从梯子上摔下：损伤模式和结果。
Falls from ladders: Injury patterns and outcomes.
机构信息
From the Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, California.
出版信息
J Trauma Acute Care Surg. 2022 Sep 1;93(3):323-331. doi: 10.1097/TA.0000000000003696. Epub 2022 May 25.
BACKGROUND
Our contemporary understanding of the impact of falls from ladders remains limited. The purpose of this study was to examine the injury patterns and outcomes of falls from ladders. Our hypothesis was that age affects both injury type and outcomes.
METHODS
The National Trauma Data Bank was queried for all patients who fell from a ladder (January 2007 to December 2017). Participants were stratified into four groups according to age: 15 years or younger, 16 years to 50 years, 51 years to 65 years, and older than 65 years. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups.
RESULTS
A total of 168,227 patients were included for analysis. Median age was 56 years (interquartile range, 45-66 years), 86.1% were male, and median ISS was 9 (interquartile range, 4-13). Increasing age was associated with a higher risk of severe trauma (ISS > 15: 8.8% vs. 13.7% vs. 17.5% vs. 22.0%; p < 0.001). Head injuries followed a U-shaped distribution, with pediatric and elderly patients representing the most vulnerable groups. Overall, fractures were the most common type of injury, in the following order: lower extremity, 27.3%; spine, 24.9%; rib, 23.1%; upper extremity, 20.1%; and pelvis, 10.3%. The overall intensive care unit admission rate was 21.5%; however, it was significantly higher in the elderly (29.1%). In-hospital mortality was 1.8%. The risk of death progressively increased with age with a mortality rate of 0.3%, 0.9%, 1.5%, and 3.6%, respectively ( p < 0.001). Strong predictors of mortality were Glasgow Coma Scale score of 8 or lower on admission (odds ratio, 29.80; 95% confidence interval, 26.66-33.31; p < 0.001) and age >65 years (odds ratio 4.07; 95% confidence interval, 3.535-4.692; p < 0.001). Only 50.8% of the elderly patients were discharged home without health services, 16.5% were discharged to nursing homes, and 15.2% to rehabilitation centers.
CONCLUSION
Falls from ladders are associated with considerable morbidity and mortality, especially in the elderly. Head injuries and fractures are common and often severe. An intensified approach to safe ladder use in the community is warranted.
LEVEL OF EVIDENCE
Therapeutic/care management; Level III.
背景
我们对梯子坠落造成的影响的当代认识仍然有限。本研究旨在研究梯子坠落造成的伤害模式和结果。我们的假设是年龄会影响伤害类型和结果。
方法
2007 年 1 月至 2017 年 12 月，国家创伤数据库对所有从梯子上坠落的患者进行了查询。根据年龄将参与者分为四组：15 岁或以下，16 岁至 50 岁，51 岁至 65 岁，65 岁以上。进行单变量和多变量分析以比较组间的伤害模式和结果。
结果
共纳入 168227 例患者进行分析。中位年龄为 56 岁（四分位距 45-66 岁），86.1%为男性，损伤严重程度评分中位数为 9（四分位距 4-13）。年龄增长与严重创伤的风险增加相关（损伤严重程度评分>15：8.8%比 13.7%比 17.5%比 22.0%；p<0.001）。头部损伤呈 U 形分布，儿科和老年患者是最脆弱的群体。总体而言，骨折是最常见的损伤类型，依次为：下肢 27.3%；脊柱 24.9%；肋骨 23.1%；上肢 20.1%；骨盆 10.3%。总体 ICU 入院率为 21.5%；然而，老年人的 ICU 入院率明显更高（29.1%）。院内死亡率为 1.8%。死亡率随年龄呈递增趋势，死亡率分别为 0.3%、0.9%、1.5%和 3.6%（p<0.001）。死亡率的强预测因子是入院时格拉斯哥昏迷量表评分 8 或更低（比值比 29.80；95%置信区间 26.66-33.31；p<0.001）和年龄>65 岁（比值比 4.07；95%置信区间 3.535-4.692；p<0.001）。只有 50.8%的老年患者无需医疗服务而出院，16.5%出院到疗养院，15.2%出院到康复中心。
结论
从梯子上坠落会导致相当大的发病率和死亡率，尤其是在老年人中。头部损伤和骨折很常见，而且往往很严重。需要在社区加强对安全使用梯子的方法。
证据水平
治疗/护理管理；III 级。
Zotero 插件