693025, Registered January 20, 2023, Updated March 1, 2023.

Fall risk and incidence of delirium in hospitalized orthopedic patients

Introduction: The fall risk and fall-related injuries, as well as the risk of developing delirium, represent a constantly increasing public health problem, especially in societies with an aging population. Objective: This study aimed to assess the level of risk for falls in patients before hip or knee surgery and the frequency of delirium after hip or knee surgery. Materials &amp; Methods: The study was conducted as an observational, analytical cross-sectional study by surveying hospitalized patients at the Clinic for Orthopedic Surgery and Traumatology, Novi-Sad, Serbia, between the beginning of December 2022 and the end of January 2023. Results: From the total number of patients (N = 106), the majority (61.3%) were over 70 years of age, of which the largest number were female (female = 80 (75.5%)). The highest percentage of respondents had a level II fall risk (73.6%), while level I and level III risks had 14 respondents each (13.2%). The results of the 4AT score showed that the largest number of patients, N = 50 (47.2%), had delirium or cognitive impairment with low probability, with possible cognitive impairment in 40 patients (37.7%), while delirium was possible in 16 patients (15.1%). Conclusion: Orthopedic patients hospitalized at the University Clinical Center had level II fall risk, and the largest number of these patients had a low probability of cognitive impairment or postoperative delirium.