Factors associated with mortality and brain injury after falls from the standing position.

BACKGROUND: Trauma centers are increasingly tasked with evaluating patients who have sustained low-acuity mechanisms of injury, such as fall from standing (FFS). Previous studies have shown that low-level falls are associated with a high incidence of injury in certain patient groups. The purpose of the current study was to assess risk factors associated with brain injury and death after fall from the standing position only. MATERIALS: A retrospective analysis was performed on all patients who presented with FFS as the mechanism of injury from 2000 to 2005. Demographic variables, past medical history, use of warfarin, blood-alcohol level, initial vital signs, injuries, disposition, and mortality outcome were recorded. Data were analyzed to determine risk factors associated with brain injury, need for intensive care unit (ICU) admission, need for emergency operation, and mortality.
RESULTS: A total of 808 patients were identified. Risk factors associated with brain injury, the need for ICU admission, and death included: Injury Severity Score, age >or=60 years, blood-alcohol level greater than 80 mg/dL, warfarin use, systolic blood pressure <100 mm Hg, and Glasgow Coma Scale <or=12. These risk factors had an additive effect for propensity for brain injury, ICU admission, and death. Increasing Injury Severity Score and use of warfarin had an independent association with mortality.
CONCLUSION: FFS is a potentially morbid mechanism of injury in those who are using warfarin, those with Glasgow Coma Scale score <or=12, and those who are not inebriated. Age more than 60 years is an additive, but not independent, risk factor for injury.