Danger at every rung: Epidemiology and outcomes of ICU-admitted ladder-related trauma |
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| Institution: | 1. Intensive Care Department, The Alfred Hospital, Melbourne, Australia;2. Critical Care Research Division, Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia;3. National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia;4. Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia;1. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway;2. Department of Clinical Medicine, University of Bergen, Bergen, Norway;1. Medical University of South Carolina, Charleston, SC;2. University of Alabama at Birmingham, Birmingham, AL;1. Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA;2. Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research Unit, University of Michigan Health System, Ann Arbor, MI 48109, USA;1. Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC;2. Department of Physical Medicine and Rehabilitation, University of Alabama-Birmingham, Birmingham, AL;1. Center for Ergonomics, University of Michigan, Ann Arbor, MI, USA;2. Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV, USA |
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| Abstract: | IntroductionThe incidence of ladder-related falls is increasing, and this represents a disturbing trend, particularly in the context of increased life expectancy and the impending retirement of the populous ‘baby-boomer’ generation. To date, there have been no critical illness-focused studies reporting on the incidence, severity and outcomes of severe ladder-related injuries requiring ICU management.MethodsMajor trauma patients admitted to ICU over a 5 year period to June 2011 after ladder falls >1 m were identified from prospectively collected trauma data at a Level 1 trauma service. Demographic and ICU clinical management data were collected and non-parametric statistical analyses were used to explore the relationships between variables in hospital mortality/survival.ResultsThere were 584 ladder fall admissions, including 194 major trauma cases, of whom 29.9% (n = 58) fell >1 m and were admitted to ICU. Hospital mortality was 26%, and fatal cases were almost entirely older males in domestic falls of ≤3 m who died as a result of traumatic brain injury. Non-survivors had lower GCS at the scene (p = 0.02), higher AIS head code (p = 0.01), higher heart rate and lower mean arterial pressure (p < 0.01) in the initial 24 h period in ICU, and were ≥55 years of age (p = 0.05). Only 46% of patients available for follow-up were living at home at 12 months without requiring additional care.ConclusionsThe incidence of ladder falls requiring ICU management is increasing, and severe traumatic brain injury was responsible for the majority of deaths and for poor outcomes in survivors. In-hospital costs attributable to the care of these patients are high, and fewer than half were living independently at home at 12 months post-fall. A concerted public health campaign is required to alert the community to the potential consequences of this mechanism of injury. The use of helmets for ladder users in domestic settings, where occupational health and safety regulations are less likely to be applied, is strongly recommended to mitigate the risk of severe brain injury. The benefits of this simple strategy far outweigh any mild inconvenience for the wearer, and may prevent catastrophic injury. |
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| Keywords: | Ladder Ladder falls Ladder-related trauma Ladder injuries High falls Traumatic brain injury Intensive care |
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