Introduction: Falling is reported to be the most common cause of mortality due to trauma in individuals over the age of 75 years. The present study is designed with the aim of determining the demographics of fall-related trauma among the elderly presenting to emergency department (ED). Methods: The present prospective cross-sectional study was carried out on all elderly patients ≥ 60 years old presenting to ED of a major referral trauma center in North West of Iran during 1 year. Demographic data, location and height of falling, duration of hospitalization, trauma severity and in-hospital outcome of the patients were gathered and reported via descriptive statistics. Results: 228 patients with the mean age of 70.96 ± 5.2 years were studied (53.9% female). Most patients were in the 66-70 years age range (32.6%) and had a history of hypertension (22.3%), who had visited following a fall inside the house (69.3%), due to slipping (73.7%), and from a height equal to or less than 2m (71.9%). 6 (2.6%) patients died in the hospital. Mean trauma severity of patients based on ISS, RTS, and TRISS were 10.65 ± 3.95 (3-19), 7.84 ±.21 (1.4-14.5) and 1.66 ±1.31 (-1.49-3.82), respectively. Regarding need for hospitalization, only ISS shows a significant difference between outpatients and inpatients (p = 0.023). Patients who died had a significantly higher trauma severity based on ISS (p &lt; 0.0001) and RTS (p &lt; 0.0001). Conclusion: Based on the findings of the present study, slipping and syncope are the most common causes of  falling in the studied elderly that had mostly happened inside the house and from a height less than 2m. Therefore, most patients were in the mild to moderate range of trauma severity. ISS and RTS were significantly higher in the 6 (2.6%) patients who died

Ahmadi, Sajjad

Hosseini, Maryam

Morteza Bagi, Hamid Reza

English

Journals Portal, Shahid Beheshti University of Medical Sciences

Emergency. 2017; 5 (1): e78DOI: http://dx.doi.org/10.22037/emergency.v5i1.18497ORIGINAL RESEARCHDemographics of Fall-Related trauma among the ElderlyPresenting to Emergency Department; a Cross-SectionalStudyHamid Reza Morteza Bagi1, Sajjad Ahmadi2∗, Maryam Hosseini31. Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran.2. Emergency Medicine Department, Maragheh University of Medical Sciences, Maragheh, Iran.3. Faculty of Medicine, Tabriz University of medical Sciences, Tabriz, Iran.Received: August 2017; Accepted: August 2017; Published online: 12 September 2017Abstract: Introduction: Falling is reported to be the most common cause of mortality due to trauma in individuals overthe age of 75 years. The present study is designed with the aim of determining the demographics of fall-relatedtrauma among the elderly presenting to emergency department (ED). Methods: The present prospective cross-sectional study was carried out on all elderly patients ≥ 60 years old presenting to ED of a major referral traumacenter in North West of Iran during 1 year. Demographic data, location and height of falling, duration of hospi-talization, trauma severity and in-hospital outcome of the patients were gathered and reported via descriptivestatistics. Results: 228 patients with the mean age of 70.96± 5.2 years were studied (53.9% female). Most patientswere in the 66-70 years age range (32.6%) and had a history of hypertension (22.3%), who had visited followinga fall inside the house (69.3%), due to slipping (73.7%), and from a height equal to or less than 2m (71.9%). 6(2.6%) patients died in the hospital. Mean trauma severity of patients based on ISS, RTS, and TRISS were 10.65± 3.95 (3-19), 7.84 ±.21 (1.4-14.5) and 1.66 ±1.31 (-1.49-3.82), respectively. Regarding need for hospitalization,only ISS shows a significant difference between outpatients and inpatients (p = 0.023). Patients who died had asignificantly higher trauma severity based on ISS (p < 0.0001) and RTS (p < 0.0001). Conclusion: Based on thefindings of the present study, slipping and syncope are the most common causes of falling in the studied elderlythat had mostly happened inside the house and from a height less than 2m. Therefore, most patients were in themild to moderate range of trauma severity. ISS and RTS were significantly higher in the 6 (2.6%) patients whodied.Keywords: Trauma severity indices; accidental falls; aged; demography; cross-sectional studies© Copyright (2017) Shahid Beheshti University of Medical SciencesCite this article as: Morteza Bagi H, Ahmadi S, Hosseini M. Demographics of Fall-Related trauma among the Elderly Presenting to EmergencyDepartment; a Cross-Sectional Study. Emergency. 2017; 5(1): e78.1. IntroductionIncrease in life expectancy has led to a rise in the num-ber of elderly individuals all over the world and aging hasbecome one of the most important challenges of publichealth in various countries. Due to their lower activity, oldpeople are less likely to face injuries but if they get injuredthey have a higher mortality rate compared to young peo-∗Corresponding Author: Dr. Sajjad Ahmadi; Department of EmergencyMedicine, Amiralmomenin Hospital, North Moallem _ Nova Road, Maragheh,Iran. Postal code: 55391-41416 E-mail: dr.ahmadi96993@gmail.com Tel:009837241597ple because of disorders in physiological functions and bodysystems as well as presence of other medical problems. Cur-rently, trauma is the 5th cause of death among elderly peo-ple and falling is the most common cause of mortality dueto trauma in individuals over the age of 75 years (1-3). Intotal, falling leads to about 40% of deaths due to trauma inold people (4). 20% to 28% of the elderly in Iran experiencefalling, and fear of falling leads to limited activity in 30% ofold people (5, 6). Falling makes up 10-15% of emergency de-partment (ED) visits (4, 7, 8) and its outcome in old peoplevaries from complete recovery to death. Duration of hospi-talization among the elderly also ranges from a few days tobeing permanently crippled (9-15). It seems that planning onThis open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jemerg.comH. Morteza Bagi et al. 2prevention of the accident is the best and most cost effectivemeasure in this regard. However, any planning requires in-formation on the epidemiologic characteristics and the situ-ation of the subject of planning. Therefore, the present studyis designed with the aim of determining the demographics offall-related trauma among the elderly presenting to ED.2. Methods2.1. Study design and settingThe present prospective cross-sectional study was carriedout on elderly patients (≥ 60 years old) presenting to ED ofImam Reza hospital, Tabriz, Iran, following trauma caused byfalling, from April 2015 to March 2016 (during 1 year). Thishospital is one of the major referral trauma centers in NorthWest of Iran. The study was approved by the ethics com-mittee of Tabriz University of Medical Sciences and the re-searchers adhered to principles of Helsinki declaration andkeeping patient data confidential. Oral consent was obtainedfrom the patients for participating in the study.2.2. ParticipantsAll patients, 60 years old or older, who had visited the traumaunit of the mentioned ED during the study period follow-ing falling and were willing to participate were included viaconsecutive sampling. Patients who had died before arrivingat the ED or were discharged against medical advice (71 pa-tients), were excluded from the study.2.3. Data gatheringA checklist consisting of baseline characteristics (age, sex,underlying illnesses), location of falling, height of falling,duration of hospitalization, data required for calculation oftrauma severity based on Injury Severity Score (ISS), RevisedTrauma Score (RTS), and Trauma and injury severity score(TRISS), and in-hospital mortality was filled for all the pa-tients. The person in charge of data gathering and calcula-tion of trauma severity was a senior emergency medicine res-ident, under supervision of the corresponding attend.- ISS is calculated based on the severity of trauma to face,head, extremities, chest, and abdomen (13). If this score isequal to or higher than 16, the patient is deemed multipletrauma (14, 15). An ISS lower than 7, indicates mild physicalinjury, 7-12 moderate injury and more than 12 shows severeinjury.- In RTS, trauma severity is calculated based on level of con-sciousness, systolic blood pressure and respiratory rate andis also used for triage of the patients (16).- TRISS indicates the prognosis of trauma patients and actsbased on the physiologic and anatomic status of the pa-tient on admission to ED. This system of determining traumaseverity is in fact a combination of ISS and RTS (17).Table 1: Baseline characteristics of the studied patientsVariable Number (%)SexMale 105 (46.1)Female 123 (53.9)Age (year)60 – 65 39 (17.1)66 – 70 74 (32.6)71 – 75 64 (28.1)76 – 80 45 (19.7)> 80 6 (2.6)Underlying diseaseHypertension 51 (22.3)Ischemic heart disease 22 (9.6)Osteoporosis 23 (10.1)Diabetes 12 (5.2)Neurologic disease 12 (5.2)None 125 (54.8)Duration of hospitalizationOutpatient 88 (38.6)< 5days 98 (43.0)> 5 days 42 (18.4)Table 2: Accident characteristics of the studied patientsVariable Number (%)Location of fallOutside the house 70 (30.7)Bathroom 47 (20.6)Kitchen 45 (19.7)Steps 34 (14.9)Other 32 (14.0)Cause of fallSlipping 168 (73.7)Altered level of consciousness 51 (22.4)Other 9 (3.9)Height of fall (m)≥ 2 134 (71.9)> 2 49 (21.5)Unknown 15 (6.6)2.4. Statistical AnalysisData were analyzed by SPSS version 21. Quantitative dataare reported as mean and standard deviation and qualitativeones are reported as frequency and percentage. To compare2 groups, t-test and chi square tests were used and to calcu-late trauma severity based on the mentioned indices, med-ical calculator was used. Significance level in analyses wasconsidered to be less than 0.05.3. Results3.1. Baseline characteristics228 patients with the mean age of 70.96± 5.2 years were stud-ied (53.9% female). Tables 1 and 2 depict the baseline char-This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jemerg.com3 Emergency. 2017; 5 (1): e78Table 3: Comparison of mean trauma severity between inpatients and outpatients as well as dead and alive patients based on ISS, RTS andTRISS indicesVariableTrauma severity (mean ± standard deviation)ISS P value RTS P value TRISS P valueHospitalizationOutpatient 9.9 ± 3.410.0237.96 ± 2.420.2951.52 ± 1.400.453Inpatient 11.12 ± 4.20 7.64 ± 1.83 1.65 ± 1.23MortalityAlive 10.55 ± 3.920.00017.86 ± 2.230.00011.60 ± 1.310.406Dead 20.66 ± 6.68 13.50 ± 1.00 2.05 ± 0.91acteristics of the patients and fall characteristics. Accord-ing to these results, most patients were in the 66-70 yearsage range (32.6%) and had a history of hypertension (22.3%),who had visited following a fall inside the house (69.3%), dueto slipping (73.7%), and from a height equal to or less than2m (71.9%). 6 (2.6%) patients died in the hospital and oth-ers were discharged from ED (38.6%) or from surgery depart-ment after a few days of hospitalization (61.4%).3.2. Trauma severityMean trauma severity of patients based on ISS, RTS, andTRISS were 10.65 ± 3.95 (3-19), 7.84 ±.21 (1.4-14.5) and 1.66±1.31 (-1.49-3.82), respectively. Trauma severity based on ISSwas less than 7 in 60 (26.3%) patients, between 7 and 12 in98 (43.0%) and over 12 in 70 (30.7%) injured patients. Table3 compares mean trauma severity of the patients based onthe 3 mentioned indices between patients who survived andthose who died as well as outpatients and inpatients. As canbe seen, only ISS shows a significant difference between out-patients and inpatients (p = 0.023). In addition, patients whodied had a significantly higher trauma severity based on ISS(p < 0.0001) and RTS (p < 0.0001).4. DiscussionBased on the findings of the present study, slipping and syn-cope were the most common causes falling in the studied el-derly, who had mostly fallen from a height less than 2m andinside the house. Most patients were in the mild to moder-ate range of trauma severity. ISS and RTS were significantlyhigher in the 6 (2.6%) patients who had died.Statistics show that each year on average 28 to 35% of the el-derly over 60 years old fall and in those over the age of 70years this rate rises to 32 to 42% and in half of the cases, ithappens recurrently. This emphasizes the necessity of tak-ing preventive measures and applying plans to prevent thisfrom happening again (18, 19). In a study carried out in 2004by Schoenfelder et al., falling rate was higher in women com-pared to men (82.10% versus 17.90%) (4). Swanenburg et al.in 2010 also reported the higher prevalence of this problemin women (83% vs. 17%) (20). However, in the present studyaffected men and women were relatively equal. In Corsinoviet al. study on 620 elderly patients that were treated followinga fall, no correlation was found between age and falling rate(14).Regarding quantitative trauma severity, findings showed thatmean ISS was 10.67 and most patients had moderate injury.In a study by Zare et al. evaluating trauma in emergency pa-tients whose mean age was 29.60 years, the results showedthat quantitative trauma severity was 16.98, which can showthe higher severity of trauma and risky behaviors in youngpeople compared to the elderly (21). In 2009, Hariharan etal. evaluated the clinical value of TRISS in 326 trauma pa-tients. Mean survival rate in adults was reported to be 98.50%in the study, which indicates 1.5% mortality in these patients.These researchers concluded that TRISS was not so accuratein predicting the prognosis of trauma patients (22). In ad-dition in 2004, Murlidhar et al. evaluated TRISS in a studyof trauma patients’ outcome and reported that the predictedmortality rate in patients by this index was 10.89%. This ratewas 61.60% and 16.60% for RTS and ISS, respectively but thereal mortality rate was 21.26%. The researchers reported thecause of this vast difference to be the higher age of the pa-tients studied compared to other studies (23). Meanwhile, inanother study conducted by Mitchell et al. in 2007 in Canadathe ability of indices such as TRISS to predict the prognosis oftrauma patients were evaluated and shown to be acceptable(24).The obtained results regarding trauma severity indicesshowed that TRISS did not correlate with hospitalization sta-tus and mortality of the patients; however, ISS correlated withhospitalization status and both ISS and RTS correlated withmortality of the patients.Studies show that falling happens following a complex inter-ference of risk factors that affect the health status of an el-derly individual, directly or indirectly. These factors are cat-egorized in 4 groups: biological, behavioral, environmental,and socioeconomic factors (18). Although in this study, thesefactors were not evaluated individually, the evidence showsthat evaluating and controlling these factors is of great im-This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jemerg.comH. Morteza Bagi et al. 4portance.5. LimitationSmall sample size, being single-centered and the evaluatedvariables being few could be counted as the limitations ofthis study. However, considering the limited number of thesestudies in Iran, the findings of this study can help in under-standing the conditions ruling trauma due to falling in theelderly.6. ConclusionBased on the findings of the present study, slipping and syn-cope are the most common causes of falling in the studiedelderly that had mostly happened inside the house and froma height less than 2m. Therefore, most patients were in themild to moderate range of trauma severity. ISS and RTS weresignificantly higher in the 6 (2.6%) patients who died.7. Appendix7.1. AcknowledgementsAll the ED staff members are acknowledged for cooperatingduring the project.7.2. Author contributionAll authors passed four criteria for authorship contributionbased on recommendations of the International Committeeof Medical Journal Editors.7.3. Funding/SupportNone.7.4. Conflict of interestHereby, the authors declare that there is no conflict of interestregarding the present study.References1. Tavakoli H, Ahmadi Amoli H, Yaghoubi Notash A,Adelyazdankhah Konari A, Gholkhani F, Khashayar P.Trauma-related morbidity and mortality in elderly pa-tients. Iranian Journal of Ageing. 2009;4(1):30-6 [Persian].2. McMahon DJ, Schwab CW, Kauder D. Comorbidity andthe elderly trauma patient. World J Surg. 1996;20(8):1113-20.3. Close J, Ellis M, Hooper R, Glucksman E, Jackson S, SwiftC. Prevention of falls in the elderly trial (PROFET): a ran-domised controlled trial. The Lancet. 1999;353(9147):93-7.4. Schoenfelder DP, Rubenstein LM. An exercise program toimprove fall-related outcomes in elderly nursing homeresidents. Appl Nurs Res. 2004;17(1):21-31.5. Salarvand S, Birjandi M. Assessing related factors withfalling in older adults living in Khoramabad. BimonthlyIran Journal of Nursing. 2009;21:51-60.6. Akbari Kamrani AA, Azadi F, Foroughan M, Siadat S, KaldiAR. Characteristics of falls among institutionalized el-derly people. Iranian journal of Ageing. 2007;1(2):101-5.[Persian]7. Scott V, Pearce M, Pengelly C. Technical report: hospital-izations due to falls among Canadians age 65 and over.Report on Seniors’ falls in Canada Canada, Minister ofPublic Works and Government Services. 2005.8. Fu D, Yoshida S, Al-Faisal W, et al. World Health Organ-isation Global Report on Falls Prevention in Older Age.2007.9. Zuckerman JD. Hip fracture. New England journal ofmedicine. 1996;334(23):1519-25.10. Baker SP, o’Neill B, Haddon Jr W, Long WB. The in-jury severity score: a method for describing patientswith multiple injuries and evaluating emergency care. JTrauma. 1974;14(3):187-96.11. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costsof fatal and non-fatal falls among older adults. Inj Prev.2006;12(5):290-5.12. Moradi Lakeh M, Tehrani Banihashemi S, Varasteh KiaG, Roohipour M. COMPARISON OF TRAUMA SCORINGSYSTEMS FOR PREDICTION OF PATIENTSâĂŹPROG-NOSIS. Razi Journal of Medical Sciences. 2002;9(28):129-37.13. Brenneman FD, Boulanger BR, McLellan BA, RedelmeierDA. Measuring injury severity: time for a change. JTrauma. 1998;44(4):580-2.14. Corsinovi L, Bo M, Aimonino NR, et al. Predictors offalls and hospitalization outcomes in elderly patients ad-mitted to an acute geriatric unit. Arch Gerontol Geriatr.2009;49(1):142-5.15. Copes WS, Champion HR, Sacco WJ, Lawnick MM, KeastSL, Bain LW. The Injury Severity Score revisited. J Trauma.1988;28(1):69-77.16. Nagurney JT, Borczuk P, Thomas S. Elderly patients withclosed head trauma after a fall: mechanisms and out-comes. J Emerg Med. 1998;16(5):709-13.17. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care:the TRISS method. J Trauma. 1987;27(4):370-8.18. Hatamabadi H, Rafieenejad A, Alavi Moghaddam M, SumS. A study on consequences of fall among elderly peoplereferred to Emam Hossein hospital in Tehran city dur-ing 2010-2011. Iranian Journal of Ageing. 2014;9(1):55-62.[Persian]19. Hatamabadi H, Dolatabadi AA, Atighinasab B, Safari S.This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jemerg.com5 Emergency. 2017; 5 (1): e78Baseline Characteristics of Fall from Height Victims Pre-senting to Emergency Department; a Brief Report. Emer-gency. 2017;5(1):e55.20. Swanenburg J, de Bruin ED, Uebelhart D, Mulder T. Fallsprediction in elderly people: a 1-year prospective study.Gait Posture. 2010;31(3):317-21.21. Zare M, Karegar S. 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Demographics of Fall-Related trauma among the Elderly Presenting to Emergency Department; a Cross-Sectional Study

Introduction: Falling is reported to be the most common cause of mortality due to trauma in individuals over the age of 75 years. The present study is designed with the aim of determining the demographics of fall-related trauma among the elderly presenting to emergency department (ED). Methods: The present prospective cross-sectional study was carried out on all elderly patients ≥ 60 years old presenting to ED of a major referral trauma center in North West of Iran during 1 year. Demographic data, location and height of falling, duration of hospitalization, trauma severity and in-hospital outcome of the patients were gathered and reported via descriptive statistics. Results: 228 patients with the mean age of 70.96 ± 5.2 years were studied (53.9% female). Most patients were in the 66-70 years age range (32.6%) and had a history of hypertension (22.3%), who had visited following a fall inside the house (69.3%), due to slipping (73.7%), and from a height equal to or less than 2m (71.9%). 6 (2.6%) patients died in the hospital. Mean trauma severity of patients based on ISS, RTS, and TRISS were 10.65 ± 3.95 (3-19), 7.84 ±.21 (1.4-14.5) and 1.66 ±1.31 (-1.49-3.82), respectively. Regarding need for hospitalization, only ISS shows a significant difference between outpatients and inpatients (p = 0.023). Patients who died had a significantly higher trauma severity based on ISS (p &lt; 0.0001) and RTS (p &lt; 0.0001). Conclusion: Based on the findings of the present study, slipping and syncope are the most common causes of  falling in the studied elderly that had mostly happened inside the house and from a height less than 2m. Therefore, most patients were in the mild to moderate range of trauma severity. ISS and RTS were significantly higher in the 6 (2.6%) patients who died.</p

Demographics of Fall-Related trauma among the Elderly Presenting to Emergency Department; a Cross-Sectional Study

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