School of Medicine, University of California, San Diego, CA.
Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of California, San Diego, CA.
Surgery. 2023 Aug;174(2):337-342. doi: 10.1016/j.surg.2023.04.006. Epub 2023 May 12.
San Diego County hospitals commonly care for patients injured by falls from the United States-Mexico border. From 2018 to 2019, the height of >400 miles of an existing border wall was raised. Prior work has demonstrated a 5-fold increase in traumatic border wall fall injuries after barrier expansion. We aimed to examine the impact of a barrier height increase on fracture burden and resource use.
We performed a retrospective review of patients admitted to a level 1 trauma center from 2016 to 2021 with lower extremity or pelvic fractures sustained from a border wall fall. We defined the pre-wall group as patients admitted from 2016 to 2018 and the post-wall group as those admitted from 2019 to 2021. We collected demographic and treatment data, hospital charges, weight-bearing status at discharge, and follow-up.
A total of 320 patients (pre-wall: 45; post-wall: 275) were admitted with 951 lower extremity fractures (pre-wall: 101; post-wall: 850) due to border wall fall. Hospital resources were utilized to a greater extent post-wall: a 537% increase in hospital days, a 776% increase in intensive care unit days, and a 468% increase in operative procedures. Overall, 86% of patients were non-weight-bearing on at least 1 lower extremity at discharge; 82% were lost to follow-up.
Traumatic lower extremity fractures sustained from border wall fall rapidly rose after the wall height increase. Hospital resources were used to a greater extent. Patients were frequently discharged with weight-bearing limitations and rarely received scheduled follow-up care. Policymakers should consider the costs of caring for border fall patients, and access to follow-up should be expanded.
圣地亚哥县的医院经常收治从美国-墨西哥边境坠落受伤的患者。从 2018 年到 2019 年，现有的超过 400 英里长的边境墙高度增加了。先前的研究表明，在隔离墙扩建后，边境墙坠落造成的创伤性伤害增加了 5 倍。我们旨在研究隔离墙高度增加对骨折负担和资源利用的影响。
我们对 2016 年至 2021 年期间因从边境墙坠落而导致下肢或骨盆骨折入住一级创伤中心的患者进行了回顾性研究。我们将术前组定义为 2016 年至 2018 年入院的患者，术后组定义为 2019 年至 2021 年入院的患者。我们收集了人口统计学和治疗数据、医院费用、出院时的负重状态和随访情况。
共有 320 名患者（术前组：45 名；术后组：275 名）因边境墙坠落导致 951 例下肢骨折（术前组：101 例；术后组：850 例）入院。术后组的医院资源利用程度更高：住院天数增加了 537%，重症监护病房天数增加了 776%，手术次数增加了 468%。总体而言，86%的患者出院时至少有 1 条下肢不负重；82%的患者失访。
边境墙增高后，边境墙坠落导致的下肢创伤性骨折迅速增加。医院资源的利用程度更高。患者出院时经常有负重限制，很少接受预定的随访护理。政策制定者应考虑照顾边境坠落患者的成本，并扩大获得随访的机会。
