Falls from Ladders: Injury Patterns and Outcomes.

BACKGROUND: Our contemporary understanding of the impact of falls from ladders remains limited. The purpose of this study was to examine the injury patterns and outcomes of falls from ladders. Our hypothesis was that age affects both injury type and outcomes.

METHODS: The NTDB was queried for all patients who fell from a ladder (01/2007-12/2017). Participants were stratified into 4 groups according to age: ≤15, 16-50, 51-65, and > 65 years. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups.

RESULTS: A total of 168,227 patients were included for analysis. Median age was 56 years (IQR: 45-66), 86.1% were male, and median ISS was 9 (IQR: 4-13). Increasing age was associated with a higher risk of severe trauma (ISS > 15: 8.8% vs 13.7% vs 17.5% vs 22.0%, p < 0.001). Head injuries followed a U-shaped distribution with pediatric and elderly patients representing the most vulnerable groups. Overall, fractures were the most common type of injury, in the following order: lower extremity 27.3%, spine 24.9%, rib 23.1%, upper extremity 20.1%, and pelvis 10.3%. The overall ICU admission rate was 21.5%; however, it was significantly higher in the elderly (29.1%). In-hospital mortality was 1.8%. The risk of death progressively increased with age with a mortality rate of 0.3%, 0.9%, 1.5%, and 3.6%, respectively (p < 0.001). Strong predictors of mortality were GCS ≤8 on admission (OR 29.80, 95% CI 26.66-33.31, p < 0.001) and age > 65 years (OR 4.07, 95% CI 3.535-4.692, p < 0.001). Only 50.8% of elderly patients were discharged home without health services, 16.5% were discharged to nursing homes and 15.2% to rehabilitation centers.

CONCLUSION: Falls from ladders are associated with considerable morbidity and mortality, especially in the elderly. Head injuries and fractures are common and often severe. An intensified approach to safe ladder use in the community is warranted.

LEVEL OF EVIDENCE: IV.