title: Tree stand falls: A persistent cause of neurological injury in hunting.
abstract: OBJECTIVE
  To characterize and compare our current series of patients to prior reports in order to identify any changes in the incidence of neurological injury related to hunting accidents in Rochester, New York.
  
  
  METHODS
  All tree stand-related injuries referred to our regional trauma center from September 2003 through November 2011 were reviewed. Information was obtained from the hospital's trauma registry and medical records were retrospectively reviewed for data pertaining to the injuries.
  
  
  RESULTS
  Fifty-four patients were identified. Ninety-six percent of patients were male with a mean age of 47.9 years (range 15-69). The mean Injury Severity Score was 12.53 ± 1.17 (range 2-34). The average height of fall was 18.2 feet (range 4-40 feet). All patients fell to the ground with the exception of one who landed on rocks, and many hit the tree or branches on the way down. A reason for the fall was documented in only 13 patients, and included tree stand construction (3), loss of balance (3), falling asleep (3), structural failure (2), safety harness breakage (3) or light-headedness (1). The most common injuries were spinal fractures (54%), most commonly in the cervical spine (69%), followed by the thoracic (38%) and lumbar (21%) spine. Eight patients required operative repair. Head injuries occurred in 22%. Other systemic injuries include rib/clavicular fractures (47%), pelvic fractures (11%), solid organ injury (23%), and pneumothorax or hemothorax (19%). No patient deaths were reported. The average hospital length of stay was 6.56 ± 1.07 d. Most patients were discharged home without (72%) or with (11%) services and 17% required rehabilitation.
  
  
  CONCLUSIONS
  Falls from hunting tree stands are still common, with a high rate of neurological injury. Compared to a decade ago we have made no progress in preventing these neurological injuries, despite an increase in safety advances. Neurosurgeons must continue to advocate for increased safety awareness and participate in leadership roles to improve outcomes for hunters.
authors.affiliation: Clifford A Pierre, Benjamin A Plog, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14623, United States.
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Pierre
authors.affiliation: Clifford A Pierre, Benjamin A Plog, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14623, United States.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Plog
authors.affiliation: Clifford A Pierre, Benjamin A Plog, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14623, United States.
authors.forename: Vasisht
authors.initials: V
authors.lastname: Srinivasan
authors.affiliation: Clifford A Pierre, Benjamin A Plog, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14623, United States.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Srinivasan
authors.affiliation: Clifford A Pierre, Benjamin A Plog, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14623, United States.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Petraglia
authors.affiliation: Clifford A Pierre, Benjamin A Plog, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14623, United States.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Huang
keywords: Hunting; Neurological sports medicine; Spine injury; Traumatic brain injury; Tree stand falls