Low-level Fall Research Articles

Which adults aged 65 and older are at low-risk for cervical spine injuries after low-level falls?

The population is aging and falls are a common reason for emergency department visits. Appropriate imaging in this population is important. The objectives of this study were to estimate the prevalence of cervical spine injury and identify factors associated with cervical spine injuries in adults ≥ 65years after low-level falls. This was a pre-specified sub-study of a prospective observational cohort study of intracranial bleeding in emergency patients ≥ 65years presenting after low-level falls. The primary outcome was cervical spine injury. The risk factors of interest were Glasgow coma scale (GCS) < 15, head injury, neck pain, age, and frailty defined as Clinical Frailty Scale ≥ 5. Multivariable logistic regression was used to measure the strength of association between risk factors and cervical spine injury. A descriptive analysis of absence of significant risk factors was performed to determine patients who may not require imaging. There were 4308 adults ≥ 65 who sustained low-level falls with mean age of 82.0 (standard deviation ± 8.8) years and 1538 (35.7%) were male; 23 [0.5% (95% confidence interval (CI) 0.3-0.8%)] were diagnosed with cervical spine injuries. The adjusted odds ratios and 95% CIs were 1.3 (0.5-3.2) for GCS < 15, 5.3 (1.7-26.7) for head injury, 13.0 (5.7-31.2) for new neck pain, 1.4 (1.0-1.8) for 5-year increase in age, and 1.1 (0.4-2.9) for frailty. Head injury or neck pain identified all 23 cervical spine injuries. Management was a rigid collar in 19/23 (82.6%) patients and none had surgery. In emergency patients ≥ 65years presenting after a low-level fall, head injury, neck pain, and older age were associated with the diagnosis of cervical spine injury. There were no cervical spine injuries in those without head injury or neck pain. Patients with no head injury or neck pain may not require cervical spine imaging.

The onset of falls and its effects on perceived social exclusion and loneliness. Evidence from a nationally representative longitudinal study

PurposeIt remains unclear how falls affect older people's social relations. In particular, the characteristics of fallers in their second half of life are unclear. Several studies have reported that people with a low educational level fall more often, and that low educational level is a predictor for perceived social exclusion. We conducted the first longitudinal analysis on the association between falls and social relations among people of different educational levels. MethodsLongitudinal data were used from two waves (2014 and 2017) of the German Ageing Survey with an analytical sample of 11,227 individuals aged ≥ 40 years. Fall history in the past 12 months (yes; no) was assessed. Perceived social exclusion (outcome measure) was assessed using a validated scale developed by Bude and Lantermann. Loneliness (outcome measure) was measured using a short form of the validated De Jong Gierveld Loneliness Scale. ResultsControlling for various potential confounding variables, fixed effects regression analysis stratified by educational level and gender revealed that experiencing a fall was associated with greater perceived social exclusion (β = 0.21 p < 0.05) among men with low/medium educational level. The experience of a fall was not associated with increased loneliness. ConclusionOur results suggest an association between falls and feelings of social exclusion. This association was found only for men in their second half of life with low/medium educational level. Falls were not associated with loneliness.

Antithrombotic Agent Use in Elderly Patients Sustaining Low-Level Falls

BackgroundElderly patients who are injured from a low-level fall comprise an increasing percentage of trauma admissions. We sought to evaluate the prevalence of antithrombotic (anticoagulant or antiplatelet) agent use, injury patterns, and outcomes in this population, focusing on intracranial hemorrhage (ICH). MethodsWe retrospectively reviewed the trauma registry at an American College of Surgeons–verified Level I trauma center for all patients aged 65 y or older admitted between 2007 and 2016 following a low-level fall. Medical records of patients on antithrombotic agents were examined in detail. Patients were divided into four groups based on the presence/absence of ICH and presence/absence of preadmission antithrombotic medication use. ResultsThere were 4074 elderly patients admitted after a low-level fall, of which 1153 (28.3%) had a traumatic ICH, and 1238 (30.4%) were on antithrombotic agents. Notably, 35.9% of patients on antithrombotics had an ICH, as compared to 25.0% of 2836 patients not on antithrombotics other than aspirin (P < 0.001). The overall distribution of antithrombotic agent use differed significantly between the ICH and non-ICH groups; the ICH group had more coumadin usage. The mortality rate was significantly different across groups, with the group having ICH and a history of antithrombotics having the highest mortality at 14.2% (P < 0.001). Excluding the 27.8% of patients who were transferred into our hospital demonstrated that significantly more admissions on antithrombotics had ICH (22.4%) versus ICH admissions not on antithrombotics (14.7%, P < 0.001). The mortality rate was significantly different across groups, with the group having ICH and a history of antithrombotics having the highest mortality at 12.0% (P < 0.001). On multivariable analysis, anticoagulants, antiplatelets, and aspirin were all significantly associated with ICH; but only anticoagulants were significantly associated with mortality. ConclusionsAntithrombotic agent use was common in admitted elderly patients sustaining a low-level fall and is associated with an elevated rate of ICH. Anticoagulants were also associated with increased mortality.

Predictors of transport to hospital after emergency ambulance call-out for older people living in residential aged care.

People living in residential aged care (RAC) frequently experience ambulance call-out. These episodes may have unintended consequences, yet remain under-investigated. Our aim was to examine clinical and sociodemographic features associated with transfer to hospital for this population. Retrospective cohort study using 6years of clinical data from Ambulance Victoria (AV). Data analysis included multilevel multivariable logistic regression analysis of factors associated with transport to hospital. Odds of transfer were greater for people in rural areas, those with a history of depression, cardiovascular disease and osteoporosis, and residents prescribed antipsychotic and antidepressant medication. Ambulance call-out for trauma (commonly low-level fall) was less frequently transferred to hospital than that for a medical complaint. These results will improve prediction of call-outs likely to require transfer. Findings include identification of clinical features to be targeted by community and preventative health programs to reduce risk of acute health deterioration and requirement for emergency hospital transfer.

Impact of Type and Number of Complications on Mortality in Admitted Elderly Blunt Trauma Patients

BackgroundAdvanced age and comorbidities are recognized risk factors for adverse outcomes in elderly trauma patients. However, the contribution of the number and type of complications to in-hospital mortality in elderly blunt trauma admissions has not been extensively studied. MethodsA retrospective review of the trauma registry at a level 1 trauma center for blunt trauma patients age ≥65 y hospitalized for at least 2 d between 2010 and 2015. ResultsThere were 2467 admissions, with a median age of 81 y and median injury severity score of 9. The most common mechanism of injury was a low-level fall. Approximately 19.6% of admissions had a complication: 11.1% major complications, 8.6% other complications. The in-hospital mortality rate was significantly different (P < 0.001) among the three groups at 16.1% of major complications group, 7.1% of other, and 2.1% of no complications (P < 0.001). On multivariate logistic regression, each major complication increased the odds for in-hospital mortality by 1.59-fold. ConclusionsComplications are not infrequent in elderly blunt trauma admissions, despite a generally lower energy mechanism of injury. Each major complication is associated with increased odds of mortality. Multifaceted interventions for prevention and mitigation of complications are indicated.

Direct oral anticoagulants do not worsen traumatic brain injury after low-level falls in the elderly

BackgroundFalls are now the leading cause of trauma and represent the most common type of trauma in the elderly. The use of anticoagulants is increasing in older patients, but there are little data on outcomes after traumatic brain injury while anticoagulated with direct oral anticoagulants compared with warfarin. We hypothesized that anticoagulated patients would have a greater mortality and complications than nonanticoagulated patients, and patients on direct oral anticoagulants would have more fatal outcomes after low-level falls because of lack of reversal agents. MethodsPatients 65 years or older admitted to level 1–3 trauma centers with 24-hour neurosurgical care were identified through the administrative database of 19 Trinity Health hospitals. Patients with International Classification of Diseases, Ninth Revision, codes consistent with low-level fall and traumatic brain injury from May 2013 through October 2015 were included. Preadmission warfarin or direct oral anticoagulant use was extracted from admission reconciliation of medications in the database. ResultsA total of 700 patients met inclusion criteria with 177 on anticoagulants before admission. Anticoagulated patients had more cardiac (P < .001), pulmonary (P < .001), and clotting (P < .02) comorbidities. Warfarin patients had the greatest neurosurgical intervention rate at 18% compared with direct oral anticoagulants (2.8%, P < .02) or nonanticoagulation (11%, P < .02). No difference was identified in overall mortality and mortality after neurosurgical intervention between the nonanticoagulated, warfarin, or direct oral anticoagulant groups. Warfarin patients received more plasma (P < .001) and red cell transfusions (P = .035) with greater intensive care unit stays (P < .001) compared with direct oral anticoagulant or nonanticoagulated patients. With logistic regression, only advancing age (P < .05) and a lesser Glasgow Coma Scale score (P < .01) were associated with greater mortality. ConclusionOlder direct oral anticoagulant patients with traumatic brain injury after low-level fall did not have increased morbidity or mortality compared with those treated with warfarin or who were not treated with anticoagulants. Concerns over the use of direct oral anticoagulant agents in this population may be overstated and deserve more scrutiny.

Postdischarge Mortality after Geriatric Low-Level Falls: A Five-Year Analysis

Geriatric trauma patients with low-level falls often have multiple comorbidities and limited physiologic reserve. Our aim was to investigate postdischarge mortality in this population. We hypothesized that five-year mortality would be higher relative to other blunt mechanisms. The registry of our Level 1 trauma center was queried for patients evaluated between July 2008 and December 2012. Adult patients identified were matched with mortality data from 2008 to 2013 from the National Death Index. Low-level falls were identified by E Codes; other types of blunt trauma were based on registry classification. Patients with multiple admissions were excluded. Univariate analysis was performed using Fisher's exact and Wilcoxon tests. Kaplan-Meier curves were plotted to compare postdischarge mortality. Seven thousand nine hundred sixteen patients were evaluated, 35.1 per cent were females. Patients aged less than 65 years and penetrating trauma were excluded, yielding 1997 patients-63.7 per cent with low-level falls versus 36.3 per cent with other blunt traumas. Geriatric patients sustaining low-level falls were older, more likely female, had a higher inpatient mortality, and were less likely to return home at discharge. Injury severity score, hospital length of stay, and intensive care unit length of stay were similar. Survival analysis demonstrated increased postdischarge mortality in the low-level fall group with 25 per cent mortality at 120 days. Geriatric patients with other blunt trauma had a significantly lower postdischarge mortality. Geriatric patients injured in low-level falls have a higher inhospital mortality, are more likely to be functionally dependent on discharge, and have a high postdischarge mortality. Opportunities likely exist for injury prevention, consideration of palliative care, and postdischarge rehabilitation.

Incidence, Outcomes, and Recidivism of Elderly Patients Admitted For Isolated Hip Fracture

IntroductionIsolated hip fracture (IHF) is a common injury in the elderly after a fall. However, there is limited study on elderly IHF patients' subsequent hospitalization for a new injury, that is, trauma-related recidivism. MethodsA retrospective review of the trauma registry at an ACS level I trauma center was performed for all elderly (age ≥ 65 y) blunt trauma patients admitted between 2007 and 2017, with a focus on IHF patients. IHF was defined as a fracture of the femoral head, neck, and/or trochanteric region without any other injuries except minor soft tissue trauma after a fall. ResultsOf the 4986 elderly blunt trauma admissions, 974 (19.5%) had an IHF. The rate of trauma-related recidivism was 8.9% (n = 87) for a second injury requiring hospitalization. The majority of recidivist (74.7%) and nonrecidivist (66.5%) patients were females. Hospital length of stay was similar at index admission (7 d for recidivists versus 8 d for nonrecidivists). The median interval between index hospitalization and admission for a second injury was 373 d (IQR 156-1002). The most common mechanism of injury at index admission (95.4%) and at second injury-related hospitalization (95.4%) was a low-level fall. Among recidivist patients at second admission, a second hip fracture was present in 34.5% and intracranial hemorrhage in 17.2%. ConclusionsAfter initial admission for an IHF, 8.9% of patients were readmitted for a second injury, at a median time of approximately 1 y, overwhelmingly from a low-level fall. Emphasis on fall prevention programs and at index admission is recommended.

Fundamental Limits of Shaking a Baby.

Basic physics places limits on the mechanics involved in shaking a baby. Fundamental definitions and practical limitations are used to compare shaking with car crashes and low-level falls. First-order mathematical considerations applied to a 6-month-old infant determine an angular velocity limit for head rotation around 75 rad/s and maximum angular acceleration less than 1600 rad/s2 without impact. By comparison, results from a low-level fall of 0.76 m (30 inches) yield values of 83 rad/s and 13,000 rad/s2 in a practical worst-case scenario.

Facies, well-log patterns, geometries and sequence stratigraphy of a wave-dominated margin: insight from the Montney Formation (Alberta, British Columbia, Canada)

This study illustrates a basin-scale sequence stratigraphic framework based on wireline well-logs, cores and outcrops from the Early Triassic Montney Formation in the Western Canada Sedimentary Basin. A very dense and well-constrained database (2200 wells, 18 cores and 4 outcrops) derived from petroleum exploration made it possible to implement and test common workflows and terminologies used for sequence stratigraphic analysis along an ancient wave-dominated margin. Following facies definition from cores and outcrops and recognition of associated well-log patterns, a two-step approach allows for the reconstruction of large-scale geometries: 1) the model-independent definition of surfaces and units; and 2) the interpretation of the sequence boundaries and systems tracts based on a depositional sequence model. The typical facies association and log pattern of different sedimentary environments including tidal, as well as wave-dominated foreshore, shoreface and offshore settings are presented. The spatial distribution of characteristic sedimentary environments associated with stratigraphic surfaces and systems tracts is also detailed at the basin scale. Among other results, this study highlights the differences in the sedimentary facies geometries across two different types of sequence boundaries: the facies geometries of the first sequence boundary are quite similar to Haq et al. (1988) sequence model, whereas the geometries of the second are similar to the Hunt and Tucker (1992) sequence model. This work shows that during a rapid, high amplitude base level fall on a high gradient slope, turbidites are more likely to occur, whereas, during slow, low amplitude base level fall on a low gradient topography, forced regressive shoreface will be more likely to occur.

Unintentional injury in England: an analysis of the emergency care data set pilot in Oxfordshire from 2012 to 2014

BackgroundA pilot injury data collection exercise at the emergency departments (EDs) of Oxford University Hospitals National Health Service (NHS) Foundation Trust (OUH) ran from 2012 to 2014 to inform the...

The impact of body mass index on severity, patterns and outcomes after traumatic brain injuries caused by low level falls.

Low level falls are a common cause of traumatic brain injuries (TBI) and are associated with significant mortality and disability. The aim of this study was to analyse whether BMI, height and weight of patients were related to severity, patterns and outcomes of TBI caused by low level falls. Data on patients with TBI where cause of injury was a low level fall (fall < 3 m) with known body mass index (BMI) (N = 683) were analysed. Patients were categorized into underweight, normal, pre-obese and obese based on BMI and demographic characteristics, injury severity, patterns and outcomes were compared. In addition, physiological status, comorbidities and length of hospitalization were analysed in a subset of patients where this information was available. The median BMI was 25.6. About 1/10 of patients were obese. The mean age and proportion of male sex of patients was increasing with increasing BMI. The patients in all BMI groups were of similar injury severity and neurological status. There was also no difference in mortality and functional outcome based on patient's BMI. Obese and pre-obese patients required longer stay at ICU and in hospital. We found no associations between BMI and severity or outcome of TBI caused by low level falls. More detailed data and further studies are needed to fully elucidate these complex relationships.

Cervical Spine Fractures in Elderly Patients with Hip Fracture After Low-Level Fall: An Opportunity to Refine Prehospital Spinal Immobilization Guidelines?

Conventional prehospital spine-assessment approaches based on low index of suspicion and mechanism of injury (MOI) result in the liberal application of spinal immobilization in trauma patients. A painful distracting injury (DI), such as a suspected hip fracture, historically has been a sufficient condition for immobilization, even in an elderly patient who suffers a simple fall from standing and exhibits no other risk factors for spinal injury. Because the elderly are at increased risk of hip fracture from low-level falls, and are also particularly susceptible to the discomfort and morbidity associated with immobilization, the prevalence of cervical spine (c-spine) fracture in this patient population was examined. Hospital billing records were used to identify all cases of traumatic femur fracture in Minnesota (USA) in 2010-2011. Concurrent diagnosis and external cause codes were used to estimate the prevalence of c-spine fracture by age and MOI. Among 1,394 patients with femur fracture, 23 (1.7%) had a c-spine fracture. When the MOI was a fall from standing or sitting height and the patient age was ≥ 65, the prevalence dropped to 0.4% (2/565). The prevalence was similar when the definition of hip fracture additionally included pelvis fractures (0.5%; 11/2,441). Eight of the 11 patients with c-spine fracture had diagnosis codes indicative of criteria other than the DI that likely would have resulted in immobilization (eg, head injury and compromised mental status). C-spine fracture is extremely rare in elderly patients who sustain hip fracture as a result of a low-level fall, and appears to be accompanied frequently by other known predictors of spinal injury besides DI. More research is needed to determine whether conservative use of spinal immobilization may be warranted in elderly patients with hip fracture after low-level falls when the only criteria for immobilization is the distracting hip injury.

Düşmeye Bağlı Yaralanmaların Adli Tıp Açısından Değerlendirilmesi

Düşmeye bağlı yaralanmalar; acil servise başvurmalarda ve yaralanmalara bağlı ölümlerde önde gelen nedenlerden biridir. Düşmeler değişik şekillerde sınıflandırılmaktadır. Çalışmamızda, yüksek seviyeden (&gt;5metre) ve alçak seviyeden (&lt;5metre) düşme şeklinde olan sınıflandırma kullanıldı. Düz zemindeki düşmeler çalışmamıza dahil edilmedi. Bu çalışmada Fırat Üniversitesi, Fırat Tıp Merkezine Ocak 2000-Aralık 2004 yılları arasında başvuran 779’u erkek, 439’u kadın, yaş ortalaması 22.2+22.9 (en küçük 1, en büyük 95 yaş) olan toplam 1218 düşme olgusu retrospektif olarak incelendi. Olguların, 927’si alçak, 213’ü yüksek, 78’i ise bilinmeyen bir seviyeden düşmüştür. Olgular; cinsiyet, yaş, yaş grupları, düşme seviyesi, basit tıbbi müdahale, yaşamsal tehlike, Glasgow Koma Skoru (GKS), yaralanan vücut bölgesi, mortalité oranı, aylara göre dağılımı açısından değerlendirildi. Yüksek ve alçak seviyeden düşme açısından cinsiyet ve yaş farkı tespit edilmedi (p = 0.1). Yüksek seviyeden düşmelerde yaşamsal tehlikeye maruz kalma %37.6 iken, alçak seviyeden düşmelerde ise bu oranın %20.4 olduğu saptandı (p = 0.0001). Benzer şekilde yüksek seviyeden düşmelerde GKS’nin, alçak seviyeden düşmelere göre daha düşük puanlarda olduğu belirlendi (p=0.0001). Düşmelerin pediatrik yaş grubunda (%59.2) daha yüksek, erişkin (%32.7) ve yaşlılarda (%8.1) daha düşük olduğu tespit edildi. Sonuç olarak; düşmeler mortalité ve morbidité riski taşımaları ve sağlık sistemine önemli bir yük getirmeleri açısından dikkate almmalıdn. Pediatrik yaş grubunda sıklıkla görülmesinden dolayı; anne baba eğitimi, oyun esnasında çocuğun gözetlenmesi, pencere ve balkonlarda güvenliği sağlayacak önlemlerin alınması gerekmektedir.Anahtar kelimeler: Düşme, yükseklik, yaşamsal tehlike, glasgow koma skoru.

Head injuries from falls in preschool children.

Falls are a leading cause of morbidity and mortality among children. We performed a retrospective analysis of pediatric patients under 7 years of age admitted to our department after a fall from January 1994 through December 1999 to describe the characteristics of fall-related head injury and to determine the clinical parameters influencing outcome. The patients were divided into two groups according to age: group I (babies and toddlers, 0-3 years) and group II (preschool children, 4-6 years). Falls were classified as low and high level. Sixty-eight cases were identified and falls accounted for 35.2% of head injuries. There were more boys than girls, and more low-level falls(LLF) than high-level falls (HLF), particularly in group I. Although more common in HLF, significant intracranial injuries were also sustained from LLF. Calvarial fractures were the most frequent type of head injury and were more common in LLF than HLF. Admission Glasgow Coma Scale score, types of head injury and hypoxia on admission were significantly correlated with Glasgow Outcome Scale score, but age, sex, extracranial injury and height of fall did not influence clinical outcome. From this study, we concluded that the height of fall should not limit the evaluation of patients and that aggressive management is mandatory to improve outcome even in patients with poor prognostic factors.

Influence of low-level fall protein supplementation on forage intake, diet digestion, and selection by beef steers grazing tallgrass-prairie range (2003)

This study evaluated the effect on forage utilization of providing a limited quantity of a high-protein (40% crude protein) supplement to beef cattle grazing tallgrass prairie during the fall. Sixteen ruminally fistulated beef steers were randomly assigned to one of two treatments (fall supplementation or no fall supplementation), which were evaluated for their effect on forage intake and digestion during September and November. Within each treatment, four steers were used for measuring diet selection (by ruminal evacuation) and four were used for determining diet digestion (by total fecal collection). Data from both groups were used to calculate forage intake. Steers were individually fed a high-protein supplement at a rate of 0.14% of body weight/day (as-fed basis; 0.80 lb/day during September and 0.99 lb/day during November) but prorated and delivered only three days per week. Quality of diet selected decreased as season progressed (decreased protein and increased fiber) and, as a result, forage intake and digestion was significantly lower during the late fall period. Neither diet selection nor forage intake were significantly influenced by fall supplementation; however, supplemented steers digested their total diet to a greater extent.

Injuries from falls in the pediatric population: An analysis of 729 cases

Background/Purpose: Falls are classified as low or high level for triage purposes. Because triage criteria dictate less urgency for low-level falls, this classification scheme has important implications for pediatric emergency care. Methods: Retrospective analysis was conducted of 729 (393 low-level and 336 high-level) pediatric patients treated for fall-related trauma (1992 through 1998). Falls were classified as low (<15 feet) or high-level (≥15 feet). All falls were reported as accidental or unintentional. Results: The overall mortality rate was 1.6% (2.4% for high-level falls compared with 1.0% for low-level falls). All 4 patients who died of a low-level fall had an abnormal head computed tomography (CT) scan and intracranial hypertension. Half of deaths from high-level falls were attributable to intracranial injuries, and half were caused by severe extracranial injuries. Common extracranial injuries were upper extremity fracture (6.2%), lower extremity fracture (5.6%), pulmonary contusion (1.8%), pneumothorax (1.1%), liver laceration (1.1%), bowel injury (1.0%), and splenic injury (2.1%). Orthopedic and thoracic injuries resulted more commonly from high-level falls, whereas abdominal injuries were as likely to occur after a low-level fall. Conclusions: Intracranial injury accounts for the majority of deaths from falls. Children suffering low-level falls were at similar risk for intracranial and abdominal injuries compared with those who fell from greater heights. Pediatric trauma triage criteria should account for these findings. J Pediatr Surg 36:1528-1534. Copyright © 2001 by W.B. Saunders Company.

“Insignificant” mechanism of injury: not to be taken lightly

BACKGROUND:Trauma resources should be spent rationally. The mechanism of trauma is used extensively to triage patients to appropriate levels of care. We examine the hypothesis that patients with “insignificant” mechanism of trauma may have major injuries that require expert trauma care.STUDY DESIGN:Over 9 months at a high-volume Level I trauma center, a prospective study was done on patients who sustained ground-level falls (GLF), low-level falls (LLF) from less than 10 feet, or were found down (FD) with no external evidence of significant trauma, and required evaluation by the trauma team. Of 301 patients included, 110 (37%) had GLF, 95 (31%) LLF, and 96 (32%) FD. Our main outcomes measure was significant injuries, defined as visceral or intracranial injuries, long-bone, pelvic, facial, or spinal fractures.RESULTS:One hundred ten patients (37%) had significant injuries, 20 (7%) were admitted to the ICU, 14 (5%) required an operation, and 4 (1%) died. The most common injuries were intracranial and skeletal. Almost all patients were evaluated by CT (95%), but only one-quarter had abnormal findings on it. LLF, age more than 55 years, and the absence of severe intoxication (blood alcohol level of less than 200 mg/dL) were independent risk factors for significant injuries. A statistical prediction model showed that, when all risk factors are present, the probability of significant injuries is 73%; when all risk factors are absent, there is still a 16% chance for significant injuries. Patients with significant injuries had more operations, longer hospital stays, and higher hospitalization costs compared with patients without significant injuries.CONCLUSIONS:Low-energy trauma may produce significant injuries, predominantly intracranial and skeletal. Trauma care providers should be cautious about dismissing such patients based on the trivial mechanism of injury. Patients with LLF who are older than 55 years and not severely intoxicated have a high likelihood for significant injuries. Resources should be spent rationally for patients who do not have these characteristics, because the probability of significant injuries among them is low, but not zero.

Influence of low-level fall supplementation with a self-fed, high-protein supplement and level of winter supplementation on performance of beef cows grazing tallgrass-prairie range (2001)

An experiment was conducted to determine the effect of providing a small amount of a high-protein supplement during the fall and effects of increasing subsequent level of winter supplementation on cow-calf performance. One hundred-sixty spring-calving Hereford × Angus cows grazing tallgrassprairie range were used. During the fall, cows either had access to a self-fed, highprotein supplement (30% CP) or were not supplemented. During the winter, range cubes (20% CP) were fed at a daily equivalent of 1, 2, 3, or 4 lb/head and all cows had access to the same self-fed supplement used during the fall period. Cumulative performance (as measured by changes in body condition score and body weight) tended to show limited response to low-level fall supplementation, but was significantly improved as level of winter supplementation increased.

Analysis of pediatric head injury from falls

The authors conducted a study to describe the incidence and types of fall-related head injury observed at a pediatric trauma center. We performed a retrospective analysis of all patients under 15 years of age treated for fall-related trauma between 1992 and 1998. Falls were classified as low (< 15 feet) and high level (> or = 15 feet). Seven hundred twenty-nine cases were identified with a mortality rate of 1.7%. A fall of greater than 15 feet (high-level fall) was associated with a higher mortality rate than low-level falls (2.4% compared with 1.0%, respectively). Ninety-eight patients had sustained a calvarial fracture and 93 experienced a basal skull fracture. Twenty-six patients had suffered a cerebral contusion, 25 a subarachnoid hemorrhage, 22 a subdural hematoma, and 12 had an epidural hematoma. Forty-nine patients required surgery for traumatic injuries; of these, 10 underwent craniotomy for evacuation of a blood clot. Height was not predictive of the Glasgow Coma Scale (GCS) score. In all four deaths resulting from a low-level fall there was an admission GCS score of 3, and abnormal findings were demonstrated on computerized tomography scanning. Death from high-level falls was attributable to either intracranial injuries (50%) or severe extracranial injuries (50%). Intracranial injury is the major source of fall-related death in children and, unlike extracranial insults, brain injuries are sustained with equal frequency from low- and high-level falls in this population. The only cause of mortality from low-level falls was intracranial injury. Trauma triage criteria must account for these differences in the pediatric population.