1. PROGNOSTIC FACTORS FOR INJURIES AFTER FALLS FROM HEIGHTS
Ir.Christodoulou, Chr.Pogonidis, Eug.Xenodoxidou, M.Tsolakis, D.Babalis,L.Borgi, J.Nakopoulos, D.Gymnopoulos
SURGICAL DEPARTMENT,
SISMANOGLION HOSPITAL, KOMOTINI, THRACE, GREECE

2. Introduction
Falls from heights are common causes of multi-systemic injuries.
It is not always easy to foretell the prognosis of these cases because many factors are involved.

3. Introduction
There have been recognized patterns of injuries after falls from heights.
It is of great importance for the Emergency Physician to be informed about the mechanism of the injury/ height of fall, not always referred at the Emergencies Room.

4. Fall prevention has become a scientific field

5. Falls and fatalities
Falls are the leading cause of fatalities in the construction industry.
An average of 363 fatal falls occured each year from 1995 to 2005, with the trend on the increase.
In 2005, 1152 construction workers died on the job, with 32.4% resulting from falls.

6. Fall protection era Analysis of fall hazards arising from work methods
Specific fall protection plans/programs
Compatible fall arrest systems.
Supervision of the installation of fall protection systems with Professional Engineers.
Training of construction industry workers and supervisors.

7. OSHA Regulations: Height at which fall protection is required
Construction Standard (Subpart M): 6 feet height Steel Erection Standard : 15 feet height

8. OSHA Grants
National News Release NAT September 29, 2006 Contact: ********* Phone: *******
U.S. Department of Labor Awards More than $10 Million in Grants for Safety and Health Training Programs

9. Climbing safety systems

12. Imbalance of industry interest with medical investigation on fall from heights
Only 136 medical studies since 1965,
Most of them case reports….

13. Purpose of the study
To investigate the prognostic factors in injuries after falls from heights.

14. Methods Retrospective study
Period of retrospective study:
Subjects: casualties admitted in the Surgical Department of our Hospital after falls from heights.
Limitations: Falls at ground level were excluded and only falls > 2 meters were included ( 97 patients).

15. Methods Age: 5 - 77 years old, Median age 37 years old.
Sex: 84 men- 13 women
Statistical comparisons were made with Χ2 test. A p< 0.05 statistical level was used.

16. Results The height factor
Mean fall height 6,5 metres( range 2,5- 20 metres).
The height of the fall was higher than 5 metres in 46 cases.
Only 5 patients fell from a height of more than 15 metres.

17. Results Intoxication was detected in 32 cases. Alcohol 27 cases
Drugs cases
Both cases
Intentional fall ( possibly) cases

18. Head injuries Brain injuries 85 patients
Maxilofacial injuries patients
Neurosurgery patients
Maxillofacial surgical repair-12 patients.
A severe head injury was the main cause for the admission in ICU in 14 patients.

19. Thoracic Injuries Thoracic injury 27 patients Pneumothorax 6 patients
Hemothorax patients
Emergent thoracotomy - 2 patients

20. Pelvic injury Pelvic fractures 15 patients
Synchronous retroperitoneal hemorrhage in 13 patients ( severe in 2).

21. Spine injuries Cervical spine injuries 37 patients
Cervical spine fractures 1 patient
Thoracic spine patients
Lumbar fractures patients
Limbs’ fractures patients

22. Fractures and neurological deficits
Fractures were the most common type of injury.
Spinal fractures were detected in 23 patients and were associated with neurologic deficits in 3.
Orthopedic operations -12 patients.

23. Abdominal injuries
Abdominal injury patients
Laparotomy patients

24. Abdominal operations Solid organ lacerations 9 cases
Small bowel perforation cases
Bladder rupture case
Significant Retroperitoneal hematoma 2 cases

25. Results
14 patients were admitted in Intensive Care Unit (ICU) (12 days to 5 months)
Mortality –
2 DEATHS in the first post traumatic week and
+ 2 DEATHS happened in the first post-traumatic month( ARDS,sepsis).

26. Admission in ICU and injuries
Severe hemorrhage was present in 9 critically injured patients admitted in the ICU.
Head injury was present in all patients entering the ICU.

27. Death and injuries
Severe hemorrhage was present in all lethal cases(4).
Head injury was present in the 3/4 deaths
All fatal accidents happened after a fall from the fifth floor of a building or higher.

28. Conclusions The height of the fall correlated with
the severity of injury,
the need for operation,
the length for hospitalization and
mortality

29. Conclusions Most falls occurred from moderate heights.
The spinal column was frequently injured
( 35%) and therefore should be thoroughly assessed clinically and with X-rays.
Intra-abdominal injuries were most common than retroperitoneal.

30. Conclusions
The height of the fall is a good predictor of injury severity and outcome prognosis.

31. Also our study adds the result that severe hemorrhage has a lethally worsening impact in trauma cases with brain injuries.
Discussion
Brain injury is a leading bad prognostic factor, but we conclude that patients with maxillofacial trauma without brain injury have a better prognosis.

32. Thank you for your attention