C. J. Allen1, W. M. Hannay1, C. R. Murray1, R. J. Straker1, J. P. Meizoso1, J. J. Ray1, M. Hanna1, C. I. Schulman1, A. S. Livingstone1, N. Namias1, K. G. Proctor1 1University Of Miami,Trauma And Critical Care,Miami, FL, USA
Introduction: Fall-related mortality is projected to exceed both MVC and firearm mortality rates. One in three elderly adults falls each year. Although tremendous resources are focused on this growing public health concern with many arguing we require more devoted trauma centers to address this issue, exactly how these patients die is unknown. To fill this gap, we analyzed all falls at a level I trauma center. We hypothesize there is large portion of elderly fatalities that do not die directly from the fall injury itself.
Methods: From 01/2002 to 12/2012, 7,293 fall admissions were reviewed. Demographics, fall height, injury patterns, procedures and outcomes were obtained. Each elderly (≥65y) fatality was analyzed for root cause of death and categorized as either: direct result from fall, complication of prolonged hospital stay (indirectly related to injury of fall), or fatal event preceding fall. Physician notes were used to define cause of death, and medical examiner and autopsy reports were reviewed in ambiguous cases. Parametric data is represented as mean ± standard deviation and non-parametric data as median (interquartile range). Student’s t-test and Fisher’s Exact test were used as appropriate.
Results: In 2002-2007, 25% of all falls were elderly, but in 2008-2012 this proportion increased to 30% (p<0.001). When comparing non-elderly (n=5,187) to elderly (n=2,076), age was 38±17y vs 78±8y, 76% vs 50% M (p<0.001), ISS 10±10 vs 12±10 (p=NS), LOS 8±6d vs 12±6d (p<0.001), mortality 3.4% vs 13.7% (p<0.001). Non-elderly fatalities (n=180) were 82% M, and ISS 32±15, while elderly fatalities (n=285) were 58% M (p<0.001), 91% ground-level height, ISS 23±11 (p<0.001). Elderly cause of death is detailed in the figure below.
Conclusion: The fall population is becoming proportionately more elderly. Although with similar injury severity, elderly are associated with a higher LOS and >4x the mortality rate compared to the non-elderly. As the vast majority of elderly fatalities fall from ground-level height, they have a significantly lower injury severity than non-elderly fatalities. Over one-third of elderly deaths are due to a fatal event preceding the fall or from complications from a prolonged hospital stay. Since fall mortality rates continue to rise despite public health concern, it is notable that a large portion of these deaths are not directly related to the fall injury. As focus on elderly fall mortality increases and as many believe we require more devoted trauma centers to combat this growing health concern, defining the true causes of death may be necessary to focus resources to the actual issues.
