Prognostic factors in victims of falls from height.
OBJECTIVE
Falls from height cause significant mortality in the urban environment, but reliable prognostic factors have not been identified. Even the intuitive relation between the distance fallen and mortality rate has been questioned. Our objective was to determine factors predictive of increased mortality rate in victims of falls from height.


METHODS
Clinical observational study, retrospective for January 1998 to May 1999 and prospective from June 1999 to September 2000.


METHODS
The study population was drawn from Seine-Saint-Denis, an urban region near Paris with 1.3 million inhabitants treated by a French out-of-hospital medical emergencies unit.


METHODS
Patients were victims of falls from height >3 m, age >12 yrs. Study entry was performed on the scene by an emergency physician from the medical emergencies unit.


METHODS
None.


RESULTS
Studied data included age, gender, circumstances of fall, height of fall, nature of the impact surface (soft or hard), transient impact preceding final impact, and part of the body touching the ground first. The primary end point was mortality. The study included 287 patients, 116 (40%) during the retrospective phase and 171 (60%) during the prospective phase. Ninety-seven patients (34%) ultimately died. In multivariate analysis, age (mean, 41.6 +/- 16.6 yrs in patients who died vs. 34.9 +/- 14.9 in survivors; odds ratio, 1.05; p < .0005); height of fall (median, 5.0; 3.8-8.0 vs. 2.0; 1.2-3.0 floors; odds ratio, 1.24; p < .0001); nature of the impact surface (hard in 39% vs. soft in 22%; odds ratio, 2.7; p < .05); and head, anterior, and lateral body surfaces touching the ground first (with respectively mortality rates of 44%, odds ratio, 16.7, p = .0001; 57%, odds ratio, 10.6, p < 0.005; 32%, odds ratio, 11.1, p < .001) were independently correlated with the final mortality rate.


CONCLUSIONS
Patient age, height of fall, impact surface nature, and body part first touching the ground are independent prognostic factors in victims of falls from height.
Lapostolle
Frédéric
F
Hôpital Avicenne, Bobigny, France.
Gere
Christophe
C
Borron
Stephen W
SW
Pétrovic
Tomislav
T
Dallemagne
Frédéric
F
Beruben
Arielle
A
Lapandry
Claude
C
Adnet
Frédéric
F
D000058:Accidental Falls / Q000401:mortality*; D000328:Adult; D005260:Female; D005602:France / Q000453:epidemiology; D006112:Gravitation; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors