The WHO definition of fall was followed in the current study, which refers fall as “inadvertently coming to rest on the ground or other lower level, excluding intentional change of position to lean on furniture, walls or other objects” (6). A retrospective study was conducted among patients admitted to the Hamad Trauma Center (HTC) of Hamad General Hospital (HGH) in Doha, Qatar. The study included all patients admitted to the HTC following fall-related injuries (intentional and unintentional) in the duration between January 2010 and December 2017. Patients with mild injuries following fall and presented to the Emergency Department (ED), and discharged without admission were excluded from the analysis. Brought in Dead (BID) cases were also excluded from the study.
The HTC is the only tertiary care facility in Qatar with 1500-1700 trauma admissions each year . Data included in the study were nationally representative, retrieved from a prospectively maintained national trauma registry of trauma surgery section under the department of surgery in HGH. Qatar Trauma Registry is a mature database that participates in both National Trauma Data Bank and Trauma Quality Improvement Program of Committee on Trauma by the American College of Surgeons.
Data Collection: Data on fall-related injuries required trauma admission in the study duration were collected from the Qatar Trauma Registry. The trauma registry records the fall data using codes by International Classification of Diseases-10th Revision (ICD-10) which classified unintentional falls into 20 subcategories (W00-W19). Ethical approval for the study was granted from the medical research center and institutional review board of Hamad Medical Corporation, Doha, Qatar (IRB#MRC-01-18-004)
Data collected include patients’ demographics such as age, gender, nationality and occupation; locations of falls including workplace, home or recreational-related; heights of fall in meters; body regions injured , clinical characteristics ; vital signs and various injury scores and outcomes including length of stays in intensive care unit (ICU), ventilator and hospital (HLOS), and in-hospital mortality .
Consciousness following head injury was assessed using Glasgow Coma Scale (GCS) ranges from 3 to 15 in which GCS < 8 is severe, 9-12 is moderate and ≥ 13 is minor head injuries . The Abbreviated Injury Scale (AIS) describe the severity of injuries at different body regions; the score ranges from 1-6, representing minor, moderate, serious, severe, critical and non-survivable injuries respectively from 1 to 6 . AIS scores of 3 most severely injured body regions are squared and added together to estimate the Injury Severity Score (ISS) which provides an overall score for polytrauma . The ISS score is ranges from 0 to 75; 1-8 is major, 9-15 is moderate, 16-24 is serious, 50-74 is critical and 75 is non-survivable . The Revised Trauma Score (RTS) provides information about starting triage based on GCS, systolic blood pressure (SBP) and respiratory rate (RR), ranges from 0 to 12 in which 3-10 indicates immediate, 11 urgent and 12 delayed triages. RTS is calculated using following equation :
RTS = 0.9368 (GCS) + 0.8326 (SBP) + 0.2908 (RR)
Trauma and injury severity score (TRISS), is an index that determines probability of survival based on RTS, ISS and age of the patient. The survival probability by TRISS is calculated using following formula .
Survival probability = 1/(1+ e-b) where b for blunt and penetrating injuries are
bBlunt = -0.4499 + 0.8085 x RTS - 0.0835 x ISS - 1.7430 x Age Index
bPenetrating = -2.5355 + 0.9934 x RTS - 0.0651 x ISS - 1.1360 x Age Index
Population data of Qatar was collected from the official website of Ministry of Development Planning and Statistics, Qatar to estimate the rates of injuries in each year .
Data were expressed as rates per 10,000 population, proportions, mean ± standard deviation or medians whenever appropriate. Percentage change was calculated to express the pattern of burden of fall-related injuries over the years. Comparative analyses were performed by classifying patients into groups by gender; by age-groups (0-19 yrs., 20-59 yrs. and ≥ 60 yrs.); and by height of fall in meters (< 1m, 1.0 -2.9m,3.0 -5.9 m and ≥ 6m). Differences in categorical variables between groups were analyzed using Chi square tests or Fisher exact tests when observed cell values n < 5. The continuous variables were analyzed using student’s t tests and two-tailed p values < 0.05 were considered as significant. One-way ANOVA tests were performed for multiple comparisons of means between the groups using Bonferroni technique when equal variances were assumed with the mean difference is at significant level <0.05. Data analysis was carried out using the Statistical Package for Social Sciences version 18 (SPSS Inc. Chicago, Illinois, USA).