Alizo G, Sciarretta J D, Gibson S, Muertos K, Romano A, Davis J, Pepe A
Grand Strand Medical Center, University of South Carolina, 809 82nd Parkway, Myrtle Beach, SC, 29572, USA.
Grand Strand Medical Center, University of South Carolina, 849 82nd Parkway, Myrtle Beach, SC, 29572, USA.
Eur J Trauma Emerg Surg. 2018 Jun;44(3):411-416. doi: 10.1007/s00068-017-0799-1. Epub 2017 Jun 22.
Fall from heights is high energy injuries and constitutes a fraction of all fall-related trauma evaluations while bearing an increase in morbidity and mortality. We hypothesize that despite advancements in trauma care, the overall survivability has not improved in this subset of trauma patients.
All adult trauma patients treated after sustaining a fall from heights during a 40-month period were retrospectively reviewed. Admission demographics, clinical data, fall height (ft), injury patterns, ISS, GCS, length of stay, and mortality were reviewed.
116 patients sustained a fall from heights, 90.4% accidental. A mean age of 37± 14.7 years, 86% male, and a fall height of 19 ± 10 ft were encountered. Admission GCS was 13 ± 2 with ISS 10 ± 11. Overall LOS was 6.6 ± 14.9 days and an ICU LOS of 2.8 ± 8.9 days. Falls ≥ 25 ft.(16%) had lower GCS 10.4 ± 5.8, increased ISS 22.6 ± 13.8, a fall height 37.9 ± 13.1 ft and associated increased mortality (p < 0.001). Mortality was 5.2%, a mean distance fallen of 39 ± 22 ft. and an ISS of 31.5 ±16.5. Brain injury was the leading cause of death, 50% with open skull fractures.
Level of height fallen is a good predictor of overall outcome and survival. Despite advances in trauma care, death rates remain unchanged. Safety awareness and injury prevention programs are needed to reduce the risk of high-level falls.
高处坠落是高能量损伤，在所有与跌倒相关的创伤评估中占一定比例，且发病率和死亡率呈上升趋势。我们推测，尽管创伤护理有所进步，但这类创伤患者的总体生存率并未提高。
回顾性分析40个月期间所有因高处坠落接受治疗的成年创伤患者。对入院人口统计学、临床数据、坠落高度（英尺）、损伤模式、损伤严重程度评分（ISS）、格拉斯哥昏迷评分（GCS）、住院时间和死亡率进行了分析。
116例患者发生高处坠落，90.4%为意外事故。患者平均年龄37±14.7岁，86%为男性，坠落高度为19±10英尺。入院时GCS评分为13±2，ISS评分为10±11。总体住院时间为6.6±14.9天，重症监护病房（ICU）住院时间为2.8±8.9天。坠落高度≥25英尺（16%）的患者GCS评分较低，为10.4±5.8，ISS评分升高，为22.6±13.8，坠落高度为37.9±13.1英尺，且死亡率增加（p<0.001）。死亡率为5.2%，平均坠落距离为39±22英尺，ISS评分为31.5±16.5。脑损伤是主要死因，50%的患者伴有开放性颅骨骨折。
坠落高度是总体预后和生存的良好预测指标。尽管创伤护理有所进步，但死亡率仍未改变。需要开展安全意识和 injury prevention programs（此处原文有误，推测可能是injury prevention programs，意为“伤害预防计划”） 以降低高处坠落的风险。
