This retrospective study was conducted at the Westchester Medical Center, Valhalla, NY, a 895 bed facility and a Level I regional trauma center that provides care to > 3.5 million people in New York’s Hudson Valley region and beyond. The medical center covers a population across 6,200 square miles.
We retrieved data from the Trauma Registry System of our institution for all adult trauma patients ≥18 years old between January 2012 and December 2016. The registry follows the American College of Surgeons guidelines for data acquisition and storage in a Level I trauma center registry. This study follows STROBE checklist (Supplementary Table 1). Data were analyzed and compared on an annual basis across a 6-year period. Inclusion criteria included all men and women who sustained fall from height at age 60 years old and above. We excluded patients who died at the scene or lack relevant information (i.e., other mechanism of injury or incomplete fall-related data). Patients were divided into 3 groups based on their age: Group-I: 60–69, Group-II: 70–79 and Group-III: ≥80 years old.
Variables used in the data analysis for this study included demographics, age, gender, mechanism of injury (MOI), vital signs on arrival, the first Glasgow Coma Scale (GCS) score in the emergency department, height of fall (<1m, 1–3m, 3–6m, >6m), alcohol use, Abbreviated Injury Scale (AIS) scores for each body region, ISS, New Injury Severity Score (NISS), Trauma and injury severity score (TRISS), blood transfusion, length of hospital stay (HLOS), in-hospital mortality, and diabetes mellitus and alcoholism. In brief, AIS, ISS, and NISS are anatomical, GCS is a physiological scoring system, and TRISS is a combined scoring system for survival prediction.
Definition of fall from height: A fall is defined as an injury to a person that occurs after landing on the ground after falling from a higher place or fall from any distance that causes injury and requires a transfer to the emergency department (<1, 1–3, 3–6, >6 meters(m)). Shock index (SI) was defined as admission heart rate divided by the systolic blood pressure [18,19]. Normal SI range is between 0.50–0.70. The ISS scores range from 1 to 75, being one the least severe and 75 the most severe trauma injury. Any injury coded AIS 6 implies an ISS of 75. The AIS code for each injury ranges from 1 (minor injuries) to 6 (maximum injuries, almost always fatal). The NISS results from the sum of the squares of the three highest AIS scores regardless of the body region affected. TRISS (probability of survival) is a combination index based on Trauma Score (RTS), (ISS), and patient’s age. The higher the TRISS value, the better the patient survival.
This study granted ethical approval from the Westchester Medical Center, and New York Medical College, Valhalla, NY, USA (IRB approval number, L–12,432).
Statistical analysis: Descriptive and inferential statistics were applied for data analysis. Data were presented as mean (standard deviation), median (range), median (interquartile range; IQR) or number (%) as appropriate. Data were analyzed and compared using Chi-square and one-way analysis of variance (ANOVA) tests. The Post Hoc Bonferroni test was used for the pairwise comparison. We compared patients’ characteristics and outcomes in each gender, age groups (60–69, 70–79 vs ≥80 years) and within each gender (< vs > 65 years old) and different heights. The association between age, gender and falls was assessed by logistic regression. The association between the fall height and other variables were assessed by ANOVA. For predictors of mortality among patients with fall-related injury, multivariable logistic regression analysis was conducted after adjustment for the potential relevant variables and significant univariate differences.. Data were expressed with odds ratio (OR) and 95% confidence intervals (CI). Statistical significance was defined as a p-value < 0.05. Data were analyzed using Statistical Package for the Social Sciences (SPSS) for Windows Version 21.0 (SPSS Inc; Chicago, IL, USA).