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