Major Traumatic Illnesses with Insignificant Mechanisms

When a patient enters the emergency room, they are triaged. This means that someone quickly assesses the mechanism of injury and the obvious injuries and decides where to put the patient in the emergency room and how fast they get seen. The idea behind this is that those with minor mechanisms of injury should have minor degrees of trauma that can wait until seen by the doctor.

The researchers in this study challenged the hypothesis, saying that people with minor mechanisms of injury could have a severe trauma. They evaluated patients seen over a nine month period of time at a level I trauma center. The patients studied were those who had sustained a ground level fall or a low level fall from less than ten feet. Patients found down with no evidence of trauma were evaluated.

A total of 301 patients were included in the study. One hundred ten patients had a ground level fall, 95 patients had a fall from less than 10 feet and 96 percent were found down with no obvious degree of injury. The main outcomes they measured were significant injury, such as a visceral injury, a long bone fracture, a pelvic fracture, spinal fractures, facial fractures or intracranial injuries.

A total of 37 percent of patients had significant injuries. Seven percent were admitted to the intensive care unit, 5 percent required some type of surgical intervention and 4 patients (1 percent) died. The most common injuries to the body were intracranial injuries and skeletal injuries. Almost all patients (95 percent) received a CT scan. About ¼ of patients had abnormal CT findings. Age greater than age 55 and being intoxicated by alcohol contributed to the seriousness of the injuries. The probability of patients having a serious injury was 73 percent and even when there were no risk factors, the risk of serious injury was 16 percent.

Those with serious injuries stayed in the hospital longer, had more surgeries and had higher costs of hospitalization when compared to those that didn’t have significant injuries. The researchers felt that doctors should recognize that even low level trauma mechanisms can yield significant injuries in the patient, especial those who are older or are intoxicated at the time of injury. The fact that 4 people died following “minor” trauma is significant and points out the need for careful triage of patients that are found down or that are older and more susceptible to severe trauma.

Emergency rooms have only so many resources and must see the most severe patients first, letting those who have less severe injuries wait to be seen when the emergencies are taken care of. Now it appears that it isn’t completely clear who has the serious injury and who doesn’t. This should change emergency room staffing so that doctors get to see all patients in a timely fashion. More patients with suspected injuries should receive CT scans of the head, facial bones and possibly the pelvic area because these are areas that are difficult to assess using a plain film x-ray.