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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (6): 1065-1068. doi: 10.19723/j.issn.1671-167X.2024.06.019

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Prehospital factors influencing patients' injury severity score who fell from height

Zhe DU, Tianbing WANG*()   

  1. Trauma Medicine Center, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration Mi-nistry of Education; National Center for Trauma Medicine of China, Beijing 100044, China
  • Received:2022-03-01 Online:2024-12-18 Published:2024-12-18
  • Contact: Tianbing WANG E-mail:wangtianbing@pkuph.edu.cn

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Abstract:

Objective: To analyze the clinical characteristics of patients with severe fall injury and explore the prehospital factors affecting the injury severity score (ISS). Methods: Clinical data of severe trauma patients with fall injury and ISS≥16 from January 2018 to December 2020 were retrieved from trauma database of Peking University People' s Hospital. The patients' age, gender, suicidal tendencies, psychiatric disorders, fall height, properties of the impact surface, the body part hitting the ground, abbreviated injury scale, Glasgow coma scale (GCS), length of stay in intensive care unit (ICU), operation were collected. And the in-hospital mortality were calculated. Univariate analysis and multiple linear regression models were used to analyze the relationship between the above factors and ISS. The patients' GCS, length of stay in ICU, surgery, and in-hospital mortality were collected to analyze the general clinical characteristics of patients. Results: A total of 160 patients were finally eligible, including 138 males and 22 females, with an average age of (45.56±15.85) years. Among the 160 patients, there were 36 cases (22.50%) with suicidal tendencies, 12 cases (7.50%) with psychiatric disorders. Their average fall height was (7.20±8.33) meters, and 48 cases (30.00%) hit the soft contact medium. 40 cases (25.00%) with impact on the head at the ground, lower limbs in 26 cases (16.25%), ventral in 16 cases (10.00%), dorsal in 40 cases (25.00%), lateral in 38 cases (23.75%). The patients' ISS was 22.8±6.85, GCS was 13.49±3.39, lengths of ICU stays were (9.96±8.12) days, and 142 (88.75%) patients underwent surgery, 8 in-hospital deaths were all due to head trauma, with an in-hospital mortality rate of 5.00%. Univariate analysis suggested that the main factors influencing ISS were the presence of suicidal tendencies (P=0.01) and the site of impact on the ground (P=0.02). Multiple linear regression analysis indicated that suicidal tendencies and head impact on the ground were in-fluential factors for high ISS. Conclusion: Collecting prehospital information of patients with fall injuries, such as whether they have suicidal tendencies and whether they hit the ground with their heads, can effectively predict the severity of patients' injuries, which is conducive to early diagnosis, early care, and early treatment, thus reducing preventable death.

Key words: Wounds and injuries, Accidental falls, Injury severity score, Prehospital factors, Fall injury

CLC Number: 

  • R649.9

Table 1

General characteristics of all patients"

Items Data
Age/years 45.56±15.85
   < 18 6 (3.75)
  18-65 140 (87.50)
  >65 14 (8.75)
Gender
  Male 138 (86.25)
  Female 22 (13.75)
Suicide attempt 36 (22.50)
Psychiatric disorders 12 (7.50)
Fall height/m 7.20±8.33
   < 3 30 (18.75)
  3-5 64 (40.00)
  >5 66 (41.25)
Properties of the impact surface
  Soft 48 (30.00)
  Hard 112 (70.00)
The body part hitting the ground
  Head 40 (25.00)
  Lower limbs 26 (16.25)
  Ventral region 16 (10.00)
  Dorsal region 40 (25.00)
  Lateral region 38 (23.75)
ISS 22.8±6.85
AIS (head) 3.46±0.95
AIS (face) 2.60±0.55
AIS (thorax) 3.12±0.45
AIS (abdomen) 3.33±0.48
AIS (extremities) 3.33±0.58
AIS (soft tissues) 1.33±0.52
GCS 13.49 ±3.39
Length of stay in ICU/d 9.96 ±8.12
Surgery 142 (88.75)
In-hospital mortality 8 (5.00)

Table 2

Univariate analyses of the factors associated with ISS"

Items ISS P
Age/years 0.48
   < 17 25.67±8.02
  18-65 22.9±6.93
  >65 20.29±5.74
Gender 0.66
  Male 22.91±7.01
  Female 21.91±5.96
Suicide attempt 0.01
  Yes 26.67±7.67
  No 21.65±6.22
Psychiatric disorders 0.29
  Yes 25.67±5.61
  No 22.54±6.92
Fall height/m 0.14
   < 3 22.07±7.76
  3-5 21.28±6.49
  >5 24.55±6.56
Properties of the impact surface 0.28
  Soft 24.04±6.62
  Hard 22.23±6.94
The body part hitting the ground 0.02
  Head 26.55±8.17
  Lower limbs 22.15±7.44
  Ventral region 23.38±4.37
  Dorsal region 22.6±6.14
  Lateral region 19.16±4.62

Table 3

Multiple linear regression analysis examining covariates of ISS"

Model B SE Beta t P
Constant 35.04 8.83 3.97 < 0.01
Age -1.86 2.10 -0.10 -0.89 0.38
Gender -0.18 2.21 -0.01 -0.08 0.94
Suicide attempt -5.80 2.18 -0.36 -2.66 0.01
Psychiatric disorders 2.35 3.19 0.09 0.74 0.47
Fall height 1.27 1.10 0.14 1.15 0.25
Properties of the impact surface -0.36 1.71 -0.02 -0.21 0.83
The body part hitting the ground
  Lower limbs -5.45 2.26 -0.30 -2.41 0.02
  Ventral region -5.31 2.66 -0.23 -2.00 0.04
  Dorsal region -4.37 1.97 -0.28 -2.22 0.03
  Lateral region -9.12 2.08 -0.57 -4.40 < 0.01
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