Survival factors in patients of high fall - A 10-year level-I multi-trauma center study

Pei-Hsiu Wang; Chun-Hsiang Huang; I-Chung Chen; Edward Pei-Chuan Huang; Wan-Ching Lien; Chien-Hua Huang

doi:10.1016/j.injury.2021.12.029

Survival factors in patients of high fall - A 10-year level-I multi-trauma center study

Injury. 2022 Mar;53(3):932-937. doi: 10.1016/j.injury.2021.12.029. Epub 2021 Dec 23.

Authors

Pei-Hsiu Wang¹, Chun-Hsiang Huang¹, I-Chung Chen², Edward Pei-Chuan Huang³, Wan-Ching Lien⁴, Chien-Hua Huang⁵

Affiliations

¹ Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Emergency Medicine, Yun-Lin Branch, National Taiwan University Hospital, Yunlin, Taiwan.
³ Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsinchu, Taiwan.
⁴ Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: [email protected].
⁵ Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

PMID: 34972562
DOI: 10.1016/j.injury.2021.12.029

Abstract

Objectives: This study aims to investigate the characteristics of patients after free falls at the Level-I trauma centers. The factors associated with survival were differentiated.

Methods: This retrospective study was conducted at the National Taiwan University Hospital, the Hsin-Chu branch, and the Yun-Lin branch, all accredited as Level-I trauma centers between January 2010 and September 2020. Adult patients with falls from height of more than one story (i.e. 3.6 m) were included. Clinical data were obtained from electronic medical records. Odds ratios (OR) were computed with 95% confidence intervals (CIs) for significant parameters for survival.

Results: A total of 371 patients were included. Only 2 survived to discharge with poor neurologic outcomes in 101 patients with OHCA. The overall mortality rate was 98% and 11% in patients with and without OHCA. A higher falling height with a one-meter increase (OR, 1.14, 95% CI, 1.10-1.19) was significantly related to OHCA, especially the height over 6 m (OR, 3.07, 95% CI, 1.19-7.94). A higher trauma injury severity score (TRISS) was significantly related to survival among patients without OHCA (OR, 1.07, 95% CI, 1.04-1.11), especially TRISS≧0.945 (OR, 5.21, 95% CI, 1.28-21.24). Patients without severe head/neck injury of Abbreviated Injury Scale (AIS)≧3 (OR, 0.17, 95% CI, 0.07-0.42) were positively associated with survivors among patients without OHCA.

Conclusion: Patients with traumatic OHCA following falls had a high mortality rate of 98% and dismal outcomes, compared with non-traumatic OHCA. Falling heights, especially over 6 m was associated with OHCA. Patients without OHCA had a mortality rate of 11%. Patients with a higher TRISS, especially more than 0.945, or without severe head injury had more chances to survive in the non-OHCA group. The study provided the evidence to guide termination of high futility resuscitation for traumatic OHCA secondary to falls to conserve the clinical resources.

Keywords: Falling from height; Head injury; Height; Out-of-hospital cardiac arrest (OHCA); Trauma injury severity score (TRISS).

MeSH terms

Accidental Falls
Adult
Cardiopulmonary Resuscitation*
Emergency Medical Services*
Humans
Out-of-Hospital Cardiac Arrest*
Retrospective Studies
Survival Rate
Trauma Centers