Universita degli Studi di Pavia Scuola di specializzazione

Universita’ degli Studi di Pavia Scuola di specializzazione in Chirurgia Generale Direttore: Prof. Paolo Dionigi U. S. C. Chirurgia 1° Generale e d’Urgenza ASST Papa Giovanni XXIII Bergamo Direttore Dott. L. Ansaloni FALL FROM HEIGHT TRAUMA: Revision of “Papa Giovanni XXIII” Bergamo Hospital TRAUMA REGISTRY and comparison between ACCIDENTAL AND INTENTIONAL EVENTS Dott. ssa FRANCESCA RUBERTA’

INTRODUCTION FALLERS JUMPERS

PATTERN OF INJURIES IN FALLERS FROM HEIGHT GENERALITY • Multiple injuries • Complex management

PATTERN OF INJURIES IN FALLERS FROM HEIGHT GENERALITY • Height • Surface of landing • Water • Soil v = √ 2 gh • Position of landing • Vertical » Head-first » Feet-first • Horizontal Height impact velocity MORTALITY

PATTERN OF INJURIES IN FALLERS FROM HEIGHT GENERALITY • Deceleration trauma • internal organ lesions • Direct impact trauma • fractures » Head-first » Feet-first » Horizontal landing

PATTERN OF INJURIES IN FALLERS FROM HEIGHT DISTRIBUTION OF INJURIES Teh et al 399 pts: 57 jumpers and 342 fallers

PATTERN OF INJURIES IN FALLERS FROM HEIGHT DISTRIBUTION OF INJURIES LOWER LIMB TRAUMA • Calcaneus fractures are associated with spine injuries Feet-first landers JUMPERS CHARACTERISTIC

PATTERN OF INJURIES IN FALLERS FROM HEIGHT DISTRIBUTION OF INJURIES • Head and chest trauma are PREDICTIVE FACTORS OF DEATH • Pelvic fractures are associated with haemorrahage » Feet-first landers

SUICIDE BY JUMPING IN EUROPE: • • Middle-aged male Single Unemployed Association with mental diseases IN ITALY: (ISTAT DATA) • Psychical diseases suicide-correlated: • > in women • > in 35 -64 and > 65 range of ages • Physical diseases suicide-correlated: • > in males • Tumors

ACCIDENTAL FALLS • Males and children • Occupational and non-occupational • Elderly daily living activities RISK FACTORS FOR FALLS FROM HEIGHT Ø age, gender and weight Ø knowledge level Ø human behaviour and attitudes Ø physical features and health Ø sleep deprivation Ø work depression Ø fatigue Ø weather and environment

INJURY SEVERITY SCORE (ISS) Susan Baker (1974)

AIM OF THE STUDY – Compare FALLERS AND JUMPERS – Demography – Clinical – pathological parameters – Mortality – Identify risk population for suicide by jumping – Identify particular pattern of injury of fallers from height – Better management – More organised hospital setting

MATHERIALS AND METHODS HPG 23 TRAUMA REGISTRY – 1576 traumatised patients – April 2014 → July 2016 – Accidental and Intentional – Excluded: pts died prior to arrival at the ED – Trauma Team and ATLS principles management

MATHERIALS AND METHODS HPG 23 TRAUMA REGISTRY Considered parameters: Ø Demographic characteristics Ø Circumstances of trauma (domestic, work activities, territorial, and other) Ø Height of fall Ø Clinical parameters on the scene and at the ED Ø ISS Ø Distribution of lesions Ø Location of a definitive airway Ø Hospital admission Ø Need of surgery Ø ICU stay and days of mechanical ventilation Ø Hospital lenght of stay Ø mortality

RESULTS STUDY POPULATION – Suicide by jumping is preferred compared to other methods of auto-inflicted trauma Suicides Accidental traumas Total 40 (95, 2%) 259 (16, 9%) 299 (19, 0%) Other dynamics 2 (4, 8%) 1275 (83, 1%) 1277 (81, 0%) Total 42 (2, 7%) 1534 (97, 3%) 1576 (100%) FFH FALLERS JUMPERS ALL FFH 259 (86, 6%) 40 (13, 4%) 299 (100%) P < 0, 001

RESULTS

RESULTS AGE AND GENDER • Univariate analysis: p <0, 001 – April 2014 → July 2016 – Accidental and Intentional – Excluded: pts died prior to arrival at the ED • Multivariate analysis: – Age p =0, 01 – Gender p =<0, 001 FEMALE SEX AND LOWER AGE (ABOUT 45 YRS OLD) WERE PREDICTIVE INDEPENDENT FACTORS OF RISK OF SUICIDE BY JUMPING

RESULTS

RESULTS DISTRIBUTION OF LESIONS P =0, 258 P =0, 023 P =0, 428 P < 0, 001 P =0, 004

RESULTS

RESULTS HOSPITAL ADMISSION P =0, 091 FALLERS JUMPERS ALL ADMITTED FFH 180 (84, 5%) 33 (15, 5%) 213 (100%)

RESULTS HOSPITAL ADMISSION

RESULTS MORTALITY

DISCUSSION – Population at high risk of suicide = MIDDLE-AGED WOMEN – Psychiatric anamnesis unknown – Domestic setting – Preventive actions – Population at high risk of accidental FFH = • mountain sport people • workers – Preventive actions – No statistically significant difference in HEIGHT OF FALL between F and J

DISCUSSION – No statistically significant difference in cranial trauma between F and J – Feet-first landing is protective? ? – No statistically significant difference in chest trauma between F and J – Horizontal landing – Statistically significant differences in abdomen and extremities trauma between F and J – Feet-first landing

CONCLUSIONS • POPULATION AT RISK FOR JUMPING – WOMEN – ABOUT 45 YRS OLD • MORBIDITY AND MORTALITY HIGHER IN JUMPERS TRAUMA REGISTRY: A TOOL TO RECOGNISE PATIENTS AT RISK FOR SUICIDE ²Plan preventive and clinic actions ²optimize the health path of these pts

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