Falls from Heights in and Around the City of Kars in Turkey
Emergency Medicine Investigations
Aim: Falls and fall-related injuries are important public health problems and need attention. Our aim in this study was to review and present our data on the cases presenting to the Emergency Department of Kars Kafkas University following a fall. Material and Method: We included a total of 200 cases that had presented to the emergency service of Kafkas University Faculty of Medicine between January 2012 and July 2017 in the study. The medical charts were reviewed retrospectively. The
... ely. The demographic features of the patients, fall distance, fall type, organs injured, treatment types, and mortality rates were recorded. All patients were seen from their charts to have been resuscitated according to the Advanced Trauma Life Support Program. The Glasgow Coma Scale scores had been recorded. The Kars province has a population of 289,786. The rural population is involved in agriculture and animal husbandry. They are involved in agricultural work from May to the end of September. Falls from horses and donkeys in rural areas are therefore seen in the summer. The urban population presents with falls from construction sites during the summer period when construction work is more active. We collected the admission and discharge data of the fall from height cases from the charts. Information for the fatal cases was collected from autopsy reports. The following groups were used in the study: 1) Falls from animals, 2) Falls from a height (household accidents, fall from a garden wall or the roof), and 3) Falls while working at a construction site. We excluded cases of suspicious death, cases that had been referred to us from other hospitals after treatment, and cases that did not come for follow-up after initial treatment at our hospital. Results: There was a total of 200 patients, consisting of 184 males and 16 females, that had fallen from a height in this study. A total of176 were admitted while 24 were sent home from the emergency service after the treatment was arranged. The mean age was 29+/-11.2 years. The mean height was 6+/-2 meters. All the falls were accidental. The Glasgow coma scale score was lower than 8 in falls from less than 5 meters. The number of falls from an animal was 55, from a height 62 and from a construction site 83. There were 32 patients who had fallen from a height of 5+/-2 meters and had been working at construction sites. These patients died because of hemorrhagic shock and multiple organ injuries. The distribution of injuries was 122 with extremity injuries, 16 with thoracic injuries, 20 with intraabdominal injuries, 10 with head injuries and 32 with multiple organ injuries. We had 77 patients with upper extremity injury and 45 with lower extremity injury. The thoracic injuries consisted of 9 cases with pneumothorax and 7 cases with lung contusion. The intraabdominal injuries involved the liver in 8, small intestines in 5, spleen in 4 and kidney in 3. Once the cases were admitted to the emergency services, the surgical indication was determined according to the physical examination, laboratory tests and radiological imaging results. The mortality rate was21%. There were 13 patients aged over 65 years. The mean inpatient duration was 20.2+/-14.3 days. Discussion: Falls from heights need to be evaluated in a multidisciplinary fashion as supported by imaging methods to determine the trauma severity. Taking the necessary measures and increasing the socioeconomic level of the patients will decrease exposure to such trauma.