1. FALL FROM HEIGHT TRAUMA:
Universita’ degli Studi di Pavia Scuola di specializzazione in Chirurgia Generale Direttore: Prof. Paolo Dionigi U.S.C. Chirurgia 1° Generale e d’Urgenza ASST Papa Giovanni XXIII Bergamo Direttore Dott. L. Ansaloni
FALL FROM HEIGHT TRAUMA:
Revision of “Papa Giovanni XXIII” Bergamo Hospital
TRAUMA REGISTRY
and comparison between
ACCIDENTAL AND INTENTIONAL EVENTS
Dott.ssa FRANCESCA RUBERTA’

2. INTRODUCTION
FALLERS
JUMPERS

3. PATTERN OF INJURIES IN FALLERS FROM HEIGHT
GENERALITY
Multiple injuries
Complex management

4. GENERALITY Surface of landing Position of landing Height
PATTERN OF INJURIES IN FALLERS FROM HEIGHT
GENERALITY
Height
Surface of landing
Water
Soil
Position of landing
Vertical
Head-first
Feet-first
Horizontal
v = √2gh
 Height  impact velocity  MORTALITY

5. PATTERN OF INJURIES IN FALLERS FROM HEIGHT
GENERALITY
Deceleration trauma
internal organ lesions
Direct impact trauma
fractures
Head-first
Feet-first
Horizontal landing

6. PATTERN OF INJURIES IN FALLERS FROM HEIGHT DISTRIBUTION OF INJURIES
Teh et al
399 pts: 57 jumpers and 342 fallers

7. DISTRIBUTION OF INJURIES LOWER LIMB TRAUMA
PATTERN OF INJURIES IN FALLERS FROM HEIGHT
DISTRIBUTION OF INJURIES
LOWER LIMB TRAUMA
Calcaneus fractures are associated with spine injuries
Feet-first landers
JUMPERS CHARACTERISTIC

8. PATTERN OF INJURIES IN FALLERS FROM HEIGHT DISTRIBUTION OF INJURIES
Head and chest trauma are PREDICTIVE FACTORS OF DEATH
Pelvic fractures are associated with haemorrahage
Feet-first landers

9. Psychical diseases suicide-correlated:
SUICIDE BY JUMPING
IN EUROPE:
Middle-aged male
Single
Unemployed
Association with mental diseases
IN ITALY: (ISTAT DATA)
Psychical diseases suicide-correlated:
> in women
> in and > 65 range of ages
Physical diseases suicide-correlated:
> in males
Tumors

10. ACCIDENTAL FALLS Males and children Occupational and non-occupational
Elderly  daily living activities
RISK FACTORS FOR FALLS FROM HEIGHT
age, gender and weight
knowledge level
human behaviour and attitudes
physical features and health
sleep deprivation
work depression
fatigue
weather and environment

11. INJURY SEVERITY SCORE (ISS)
Susan Baker (1974)

12. Compare FALLERS AND JUMPERS
AIM OF THE STUDY
Compare FALLERS AND JUMPERS
Demography
Clinical – pathological parameters
Mortality
Identify risk population for suicide by jumping
Identify particular pattern of injury of fallers from height
Better management
More organised hospital setting

13. MATHERIALS AND METHODS
HPG23 TRAUMA REGISTRY
1576 traumatised patients
April 2014 → July 2016
Accidental and Intentional
Excluded: pts died prior to arrival at the ED
Trauma Team and ATLS principles management

14. MATHERIALS AND METHODS Considered parameters:
HPG23 TRAUMA REGISTRY
Considered parameters:
Demographic characteristics
Circumstances of trauma (domestic, work activities, territorial, and other)
Height of fall
Clinical parameters on the scene and at the ED
ISS
Distribution of lesions
Location of a definitive airway
Hospital admission
Need of surgery
ICU stay and days of mechanical ventilation
Hospital lenght of stay
mortality

15. STUDY POPULATION RESULTS
Suicide by jumping is preferred compared to other methods of auto-inflicted trauma
Suicides
Accidental traumas
Total
FFH
40 (95,2%)
259 (16,9%)
299 (19,0%)
Other dynamics
2 (4,8%)
1275 (83,1%)
1277 (81,0%)
42 (2,7%)
1534 (97,3%)
1576 (100%)
FALLERS
JUMPERS
ALL FFH
259 (86,6%)
40 (13,4%)
299 (100%)
P < 0,001

16. RESULTS

17. AGE AND GENDER RESULTS Univariate analysis: p <0,001
April 2014 → July 2016
Accidental and Intentional
Excluded: pts died prior to arrival at the ED
Multivariate analysis:
Age p =0,01
Gender p =<0,001
FEMALE SEX AND LOWER AGE (ABOUT 45 YRS OLD) WERE PREDICTIVE INDEPENDENT FACTORS OF RISK OF SUICIDE BY JUMPING

18. RESULTS

19. DISTRIBUTION OF LESIONS
RESULTS
DISTRIBUTION OF LESIONS
P =0,258
P =0,023
P =0,428
P < 0,001
P =0,004

20. RESULTS

21. HOSPITAL ADMISSION RESULTS P =0,091 FALLERS JUMPERS ALL ADMITTEDFFH
180 (84,5%)
33 (15,5%)
213 (100%)

22. RESULTS
HOSPITAL ADMISSION

23. RESULTS
MORTALITY

24. Population at high risk of suicide = MIDDLE-AGED WOMEN
DISCUSSION
Population at high risk of suicide = MIDDLE-AGED WOMEN
Psychiatric anamnesis unknown
Domestic setting
Preventive actions
Population at high risk of accidental FFH =
mountain sport people
workers
No statistically significant difference in HEIGHT OF FALL between F and J

25. DISCUSSION
No statistically significant difference in cranial trauma between F and J
Feet-first landing is protective??
No statistically significant difference in chest trauma between F and J
Horizontal landing
Statistically significant differences in abdomen and extremities trauma between F and J
Feet-first landing

26. CONCLUSIONS POPULATION AT RISK FOR JUMPING
WOMEN
ABOUT 45 YRS OLD
MORBIDITY AND MORTALITY HIGHER IN JUMPERS
TRAUMA REGISTRY: A TOOL TO RECOGNISE PATIENTS AT RISK FOR SUICIDE
Plan preventive and clinic actions
optimize the health path of these pts

27. THANK YOU 27