Ground-Level Geriatric Falls: A Not-So-Minor Mechanism of Injury

Abstract

Introduction. Ground-level falls are typically regarded as a minor mechanism of injury that do not necessitate trauma team activation; however, they represent a significant proportion of hospitalised trauma and can result in multisystem injury. Case Presentation. A 79-year-old nursing home resident was brought to the emergency department following an unwitnessed fall. She suffered dementia and had a seizure in the department resulting in a reduced GCS, making history and examination difficult. She was diagnosed with a right proximal humerus fracture and admitted under joint orthopedic and medical care. Following orthopedic review, further X-rays were requested which showed bilateral neck of femur fractures. The following day she had bilateral hip hemiarthroplasties and K-wire stabilisation of the right shoulder. Several days later, when cognition had improved, she was noted to be avoiding use of the left arm and was found to also have a left proximal humerus fracture which was managed conservatively. Conclusion. Trauma patients with reduced cognitive function should undergo full ATLS assessment, and a prospective trial is required to see if age should be incorporated as a criteria for trauma team activation. More liberal use of advanced imaging such as a full body CT-scan may be beneficial.

Geriatric fall-related injuries

“…The median (range) ISS was 4 (1-16) and the median (range) GCS was 15 (12)(13)(14)(15). Four (4.3%) patients were admitted to the Intensive Care Unit.…”

“…Fall from the same level is the most common type of fall in the elderly 10 . Even low energy trauma in the elderly can be serious because they have decreased physiological reserve and associated comorbidities 8,14 . It is important to note that age alone does not reflect the patient's physiological status and each patient should be considered individually 9,15 .…”

Spinal Fractures in Older Adult Patients Admitted After Low‐Level Falls: 10‐Year Incidence and Outcomes

“…Furthermore, age greater than 70 years is predictive of mortality following low‐level falls, with a reported 4.3% mortality rate versus 1.2% mortality rate in nonelderly patients . However, low‐level falls are an underappreciated mechanism for significant injury and generally are not criteria for activation of the trauma team . Commonly used full trauma team activation criteria include reduced level of consciousness, abnormal vital signs, and anatomic criteria, but not older age .…”

Trauma Team Activation for Geriatric Trauma at a Level II Trauma Center: Are the Elderly Under-triaged?

“…3,4,22,[27][28][29] Considering the paucity of data on under-triaged geriatric patients, it is vital to incorporate age-specific guidelines in TTA criteria in order to improve geriatric trauma outcomes. 2,7,11,22,30 Using the Cribari method, our data analysis revealed the under-triage rate to be 9.5%; significantly greater than the < 5% standard set by ACS. Head trauma was the most common diagnosis in under-triaged patients, while intracranial hemorrhage was associated with the highest ISS value and mortality rate ( Table 2).…”