Factors influencing the injury severity score and the probability of survival in patients who fell from height

Fujii, Masashi; Shirakawa, Tsutomu; Nakamura, Mami; Baba, Mineko; Hitosugi, Masahito · 2021 · Crossref

DOI: 10.1038/s41598-021-95226-w

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Summary

This retrospective study investigates the factors influencing injury severity and survival probability in patients who fell from height, aiming to improve prehospital triage and in-hospital care. In Japan, falls from height are the second leading cause of trauma mortality and the primary cause among young people. While previous studies have suggested various risk factors, few have comprehensively examined determinants of anatomical injury severity or survival probability. The authors sought to identify specific variables that worsen outcomes to facilitate prompt diagnosis and prevent avoidable trauma deaths. The study analyzed hospital records of 179 patients aged 15 or older who were transported to Nagahama Red Cross Hospital between April 2014 and March 2020 after a free fall from a height of at least 2 meters. Exclusions were made for non-free falls, vehicle-related incidents, falls on snow, and patients under 14. Data collected included demographic information, fall characteristics (height, time, surface properties), body position at impact, and medical history (alcohol use, psychiatric medication, anticoagulants). Injury Severity Score (ISS) and Probability of Survival (Ps) were calculated based on clinical findings. Statistical analyses included univariate and multiple regression for ISS, and univariate and multivariate logistic regression for Ps. Additionally, the study compared characteristics between patients who attempted suicide and those who did not. The results identified fall height and body position at impact as critical determinants of outcomes. Multiple regression analysis showed that falls from ≥5 meters significantly increased the ISS compared to falls from 2–3 meters. Impacting the head, lateral, or dorsal regions also significantly increased injury severity. Regarding survival, multivariate logistic regression revealed that falls from ≥5 meters significantly lowered the probability of survival (odds ratio 0.10) compared to 2–3 meter falls. Furthermore, impacting the lateral region (odds ratio 0.11) and dorsal region (odds ratio 0.17) were independently associated with lower survival probabilities compared to feet-first impacts. The study also found distinct characteristics for suicide attempts: these patients were significantly younger, more likely to be female, had lower body weight and BMI, used psychiatric medication more frequently, fell from greater heights, impacted their lower limbs, and underwent surgery more often than non-suicide cases. The findings suggest that collecting specific prehospital information—particularly fall height and body position at impact—can aid in risk stratification and triage. Identifying patients with high-risk features, such as falls from ≥5 meters or lateral/dorsal impacts, allows for more appropriate hospital selection and initial response, potentially reducing preventable trauma deaths. The distinct profile of suicide attempters highlights the need for tailored care approaches for this subgroup.

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• fatality injury trends