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Patterns of injury in geriatric falls

Peter Ojo, Judith O'connor, Donald Kim, Kenneth Ciardiello, John Bonadies
Department of Surgery, Hospital of Saint Raphael, New Haven, CT

Objective: To review the spectrum of injury in geriatric fall patients and determine if injury patterns exist.
Design: A retrospective review of fall patients age >65 seen at a trauma center over a 9 year period (1995-2003) who were either evaluated by the trauma service and/or admitted to the hospital was conducted.
Setting: A level 2 trauma center in the greater New haven region.
Patients: 2,383 patients met the inclusion criteria.
Interventions:
Main Outcome Measures:
Results: Hip fracture (fx) proved to be the dominant injury (55%), 98% of which were isolated. 507(21%) were non-hip fxs. 238 patients (10%) sustained traumatic intracranial hemorrhage (ICH). Chest injury was the next most common injury type (6.7%) with rib fxs comprising 86% of this subgroup. Pneumothorax and hemothorax were present in 17% and 12% of rib fx patients, respectively. Cervical spine injury was the fourth most common injury identified (2.6%) with 57% of this group having concomitant ICH. Notably, abdominal injuries were the least common (<1%). Excluding patients with hip/extremity fxs, the injury frequency changed as delineated below.

Injury Type

Number (%)
Intracranial Hemorrhage238 (53%)
Chest Injury159 (36%)
Cervical Spine Fracture62* (14%)

* 57% had concomitant traumatic ICH
Conclusions: Unisystem hip fx is the dominant injury following falls in geriatric patients. Patients in this age group who do not sustain isolated hip or extremity fx however, commonly sustain significant head, chest and cervical spine injuries. A pattern of association between ICH and cervical spine fx was identified. Intra-abdominal injuries are very rare.

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