Geriatric falls: injury severity is high and disproportionate to mechanism.

OBJECTIVE Falls are a well-known source of morbidity and mortality in the elderly. Fall-related injury severity in this group, however, is less clear, particularly as it relates to type of fall. Our purpose is to explore the relationship between mechanism of fall and both pattern and severity of injury in geriatric patients as compared with a younger cohort. METHODS Our trauma registry was queried for all patients evaluated by the trauma service over a 412-year period (1994-1998). Two cohorts were formed on the basis of age greater than 65 or less than or equal to 65 years and compared as to mechanism, Injury Severity Score (ISS), Abbreviated Injury Scale score, and mortality. RESULTS Over the study period, 1,512 patients were evaluated, 333 greater than 65 years and 1,179 less than or equal to 65 years of age. Falls were the injury mechanism in 48% of the older group and 7% of the younger group (p < 0.05). Falls in the older group constituted 65% of patients with ISS >15, with 32% of all falls resulting in serious injury (ISS >15). In contrast, falls in the younger group constituted only 11% of ISS >15 patients, with falls causing serious injury only 15% of the time (both p < 0.05). Notably, same-level falls resulted in serious injury 30% of the time in the older group versus 4% in the younger group (p < 0.05), and were responsible for an ISS >15 30-fold more in the older group (31% vs. <1%; p < 0.05). Abbreviated Injury Scale evaluation revealed more frequent head/neck (47% vs. 22%), chest (23% vs. 9%), and pelvic/extremity (27% vs. 15%) injuries in the older group for all falls (all p < 0.05). The mean ISS for same-level falls in the older group was twice that for the younger group (9.28 vs. 4.64, p < 0.05), whereas there was no difference in mean ISS between multilevel and same-level falls within the older group itself (10.12 vs. 9.28, p > 0.05). The fall-related death rate was higher in the older group (7% vs. 4%), with falls seven times more likely to be the cause of death compared with the younger group (55% vs. 7.5%) (both p < 0.05). Same-level falls as a cause of death was 10 times more common in the elderly (25% vs. 2.5%, p < 0.05). CONCLUSION Falls among the elderly, including same-level falls, are a common source of both high injury severity and mortality, much more so than in younger patients. A different pattern of injury between older and younger fall patients also exists.

[1]  W. Haddon,et al.  The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. , 1974, The Journal of trauma.

[2]  M. Copass,et al.  Geriatric Trauma: Injury Patterns and Outcome , 1985 .

[3]  D. Gann,et al.  Survival after trauma in geriatric patients. , 1987, Annals of surgery.

[4]  Factors Influencing Survival of Elderly Trauma Patients , 1987 .

[5]  T. Osler,et al.  Trauma in the elderly. , 1988, American journal of surgery.

[6]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

[7]  H. Champion,et al.  A case control study for major trauma in geriatric patients. , 1989, The Journal of trauma.

[8]  Ellen J. MacKenzie,et al.  The Effect of Preexisting Conditions on Mortality in Trauma Patients , 1990 .

[9]  D. Kauder,et al.  Trauma in the geriatric patient. , 1992, Archives of surgery.

[10]  J. Riggs Mortality from accidental falls among the elderly in the United States, 1962-1988: demonstrating the impact of improved trauma management. , 1993, The Journal of trauma.

[11]  S. Trooskin,et al.  Management of trauma in the elderly patient. , 1994, The Surgical clinics of North America.

[12]  M. Tinetti,et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community. , 1994, The New England journal of medicine.

[13]  B. Cushing,et al.  Mortality Factors in Geriatric Blunt Trauma Patients , 1995 .

[14]  M A Province,et al.  The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. , 1995, JAMA.

[15]  W. Eisma,et al.  Major trauma in young and old: what is the difference? , 1996, The Journal of trauma.

[16]  P Laippala,et al.  Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study. , 1996, Age and ageing.

[17]  T. Koepsell,et al.  Long-term survival of elderly trauma patients. , 1997, Archives of surgery.

[18]  Pekka Laippala,et al.  Risk Factors for Major Injurious Falls among the Home-Dwelling Elderly by Functional Abilities , 1998, Gerontology.

[19]  F. Battistella,et al.  Trauma patients 75 years and older: long-term follow-up results justify aggressive management. , 1998, The Journal of trauma.

[20]  P. Wingo,et al.  Home Environmental Hazards and the Risk of Fall Injury Events Among Community‐Dwelling Older Persons , 1998, Journal of the American Geriatrics Society.

[21]  Geriatric trauma. , 1998, Emergency medicine clinics of North America.

[22]  S. Kivelä,et al.  [Prevention of falls in the elderly]. , 2000, Duodecim; laaketieteellinen aikakauskirja.