J. L. Carpenter1, T. L. Wiebe1, J. R. Rodriguez1, B. J. Naik1 1Texas Children’s Hospital,Division Of Pediatric Surgery, Department Of Surgery,Houston, TX, USA
Introduction: Falls are one of the leading mechanisms of injury in both children and adults. We hypothesize that children have better outcomes following falls than adults.
Methods: The 2007-2011 National Trauma Data Base (NTDB) was queried for ICD-9 code 882.0 (‘fall from height’). Patients were divided into three age groups (0-4 years, 5-14 and 15+) for comparison. Continuous outcomes were compared using ANOVA and categorical outcomes using chi-square test. Multivariate logistic regression using covariates of vital signs at presentation, Glasgow Coma Scale (GCS), Injury Severity Scale (ISS), and the need for an urgent operation was also performed to compare age groups.
Results: There were 44,416 patients identified; of these, 82% of patients were male and 15% were children <15 years of age. The mean age was 36.2 ± 20.1 years. ICU admission was required for 29% and urgent operation for 10%. Infants and toddlers had a higher rate of closed head injury than adults (5% versus 3%, p<0.001) and a concurrently higher ICU admission rate (45% versus 36%, p<0.001). The length of ICU stay (days), number of unplanned intubations, urgent operation rate, mortality, hospital length of stay (days), and ISS were all lower in children than adults (Table 1). Presenting GCS and ISS were significant predictors of ICU admission and mortality in both children and adults (p<0.001); however, vital signs on presentation were only predictive of these outcomes in the adult population (p=0.02).
Conclusion: Falls from heights are common in both children and adults. Based on our review of the NTDB, children incur less severe injuries and have better overall outcomes than adults yet have a higher rate of ICU admission. Abnormal vital signs at presentation may not be predictive of serious injury in children and may sometimes lead to over-triage for these patients.
