Kimon Bekelis1, Symeon Missios2, Robert J Spinner3. 1. Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; 2. Department of Neurosurgery, Louisiana State University-Health Sciences Center, Shreveport, Louisiana; and. 3. Departments of Neurosurgery and Orthopedics, Mayo Clinic, and Department of Anatomy, Mayo Medical School, Rochester, Minnesota.
Abstract
OBJECT: Despite the growing epidemic of falls, the true incidence of peripheral nerve injuries (PNIs) in this patient population remains largely unknown. METHODS: The authors performed a retrospective cohort study of 839,210 fall-injured patients who were registered in the National Trauma Data Bank (NTDB) between 2009 and 2011 and fulfilled the inclusion criteria. Regression techniques were used to investigate the association of demographic and socioeconomic factors with the rate of PNIs in this patient population. The association of age with the incidence of PNIs was also investigated. RESULTS: Overall, 3151 fall-injured patients (mean age 39.1 years, 33.3% females) sustained a PNI (0.4% of all falls). The respective incidence of PNIs was 2.7 per 1000 patients for ground-level falls, 4.9 per 1000 patients for multilevel falls, and 4.5 per 1000 patients for falls involving force. This demonstrated a rapid increase in the first 2 decades of life, with a maximum rate of 1.1% of all falls in the 3rd decade, followed by a slower decline and eventual plateau in the 7th decade. In a multivariable analysis, the association of PNIs with age followed a similar pattern with patients 20-29 years of age, demonstrating the highest association (OR 2.34 [95% CI 2.0-2.74] in comparison with the first decade of life). Falls involving force (OR 1.25 [95% CI 1.14-1.37] in comparison with multilevel falls) were associated with a higher incidence of PNIs. On the contrary, female sex (OR 0.87 [95% CI 0.80-0.84]) and ground-level falls (OR 0.79 [95% CI 0.72-0.86]) were associated with a lower rate of PNIs. CONCLUSIONS: Utilizing a comprehensive national database, the authors demonstrated that PNIs are more common than previously described in fall-injured patients and identified their age distribution. These injuries are associated with young adults and falls of high kinetic energy.
OBJECT: Despite the growing epidemic of falls, the true incidence of peripheral nerve injuries (PNIs) in this patient population remains largely unknown. METHODS: The authors performed a retrospective cohort study of 839,210 fall-injured patients who were registered in the National Trauma Data Bank (NTDB) between 2009 and 2011 and fulfilled the inclusion criteria. Regression techniques were used to investigate the association of demographic and socioeconomic factors with the rate of PNIs in this patient population. The association of age with the incidence of PNIs was also investigated. RESULTS: Overall, 3151 fall-injured patients (mean age 39.1 years, 33.3% females) sustained a PNI (0.4% of all falls). The respective incidence of PNIs was 2.7 per 1000 patients for ground-level falls, 4.9 per 1000 patients for multilevel falls, and 4.5 per 1000 patients for falls involving force. This demonstrated a rapid increase in the first 2 decades of life, with a maximum rate of 1.1% of all falls in the 3rd decade, followed by a slower decline and eventual plateau in the 7th decade. In a multivariable analysis, the association of PNIs with age followed a similar pattern with patients 20-29 years of age, demonstrating the highest association (OR 2.34 [95% CI 2.0-2.74] in comparison with the first decade of life). Falls involving force (OR 1.25 [95% CI 1.14-1.37] in comparison with multilevel falls) were associated with a higher incidence of PNIs. On the contrary, female sex (OR 0.87 [95% CI 0.80-0.84]) and ground-level falls (OR 0.79 [95% CI 0.72-0.86]) were associated with a lower rate of PNIs. CONCLUSIONS: Utilizing a comprehensive national database, the authors demonstrated that PNIs are more common than previously described in fall-injured patients and identified their age distribution. These injuries are associated with young adults and falls of high kinetic energy.
Entities:
Keywords:
BPI = brachial plexus injury; GCS = Glasgow Coma Scale; ISS = Injury Severity Score; NTDB; NTDB = National Trauma Data Bank; PNI = peripheral nerve injury; elderly; falls; peripheral nerve injury
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