C. L. Gross1, J. Menard2, J. Mull2, D. Skarupa2, Y. Diaz-Zuniga2, M. Crandall2 1University Of Florida College of Medicine – Gainesville, Gainesville, FL, USA 2University Of Florida College of Medicine – Jacksonville, Department Of Surgery, Jacksonville, FL, USA
Introduction:
The LD50 for falls has historically been recognized as 4 – 5 stories. However, the origin of this maxim is unclear and published literature to-date has proven inconclusive. Although research has explored mortality of ground level falls in the elderly, little research has focused on the LD50 for fall heights based on field-relevant categories like falls from greater than standing (FFGS), falls from standing (FFS), and falls from less than standing (FFLS) such as bed or chair height. These practical stratifications may improve pre-hospital and hospital characterization of fall severity, allowing more appropriate triage and treatment.
Methods:
This retrospective observational study included patients (n=1633) evaluated for a fall incident at an urban, Level I Trauma Center from 1/1/15-6/31/17. Descriptive statistics were performed to characterize the sample based on demographic variables such as age, race, sex, and insurance type, as well as medical variables like relative fall height, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), traumatic brain injury (TBI), ICU length of stay, and mortality. Bivariate analysis included Chi-square tests for categorical variables and Student t-test for continuous variables. Subsequent multiple logistic regression modeled significant variables from bivariate analyses, including age, race, insurance status, fall height, ISS, and GCS
Results:
When adjusting for sex, age, race, insurance, ISS, and GCS, adults ≥ 65 who FFS (n=271) had 1.93 times the odds of mortality than those in the FFGS group. However, those <65 who FFGS (n=591) had 2.44 times the odds of mortality than the FFS group when adjusted for the same covariates. Additionally, commercial insurance was not protective across age groups.
Conclusion:
The LD50 for FFS may be higher than FFGS under certain circumstances, particularly among those 65 years and older. Therefore, algorithms should be adjusted to account for increased severity based on such characteristics. This may help inform first responders and hospital personnel when triaging falls. Lastly, hospital transfers may account for the surprising lack of protection against mortality by commercial insurance.
