Low- and High-Energy Falls With Associated Traumatic Brain Injury: Epidemiology and Outcomes.

introductionFalls are among the most common causes of injuries treated in emergency departments (ED), accounting for approximately 30% of all injury-related ED visits. Falls are also a significant cause of traumatic brain injury (TBI), a fact for individuals across the aging spectrum. Despite an abundance of information on the association between falls and TBI, limited investigation has occurred into the differences in population characteristics and outcomes based on fall energy (low-energy vs. high-energy falls) for individuals with TBI due to unintentional falls.

methodsWe conducted a retrospective analysis of patients with diagnosed TBI at an urban trauma center. Hospital data were obtained from the Department of Surgery's trauma registry, a subset of the National Trauma Registry of the American College of Surgeons, for the years 2017-2022. Low-energy falls were defined as a fall from ground level to three feet in height, and high-energy falls were defined as falls from greater than three feet. Individuals with TBI due to low and high-energy falls were compared using descriptive, univariate, and multivariate methods. Fall height was also used as a continuous variable to examine bivariate relationships with clinical characteristics in this cohort.

resultsThis study identified 760 low-energy falls and 93 high-energy falls with associated TBI. Approximately 60% of the cohort was male, 14.5% identified as Black race, 20.1% utilized Medicaid, 12.2% had moderate-severe TBI, 15.6% had orthopedic injuries, and 7.3% died during hospitalization. Older age and Medicare insurance were associated with low energy falls. Younger age, orthopedic injuries, and alcohol use at the time of injury were associated with high-energy falls. No association was found between energy level and sex, length of stay, injury severity score (ISS), Glasgow coma scale (GCS) score on arrival, Medicaid usage, complication burden, TBI severity, disposition type, and death. Increasing fall height was associated with age, lower GCS score, greater ISS, and ventilator days. Multivariate analysis found that age and alcohol use were predictive of fall energy.

conclusionOverall, patients with high-energy falls with associated TBI were younger and were more likely to develop fractures and utilize alcohol at the time of injury. High-energy falls did not lead to more severe injuries as demonstrated by nonsignificant differences in ISS, GCS, TBI severity, and death. Targeted prevention programs should be designed to reduce traumatic injury. Further study is needed to evaluate long-term patient outcomes in this population.