Prehospital Factors Associated with Refractory Traumatic Arrest

Objective. Identification of the prehospital factors associated with a poor prognosis of immediate traumatic arrest should help reduce unwarranted treatment. We aim to reveal the clinical factors related to death after traumatic arrest on the scene. Methods. We performed a multicenter (4 tertiary hospitals in urban areas of South Korea) retrospective study on consecutive adult patients with trauma arrest on scene who were transferred by fire ambulance from January 2016 to December 2018. Patients with death on arrival in the emergency room (ER) were excluded. Prehospital data were collected from first aid records, and information on each patient’s survival outcome in the ER was collected from an electronic database. Patients were divided into ER death and ER survival groups, and variables associated with prehospital trauma were compared. Results. A total of 145 (84.3%) and 27 (15.7%) patients were enrolled in the ER death and survival groups, respectively. Logistic regression analysis revealed that asystole (OR 4.033, 95% CI 1.342–12.115, p = 0.013) was related to ER death and that ROSC in the prehospital phase (OR 0.100, 95% CI 0.012–0.839, p = 0.034) was inversely related to ER death. In subgroup analysis of those who suffered fall injuries, greater height of fall was associated with ER death (15.0 (5.5–25.0) vs. 4.0 (2.0–7.5) meters, p = 0.001); the optimal height cutoff for prediction of ER death was 10 meters, with 66.1% sensitivity and 100% specificity. Conclusions. In cases of traumatic arrest, asystole, no prehospital ROSC, and falls from a greater height were associated with trauma death in the ER. Termination of resuscitation in traumatic arrest cases should be done on the basis of comprehensive clinical factors.

Factors Associated With Severity of Falls In Adult Hospital Patients: A Retrospective Audit

Background: Injurious falls in hospital patients are threat to patient safety which can result in a financial burden on the patient’s family and health care services. Both patient specific and environmental and organisational factors are associated with injurious hospital falls. It is important to continuously analyse the factors associated with the severity of falls which can inform the implementation of any fall preventive strategies. This study aims to identify risk factors associated with the severity of falls in hospitalised adult patients in Western Australia.Methods: This study involved a retrospective analysis of hospital inpatient falls records extracted from the hospital’s Clinical Incident Database. Falls clinical incidents were reviewed and analysed from May 2014 to April 2019.Results: There were 3705 complete reported cases of falls with the average age of the patients was 68.5±17.0 years, with 40.2% identified as female. Gender, activity at time of fall and height of fall were associated with the level of severity of the fall. The risk of falling at a higher level of severity increased by approximately 20% (65-74 years), 29% (75-84 years) and 39% (>84 years) respectively compared with patients age <50 years. Females were 15.1% more likely to fall at higher severity condition compared to males (AOR = 1.151, 95% CI: 1.063, 1.247, p < 0.001). Toileting and showering activities were 14.5% more likely to cause falling in higher level of severity (AOR = 1.145, 95% CI: 1.022, 1.284, p = 0.020) compared with attempting to sit or stand. A fall in a communal area was approximately 26% more likely to resulted in higher level of severity (AOR = 1.257, 95% CI: 1.003, 1.576, p = 0.047).Conclusions: Identification of underlying risk factors associated with the severity of falls provides information which can inform the implementation of fall prevention strategies that mitigate the risk of injurious falls.

Falls from Height. Analysis of Predictors of Death in a Single-Center Retrospective Study

Falls from height (FFH) represent a distinct form of blunt trauma in urban areas. This study aimed to identify independent predictors of in-hospital mortality after accidental or intentional falls in different age groups. We conducted a retrospective study of all patients consecutively admitted after a fall in eight years, recording mechanism, intentionality, height of fall, age, site, classification of injuries, and outcome. We built multivariate regression models to identify independent predictors of mortality. A total of 948 patients with 82 deaths were observed. Among the accidental falls, mortality was 5.2%, whereas intentional jumpers showed a mortality of 20.4%. The death rate was higher for increasing heights, age >65, suicidal attempts, and injuries with AIS ≥3 (Abbreviated Injury Scale). Older patients reported a higher in-hospital mortality rate. Multivariate analysis identified height of fall, dynamic and severe head and chest injuries as independent predictors of mortality in the young adults’ group (18–65 years). For patients aged more than 65 years, the only risk factor independently related to death was severe head injuries. Our data demonstrate that in people older than 65, the height of fall may not represent a predictor of death.

Paediatric injuries due to falls from windows and balconies: an 8-year prospective and retrospective review

Background Unintentional falls from windows and balconies pose a serious health risk to children. Limited Canadian data describing such falls currently exist. This study aimed to describe the frequency, demographic characteristics, injury patterns, and risk factors associated with paediatric falls from windows and balconies. Methods This study employed both prospective data collection and retrospective medical record review. Prospectively, consenting families were enrolled from February 2015 to February 2017; retrospectively, charts from January 2009 to December 2014 were reviewed. Children 0 to 16 years of age, who presented to the Stollery Children’s Hospital (Edmonton, Alberta) emergency department due to a fall from a window or balcony, were included. Results A total of 102 children were included; thirty were enrolled prospectively and 72 retrospectively. Median age was 4.5 years (interquartile range 2.83 to 6.83) with 63.7% (65 of 102) males. About 87.2% (89 of 102) of falls were from windows and 12.8% (13 of 102) from balconies. The median estimated height of fall was 4.1 m (interquartile range 3.04 to 4.73). About 58.4% (59 of 101) had at least one major injury (i.e., concussion, fractured skull, internal injury, fractured limb, severe laceration), 36.6% had minor injuries only (i.e., abrasions, contusions, sprains), and 5.0% had no documented injuries. There were no fatalities. About 30.4% (31 of 102) were admitted, with 48.4% of these children (15 of 31) requiring surgery. Conclusion Most falls from windows and balconies occurred in children under the age of 5 years and were associated with serious morbidity, high admission rates, and need for surgery. Child supervision as well as installation of key safety features in windows may help minimize paediatric fall-related injuries.

Effect of Height of Fall on Mortality in Patients with Fall Accidents: A Retrospective Cross-Sectional Study

Background: Accidental falls are a common cause of injury and deaths. Both ground-level falls (GLF) and non-GLF may lead to significant morbidity or mortality. This study aimed to explore the relationship between height of falls and mortality. Method: This is a retrospective study based on the data from a registered trauma database and included 8699 adult patients who were hospitalized between 1 January 2009 and 31 December 2017 for the treatment of fall-related injuries. Study subjects were divided into three groups of two categories based on the height of fall: GLF (group I: < 1 m) and non-GLF (group II: 1–6 m and group III: > 6 m). The primary outcome was in-hospital mortality. The adjusted odds ratio (AOR) of mortality adjusted for age, sex, and comorbidities with or without an injury severity score (ISS) was calculated using multiple logistic regression. Results: Among the 7001 patients in group I, 1588 in group II, and 110 in group III, patients in the GLF group were older, predominantly female, had less intentional injuries, and had more pre-existing comorbidities than those in the non-GLF group. The patients in the non-GLF group had a significantly lower Glasgow Coma Scale (GCS), a higher injury severity score (ISS), worse physiological responses, and required more procedures performed in the emergency department. The mortality rate for the patients in group I, II, and III were 2.5%, 3.5%, and 5.5%, respectively. After adjustment by age, sex, and comorbidities, group II and group III patients had significantly higher adjusted odds of mortality than group I patients (AOR 2.2, 95% CI 1.64–2.89, p < 0.001 and AOR 2.5, 95% CI 1.84–3.38, p < 0.001, respectively). With additional adjustment by ISS, group II did not have significantly higher adjusted odds of mortality than group I patients (AOR 1.4, 95% CI 0.95–2.22, p = 0.082), but group III patients still had significantly higher adjusted odds of mortality than group I patients (AOR 10.0, 95% CI 2.22–33.33, p = 0.002). Conclusion: This study suggested that patients who sustained GLF and non-GLF were distinct groups of patients, and the height of fall did have an impact on mortality in patients of fall accidents. A significantly higher adjusted odds of mortality was found in the GLF group than in the non-GLF group after adjusting for age, sex, and comorbidities.

Epidemiological and Clinical Characteristics of Fall-related Injuries: A Retrospective Study

BACKGROUND: Fall-related injuries are important public health problem worldwide. We aimed to describe the epidemiological and clinical characteristics of fall-related injuries in a level 1 trauma center. METHOD: A retrospective analysis of Qatar Trauma Registry data was conducted on patients admitted for fall-related injuries between 2010 and 2017. Comparative analyses of data by gender, age-groups and height of falls were performed to describe the epidemiological and clinical characteristics of patients, and in-hospital outcomes. RESULTS: A total of 4040 patients with fall-related injuries were identified in the study duration which corresponds to the rate of 2.34 per 10,000 population in Qatar. Although the rate of fall injuries decreased over the years, the average number of patients per year still accounts for 32% of the moderate and severe injuries requiring admission. Most of the injuries were to the head (36%) followed by spines (29%) and chest (23%). Males were predominant (89%), more likely to fall at workplace, fall from a greater height and experience polytrauma than females. Working age-group (20-59 years) were the major victims (73%), more likely to fall at work place, fall from height comparing to older adults who tend to fall at home, fall from the same level. Overall in-hospital mortality was 3%. Outcomes including longer length of hospital stay and mortality were generally associated with the height of falls.CONCLUSION: Fall-related injuries remain as a significant burden in trauma center. Variations in pattern of injuries by age, gender and height of fall provide important information for targeted preventive measures

ASSESSMENT OF STABILITY OF MINING DEPARTMENTS UNDER IMPACT LOADS

Purpose of work. The purpose of the research is to determine the conditions for ensuring the stability of mine workings in the coal massif under the action of shock loads. Methods. To achieve this goal, analytical studies were performed using the basic provisions of classical mechanics and the theory of elasticity. In laboratory studies, experimental samples of crushed rock were used, which were placed in a steel cylinder. Results. In the course of experimental research, the influence of the impact force and the impact pulse of the falling load on the response of the plane on a pliable basis with inhomogeneous, piece-sized, fragmented rock was studied. It is recorded that at a constant amount of energy of a single impact (mgH = 14.7 J), when the height of the fall of the load decreases 3 times (from H = 1.5 m to H = 0.5 m), and the mass increases from m = 1.0 kg to m = 3.0 kg, the magnitude of the impact force is reduced by 50%. With an increase in the amount of energy of a single impact (from mgH = 4.9 J to mgH = 44.1 J) at the same height of fall, when the mass of the load increases threefold, there is an increase of 2.5 times the impact force. At a constant amount of energy of a single impact (mgH = const), the displacement of the plane on a pliable base of crushed rock depends on the magnitude of the impact pulse of the falling load. Novelty. It is proved that when there is collapse of lateral rocks in the coal massif containing the production, the force of impact on the surface is proportional to the time of fall of the rock blocks to the time of their impact interaction with the plane. Practical significance. In deep coal mines, as a result of mining and the probability of shock loads from landslides, to ensure the stability of mine workings in excavation sites, it is advisable to use pliable supports or filling the produced space with crushed rock, which will ensure the integrity of lateral rocks.

Automatic Body Fall Detection System for Elderly People using Accelerometer and Vision Based Technique

Body Falls in older adults are the significant cause of injury. Falls incorporate dropping from a standing position or from uncovered positions, for example, those on stepping stools or stepladders. The seriousness of damage is commonly identified with the height of fall often leading to disability or death. In this research generally we uses wearable sensor and vision based technique that is automatically detect body fall as early as possible. Accelerometer is used for measuring or maintaining orientation and angular velocity. In vision based procedure first we procure casings or video arrangements from the camera. The division module separates the body outline from the foundation. For Feature Extraction we used GLCM method. SVM method is used for classification. By using those methods we can surely detect the human body fall and can take the preventive measures.

Epidemiological and Clinical Characteristics of Fall-related Injuries: A Retrospective Study

BACKGROUND Fall-related injuries are important public health problem worldwide. We aimed to describe the epidemiological and clinical characteristics of fall-related injuries in a level 1 trauma center.METHOD A retrospective analysis of Qatar Trauma Registry data was conducted on patients admitted for fall-related injuries between 2010 and 2017. Comparative analyses of data by gender, age-groups and height of falls were performed to describe the epidemiological and clinical characteristics of patients, and in-hospital outcomes.RESULTS A total of 4040 patients with fall-related injuries were identified in the study duration which corresponds to the rate of 2.41 per 10,000 population in Qatar. The rate of fall injuries decreased over the years by 39%. The mean age of patients was 32.9±18.26 years. Males were predominant (89%), more likely to fall at workplace, fall from a greater height and experience polytrauma than females (p=0.001). Working age-group (20-59 years) were the major victims (73%). Most of the injuries were to the head (36%) followed by spines (29%) and chest (23%). Overall in-hospital mortality was 3%CONCLUSION Fall-related injuries remain as a significant burden in trauma center. Variations in pattern of injuries by age, gender and height of fall provide important information for targeted preventive measures.

Behavior of BFRP bars subjected to dynamic impact loads

Fiber Reinforced Polymer (FRP) bars are deemed to be one of the best solutions to the corrosion dilemma associated with steel reinforcement. This paper presents an experimental study on the behavior of Basalt FRP bars subjected to impact loading. Dynamic tests were conducted on eighteen BFRP bars of 17 mm and 20 mm diameters (B17 and B20) using the drop hammer test procedure. Different loading rates were achieved through varying the weight of mass and height of fall. The paper evaluated the maximum stresses attained by the BFRP bars at various loading rates. As the loading rate increased, the B20 bars reported a higher strength value. However, the B17 bars showed a drop in the strength with the increase of the loading rate, which requires further investigation. The crushing was observed to be most prominent in the top part of the bars where the bars exhibited a conical shape after failure.