B. E. Haac1,4, J. Gallaher3,4, A. Geyer5, L. Banza2, A. Charles2,3 4UNC Project,Lilongwe, LILONGWE, Malawi 5Air Force Institute Of Technology,Statistics,Wright-Patterson AFB, OHIO, USA 1University Of Maryland Medical Center,General Surgery,Baltimore, MD, USA 2Kamuzu Central Hospital,Surgery,Lilongwe, , Malawi 3University Of North Carolina At Chapel Hill,General Surgery,Chapel Hill, NC, USA
Introduction: Fall-related injuries are a leading cause of Years Lived with Disability (YLDs) worldwide, yet there remains a dearth of research on predictors of outcomes for falls in low- and middle-income countries. We aimed to further delineate risk factors and outcomes related to fall-related injuries in a Sub-Saharan African cohort.
Methods: We examined the trauma registry at an urban tertiary-care hospital in Malawi for patients presenting after a fall from 2010 to 2014. Categorical and continuous variables were compared with chi-squared and student t-tests, respectively. Logistic and linear regressions were then conducted to assess for the magnitude of effect and control for confounders. A p-value <0.05 was considered significant.
Results: Over the study time period, 73,267 patients presented with trauma. Falls were the most common mechanism of injury (28.9%), followed by traffic accidents (25.6%), and assault (24.3%). Children (age<18yo; OR 5.10), elderly (age>60yo; OR 1.16), and female (OR 1.57) patients had the highest risk of fall (p<0.001).
The three most severe injuries on presentation and the most common operations differed significantly between patients with falls compared to those suffering from other injury mechanisms (p<0.01). Those with falls had more fractures (aOR 1.82), contusions (aOR 1.86), and dislocations (aOR 2.26), and underwent more open reduction internal fixations and other orthopaedic surgeries (p<0.01).
Patients with falls had a longer mean length of stay (14.8 vs. 12.9 days, p<0.001) and lower mortality (0.4% vs. 3.9%, p<0.01). They were also less likely to be admitted to the hospital (14.4% vs. 18.8%, p<0.001).
Of patients who presented after fall, those who died were older, had higher fall heights, and lower GCS on presentation (p<0.001). Males (p<0.001) and patients who were transferred from another health care facility (p=0.002) had a higher death rate. Patients with flank/abdominal (p<0.001) or head injuries (p<0.001) or those requiring tracheostomy (p<0.001), external-fixation (p=0.042) or amputation (p<0.001) were also more likely to die. In multivariate logistic regression analysis, occupation of peasant farmer (aOR 18.91) or housekeeper/gardener/guard (aOR 16.11) and injuries occurring during the hot dry season (aOR 3.56) were associated with increased death when controlled for confounding in patients who were alive on presentation (p<0.05). Head injury (aOR19.70, p<0.001) was also associated with increased death rates when including patients who were brought-in-dead.
Conclusion: Risk factors for fall include age, sex, occupation, and season. The longer length of stay and lower mortality may be predictive of falls being a significant cause of YLDs after discharge. Age, injury pattern and season were predictive of need for surgery and hospital outcomes including death. Interventions to reduce fall-risk, and improve fall outcomes should focus on these areas.