title: Risk Factors for Intracranial Haemorrhage in Accidents Associated with the Shower or Bathtub.
abstract: BACKGROUND
  There has been little research on bathroom accidents. It is unknown whether the shower or bathtub are connected with special dangers in different age groups or whether there are specific risk factors for adverse outcomes.
  
  
  METHODS
  This cross-sectional analysis included all direct admissions to the Emergency Department at the Inselspital Bern, Switzerland from 1 January 2000 to 28 February 2014 after accidents associated with the bathtub or shower. Time, age, location, mechanism and diagnosis were assessed and special risk factors were examined. Patient groups with and without intracranial bleeding were compared with the Mann-Whitney U test.The association of risk factors with intracranial bleeding was investigated using univariate analysis with Fisher's exact test or logistic regression. The effects of different variables on cerebral bleeding were analysed by multivariate logistic regression.
  
  
  RESULTS
  Two hundred and eighty (280) patients with accidents associated with the bathtub or shower were included in our study. Two hundred and thirty-five (235) patients suffered direct trauma by hitting an object (83.9%) and traumatic brain injury (TBI) was detected in 28 patients (10%). Eight (8) of the 27 patients with mild traumatic brain injuries (GCS 13-15), (29.6%) exhibited intracranial haemorrhage. All patients with intracranial haemorrhage were older than 48 years and needed in-hospital treatment. Patients with intracranial haemorrhage were significantly older and had higher haemoglobin levels than the control group with TBI but without intracranial bleeding (p<0.05 for both).In univariate analysis, we found that intracranial haemorrhage in patients with TBI was associated with direct trauma in general and with age (both p<0.05), but not with the mechanism of the fall, its location (shower or bathtub) or the gender of the patient. Multivariate logistic regression analysis identified only age as a risk factor for cerebral bleeding (p<0.05; OR 1.09 (CI 1.01;1.171)).
  
  
  CONCLUSIONS
  In patients with ED admissions associated with the bathtub or shower direct trauma and age are risk factors for intracranial haemorrhage. Additional effort in prevention should be considered, especially in the elderly.
authors.affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Sauter
authors.affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
authors.forename: Jannes
authors.initials: J
authors.lastname: Kreher
authors.affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
authors.forename: Meret E
authors.initials: ME
authors.lastname: Ricklin
authors.affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
authors.forename: Dominik G
authors.initials: DG
authors.lastname: Haider
authors.affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos
mesh_terms: D000058:Accidental Falls; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult