Elsevier

Injury

Volume 43, Issue 12, December 2012, Pages 1996-2000
Injury

Fall related injuries: A retrospective medical review study in North India

https://doi.org/10.1016/j.injury.2011.08.004Get rights and content

Abstract

Introduction

Falls have been identified as a leading cause of injury-related morbidity and mortality in India. However, very little is known about the context and characteristics of such falls. The aim of this study was to describe the context and characteristics of fall related injuries in patients admitted to hospital for fall injury.

Methods

Medical records of patients presenting at the Emergency Department of the Nehru Hospital, Chandigarh, India between March 2008 and February 2009, were reviewed by trained investigators. All injury cases were identified and fall related injury cases were assigned an ICD 10, Chapter XX, External causes of morbidity and mortality code. A review of medical records was conducted to determine the context, nature and site of injury associated with a fall event.

Results

Ten percent (7049) of hospital emergency presentations were due to injuries, and falls were the second leading cause (20%, 1407). Seventy-six percent of the fall related presentations were in males. More than one third (36%) of the fall related presentations occurred in those aged 0–14 years old. Falls from building or structures (35%, 499) were the leading cause for all ages except for those older than 60 years, where same level falls due to slipping, tripping and stumbling (40%, 57) were predominant. Half of all the falls resulted in head injury. Nearly 10% of patients presenting for fall related injury died.

Conclusion

Fall related injuries are an important contributor to hospital emergency presentations, particularly falls from buildings in children, and slips and trips in older people. Given the high proportion of falls that resulted in head injury and death, there is a significant need to develop appropriate interventions to prevent such falls.

Introduction

Falls are the second leading cause of injury mortality worldwide. The 2004 Global Burden of Disease and Injury study estimated that 11% of all unintentional injury deaths are due to falls.1 The million death study, a nationally representative study for cause specific mortality in India, reports 25% of all unintentional injuries were due to falls.2 In absolute numbers, 160,000 deaths due to unintentional fall injuries were estimated for the year 2005; only marginally less than road traffic injury deaths (185 000) for the same year.2 Fall injuries also lead to significant disability in the population with an estimated 375 DALYs per 100,000 population in India.1

International research inidicates that the context, nature and severity of falls varies by age and gender.3, 4 A high fall injury prevelance is reported amongst children in low and middle income settings, and the limited literature suggests that these falls are from height.5, 6, 7 There are very few studies which measure the incidenceon falls in India.7, 8

Whilst there is mounting evidence of the high burden of fall-related injuries in the population, there is little understanding of the context and characteristics of these falls, which is essential for appropriate prevention and injury control programmes in India. The present study therefore aims to describe the context and characteristics of fall related injury cases presenting at a tertiary care hospital of North India.

Section snippets

Ethical considerations

The study was approved by the Ethics committee of the Post Graduate Institute of Medical Education (PGIMER), India and the Human Research Ethics Committee, University of Sydney, Australia.

Study setting

The study was conducted at the Nehru Hospital, PGIMER, one of the three hospitals in Chandigarh, North India. Nehru hospital provides services ranging from primary to specialized care, and serves urban, semi-urban and rural populations from near and far districts of the neighbouring states of Punjab, Haryana, Uttar Pradesh, Himachal Pradesh, Jammu and Kashmir. The Emergency department receives more than 50,000 presentations each year.

Case record selection and study design

All records of injured patients who presented alive at the

Results

During the review period, March 2008–2009 there were 73,645 emergency presentations; of these, 14% (10,075) were classified as medico-legal cases. After several attempts 1% (120) medical records of the 10,075 cases could not be accessed. Of the remaining 9955, we identified 75% (7049) injury cases, and 20% (1407) of these were fall injury cases.

The place of first medical attention was documented in 77% (1084) of fall injury records. First medical attention at the Nehru Hospital was sought by

Discussion

In this review of injury presentations to a large urban hospital in North India, fall-related injuries contributed a substantial burden of injury. Falls were the second leading cause of hospitalization due to an injury, and led to hospitalization of more than 14 days in 21% and death in 10% of all fall related injury presentations. One third of the falls presentations were amongst children, 35% of falls were from building or structure (half of these were amongst children) and the majority of

Conclusion

Falls were the second leading cause for injury related presentations to hospital in this study. The gaps in the present study highlight the need for standardized and complete recording of data for reliable estimation of all cause morbidity and mortality in the population. Efforts need to be made in improving the quality of data available from medical records through training of medical practitioners and other personnel involved in ICD coding and certification.

Replication of this study in other

Financial disclosures

Study had no external funding and was conducted by the research student. RI and LK are supported by National Health and Medical Research Centre (NHMRC), Australia.

Competing interests

We declare that we have no conflicts of interest.

Acknowledgements

We are thankful to Dr Wei Du for his input on use of random sampling for quality assurance.

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