CASO CLINICO - Associazione-marco-piazzalunga

CASO CLINICO - Associazione-marco-piazzalunga

Universita degli Studi di Pavia Scuola di specializzazione in Chirurgia Generale Direttore: Prof. Paolo Dionigi U.S.C. Chirurgia 1 Generale e dUrgenza 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 = 2gh 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 age, gender and weight

knowledge level human behaviour and attitudes physical features and health sleep deprivation

work depression fatigue 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 HPG23 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

HPG23 TRAUMA REGISTRY Considered parameters: Demographic characteristics Circumstances of trauma (domestic, work activities, territorial, and other) Height of fall Clinical parameters on the scene and at the ED ISS Distribution of lesions Location of a definitive airway Hospital admission Need of surgery ICU stay and days of mechanical ventilation Hospital lenght of stay 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

MORTALITY % 16,0 14,0 12,0 10,0 8,0 6,0 4,0 2,0 0,0 FALLERS

JUMPERS ALL FFH PTS 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 Plan preventive and clinic actions optimize the health path of these pts THANK YOU

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