Ladder-related injuries are a significant

Transcription

1 FALLS Falls from ladders i Australia: comparig occupatioal ad o-occupatioal ijuries across age groups Kirste Vallmuur, Rob Eley, 2,3 Agela Watso Ladder-related ijuries are a sigificat ad icreasig cause of emergecy departmet presetatios ad hospitalisatios i Australia. There have bee few studies to examie the treds, ijury patters ad severity of ladderrelated hospitalisatios for youger ad older adults or comparig occupatioal ad o-occupatioal icidets i Australia. The few Australia studies examiig the magitude ad patter of ladder-related falls usig retrospectively collected hospital data showed older males were the most at risk ad a risig rate of hospitalisatios from ladder-related falls over time. 2-4 Ket ad Pearce i South Australia examied falls from height ad foud that falls at home resulted i loger stays i hospital tha work falls, ad ladders were implicated i more tha half the deaths. 3 The Natioal Ijury Surveillace Uit reports that the mai hospitalised ijuries sustaied from ladder-related falls are ijuries to the extremities (elbows/forearm 9%, kee/lower leg 6%) ad ijuries to the head (2%) ad thorax (2%), though ijuries to the thorax were more commo i males tha females (3% males compared to 8% females), ad two-thirds of the ijuries were fractures. Studies which coducted patiet iterviews to collect more detailed iformatio about the circumstaces leadig to the fall have foud that reachig excessive distaces or icorrect ladder placemet were the most commo cotributory factors 5 ad that males most commoly fell from straight tiltig ladders durig outdoor maiteace activities. 6 A review of medical records of Abstract Objective: To examie atioal ladder-related fall ijury patters ad treds, ad compare the chages over time i occupatioal ad o-occupatioal falls across age groups. Methods: Aalysis of atioal hospital morbidity data to examie treds over time ad differeces betwee groups. Results: There were 4,92 hospitalised falls from ladders i Australia over the te year period from July 22 to Jue 22, risig from 3,374 hospitalisatios i 22/3 to 4,945 hospitalisatios i 2/2. The age stadardised rate of ladder-related fall hospitalisatios rose sigificatly for males, ad a higher icrease was evidet i people aged over 6 years. Occupatioal falls accouted for 2% of hospitalisatios, ad the hospitalisatio rate for both occupatioal ad o-occupatioal falls icreased sigificatly over the te year period. Coclusios: With almost 5, hospital admissios per year i recet years ad a sigificat rise i the rate of hospitalisatios over the past decade, this paper highlights the importace of focusig ijury prevetio efforts to reduce the growig umber of ladder-related falls. Implicatios: This study demostrates the sigificat burde that ladder-related falls are cotiuig to have o the commuity, both i the occupatioal ad domestic settig. Key words: ijury surveillace, ijury prevetio, ladder-related falls, hospitalisatios patiets who were hospitalised due to ijuries related to falls from ladders i Australia foud that almost 8% occurred i ooccupatioal settigs, ad early half were related to the istability of the ladder fallig sideways or tiltig iwards or outwards. 7 Face-to-face iterviews with patiets i New Zealad revealed that prior to fallig the perso was statioary o the ladder i two-thirds of the falls (i.e. ot ascedig or descedig), suggestig overreachig/ ladder placemet issues/ladder istability cotributed to the fall rather tha missteppig/slippig o rugs. 8 Tsipouras et al s study foud that just over half the medical records had the activity at the time of ijury recorded, with home maiteace beig the activity described for 5% ad gardeig for 9% of patiets. 7 There have bee o recet studies to examie ladder-related ijury hospitalisatio patters i Australia with the most recet reports citig hospitalisatios i Give the risig tred that was idicated i these data, alog with the more substatial rate rise reported for those aged over 6 years, 9- ad the growth i Do-It-Yourself (DIY) home reovatig shows i recet years, there is a eed to update the estimates of the extet ad patters of ladder-related ijury. This study examies atioal ladder-related ijury patters ad treds over time, ad compares the. Cetre for Accidet Research ad Road Safety - Queeslad, Queeslad Uiversity of Techology 2. School of Medicie, The Uiversity of Queeslad 3. Emergecy Departmet, Pricess Alexadra Hospital, Queeslad Correspodece to: Associate Professor Kirste Vallmuur, Cetre for Accidet Research ad Road Safety Queeslad, School of Psychology ad Cousellig, Faculty of Health, Queeslad Uiversity of Techology, Kelvi Grove, Qld 459; k.mckezie@qut.edu.au Submitted: Jauary 26; Revisio requested: April 26; Accepted: Jue 26 The authors have stated they have o coflict of iterest. Aust NZ J Public Health. 26; 4:559-63; doi:./ vol. 4 o. 6 Australia ad New Zealad Joural of Public Health Public Health Associatio of Australia

2 Vallmuur, Eley ad Watso Article chages over time i occupatioal ad ooccupatioal falls across age groups. Methods Data were obtaied from the Natioal Hospital Morbidity Database from the Australia Istitute of Health ad Welfare (AIHW) from July 22 to Jue 22. The hospital database provides electroic deidetified separatio data for all patiets admitted to public or private hospitals throughout Australia. Upo discharge from hospital, patiets diagoses ad procedures as recorded i the medical records are coded by traied cliical coders, ad these coded data are compiled, cleaed ad audited by State ad Territory Health departmets, ad these data are provided by the State ad Territory Health departmets to the AIHW o a aual basis for compilatio ito the atioal database. Data was provided to describe the patiet s age, sex, locatio, legth of stay, discharge status, all diagoses ad procedures, exteral causes of ijury, place of occurrece ad activity at the time of ijury. Cases of ladder-related falls were idetified as those cases with a ICD-- AM ijury code i the rage S-T89 AND a pricipal exteral cause code of W Fall o or from ladder. To accout for multiple episodes of care for a patiet (such as trasfers to other facilities or statistical episode chages withi their hospitalisatio), cases with a admissio mode of trasfer were removed from aalysis. Cases were assiged as beig either occupatioal or o-occupatioal icidets. Occupatioal icidets had either a activity code of U73. Activity, While workig for a icome or a Fudig Source of Worker s compesatio idicated to cover the hospital admissio costs. Cases were classified as ooccupatioal icidets if they had a differet fudig source or differet activity specified. Cases were assiged a ICD-based Ijury Severity Score (ICISS) based o their ijury diagoses usig the Diagosis-based Ijury Severity Scalig method, as described by Stepheso et al. 23, 2 which represets a estimate of the probability of death from (o chace of survival) to (% chace of survival) based o ijury diagoses. Multiple diagoses are used to provide a estimate of survival ad ICISS scores equal to or less tha.94 were coded as serious with all other values coded as o-serious. This criterio was based o New Zealad ijury idicator work that categorised serious ijuries as those where the patiet had a probability of death of 5.9% or more (i.e. probability of survivig beig 94.% or less). 3 Body regio ad ature of ijury diagostic codes were categorised usig a similar approach to that used i the ICD- ijury mortality data matrix to eable better depictio of the most prevalet clusters of ijury types by body regios. 4 Deomiators for rate calculatios were the Australia Bureau of Statistics midyear age-specific ad sex-specific estimated populatios, ad age-stadardised rates were calculated usig the direct stadardisatio method usig the Australia Bureau of Statistics Australia populatio estimates for 2 as the stadard. Statistical aalysis was coducted usig IBM Statistics for Widows, Versio 22. Treds over time ad by age were determied usig Poisso models for aual percetage chage. These chages were aalysed separately for males, females, ad all persos. Separate models were also produced for those aged uder 6 ad over 6 as well as for occupatioal ad o-occupatioal falls. Differeces betwee age groups i ICISS ad legth of stay were aalysed usig Aalysis of Variace (ANOVA). This research study was approved by the Uiversity Huma Research Ethics Committee (Approval umber 3849). Results Sex ad age differeces There were 4,92 hospitalised falls from ladders i Australia over the years from July 22 to Jue 22, risig from 3,374 hospitalisatios i 22/3 to 4,945 i 2/2. Males had the highest age stadardised rate risig from 28.3 per, populatio (95% CI ) i 22/3 to 33.8 per, (95% CI ) i 2/2; Females age stadardised rate was 7.9 per, (95% CI ) i 2/2, oly risig slightly from 6.2 per, (95% CI ) i 22/3. The age stadardised rate sigificatly icreased by 3.6% aually for all persos (p<); by 4.5% aually (p<) for males (p<), ad by 3.4% aually for females (p<). The age stadardised rate icreased by 2.% aually for those aged uder 6 (p<) ad by 6.% for those aged over 6 (p<), but the aual icrease was greater for those aged over 6 years (p<). The age specific rate (usig the average icidece rate across the -year period for both males ad females) rose by 87% across age groups (p<], with a peak of 78.8 per, for males aged over 6 years, ad a peak of 8.9 per, for females aged over 6. Figure shows the fiacial year breakdow of hospitalisatio rates for males, females ad persos ad Figure 2 shows the age specific rates for males, females ad persos (Figure ad 2). Occupatioal vs o-occupatioal falls Occupatioal falls accouted for less tha 2% of the hospitalisatios, with 7,547 hospitalisatios over the years compared to 33,545 i the o-occupatioal falls category (Figure 3). There was a statistically sigificat icrease i the umber of hospitalisatios for o-occupatioal Figure : Age-stadardised ladder-related fall hospitalisatio rate for Australia males ad females July 22 Jue 22. Figure 2: Age specific ladder-related fall hospitalisatio rate for Australia males ad females July 22 Jue 22. Rate per, populatio Females Males All persos Rate per, populatio Females Males All persos 56 Australia ad New Zealad Joural of Public Health 26 vol. 4 o Public Health Associatio of Australia

3 Falls Falls from ladders i Australia (4.% aually, p<) ad occupatioal falls (2.4% aually, p<) from ladders (o-occupatioal falls from ladders had a steeper rate rise over the time period tha occupatioal falls from ladders (p<). Almost 9% (=6,679) of the occupatioal falls occurred i patiets uder the age of 6, while o-occupatioal falls were equally divided across uder 6 year olds (=6,824) ad over 6 year olds (=6,82) (Table ). Fractures accouted for early three-quarters of ijuries i both occupatioal ad ooccupatioal icidets, with ijuries to the upper extremity accoutig for more tha 3% of ijuries, ad just over a quarter of ijuries accouted for by ijuries to the lower extremities (Table 2). Severity of ijury ad legth of stay Almost 22% of ladder-related falls cases were categorised as serious (with a ICISS <.94) ad 4% of cases had a legth of stay greater tha oe week i hospital. Differeces i the severity (usig ICISS score ad legth of stay) for occupatioal ad o-occupatioal icidets i each age group (uder 6 years ad over 6 years) were examied. There were statistically sigificat differeces betwee these groups for both ICISS score [F(3, 49) = , p<] ad legth of stay [F(3, 49) = , p<]. Specifically, occupatioal ladder-related falls i both age groups had more a serious ICISS tha o-occupatioal ladder-related falls, ad ladder-related falls i older patiets resulted i a more serious ICISS tha ladderrelated falls i youger patiets (p<) (Table 3). I additio, ladder-related falls i Table : Characteristics of hospitalisatios for occupatioal ad o-occupatioal ladder-related falls July 22 Jue 22 across Australia. No-occupatioal icidet Occupatioal icidet % % N % Age group -4 years 5-29 years 3-44 years years Sex Male Female 874,83 4,472,295 6,82 26,342 7, older people resulted i the logest legth of stay regardless of whether the fall occurred i a occupatioal or o-occupatioal settig (mea LOS 5 days (SD about 6 days) ad o sigificat differece betwee settigs), compared to those aged uder 6 years (p<). Furthermore, i the uder 6 year olds, occupatioal ladder-related falls results i a slightly loger legth of stay 3,526 2,288 2, , ,69 6,76 3,57 7,689 33,394 7,698 TOTAL 33,545 7,547 4,92 Figure 3: Number of hospitalisatios for occupatioal ad o-occupatioal ladder-related falls July 22 Jue 22 across Australia. Number of hospitalisatios No-occupatioal fall Occupatioal fall tha o-occupatioal ladder-related falls (p<). There were 226 patiets who died as a result of the ladder-related fall, with 86 (82.3%) aged over 6 years. While exact cause of death caot be ascertaied from hospitalisatio data, 7% of those who died were hospitalised with a pricipal diagosis of a head ijury. Table 2: Types of ijury hospitalisatios for occupatioal ad o-occupatioal ladder-related falls July 22 Jue 22 across Australia. Nature of ijury Icidet type ad ijury Fracture Iteral orga failure Ope woud Superficial cotusio Other ad uspecified body regio % % % % % % No-occupatioal icidet Head ad eck Spie ad upper back Torso Upper extremities Lower extremities Other ad uspecified Occupatioal icidet Head ad eck Spie ad upper back Torso Upper extremities Lower extremities Other ad uspecified 663 2,539 3,337 7,756 7,653 2, ,979,659 4, , , , , ,255,646,94 7 5, , ,538 2,82 6,3,64, , ,748 2, , vol. 4 o. 6 Australia ad New Zealad Joural of Public Health Public Health Associatio of Australia

4 Vallmuur, Eley ad Watso Article Place of occurrece The place i which ladder-related falls occurs was ot available (i.e. coded as other or uspecified place) for almost half of the populatio (=9,64). For the remaider where the place of occurrece was specified, o-occupatioal falls largely occurred at home (for over 96% of cases i both age groups), while occupatioal falls occurred predomiatly i idustrial/costructio areas ad trade ad service areas. The third most commo place of occurrece for occupatioal icidets was a home, with 9% of cases aged uder 6 coded ad 24% of cases aged over 6 occurrig at a home (Note: the category Home icludes people other tha the patiets homes (i.e. where they may be performig services/repairs/maiteace), ad icludes established homes oly, as homes ot yet occupied which are uder costructio are coded uder the Idustrial/ Costructio category). Discussio With almost 5, hospital admissios per year i recet years ad a sigificat rise i the rate of hospitalisatios over the past decade, this paper highlights the importace of focusig ijury prevetio efforts to reduce the growig umber of ladder-related falls. Particular attetio is eeded to prevetio of ladder-related falls i the over-6s, give the steeper rise, higher severity ad loger legth of stay i this age group. While occupatioal ladder-related falls were less frequet tha o-occupatioal falls (ad rose at a lower rate over time compared to o-occupatioal falls), occupatioal ladder-related falls geerally resulted i more severe ijuries tha o-occupatioal falls, highlightig the eed for cotiued vigilace of workplace health ad safety practices i this area. Caveats ad limitatios There may have bee some chages to maagemet of older patiets over time which could affect the proportio of cases admitted to hospital. There has bee a icreasig recogitio of the likelihood of back ijuries i older patiets as a result of ladder-related falls potetially resultig i more patiets admitted for further testig, as well as icreased access to imagig equipmet i hospitals. Furthermore, there has bee a rise i the use of short-stay uits i recet times. Patiets i short-stay uits Table 3: Severity of ijury ad legth of stay by activity ad age group for ladder-related fall hospitalisatios July 22 Jue 22 across Australia. < 6 years 6+ years No-occupatioal fall may oly stay for hours, however, will be classified i reportig systems as admitted patiets. However, there were o chages over the -year period i the proportio of serious ijuries (usig ICISS) i older patiets or the average legth of stay of older patiets, suggestig that while there may be a higher proportio of older patiets admitted to hospital the patiets beig admitted i recet years are sufferig ijuries of similar severity to those admitted i earlier years. Secodly, the documetatio of activity ad place of occurrece is poor i medical records, ad hece the umber of cases classified as occurrig durig occupatioal activities is likely to be a uderestimate of ukow magitude, ad the umber of cases occurrig i particular locatios is also likely to be skewed i a uquatifiable way. A previous ladder-related falls ijury report Occupatioal fall No-occupatioal fall Occupatioal fall Frequecy 6,724 6,679 6, Number (%) of cases deceased 26 (.5)% 4 (.2)% 76 (.)% (.2)% ICISS Number (%) of cases with serious ICISS Mea 95% CI 2,466 (4.7%) ,66 (6.%) ,986 (29.6%) (34.2%) Legth of stay Number (%) of cases with LOS > week,497 (8.9%) 65 (9.7%) 3,598 (2.4%) 74 (2%) Mea (SD) 3.35 (4.22) (4.59) 5.7 (6.8) (6.35) 95% CI a: ICISS Score <.94 (2) Table 4: Place of occurrece of hospitalised ladder-related falls by occupatioal status ad age groups July 22 Jue 22. < 6 years 6+ years No-occupatioal fall Occupatioal fall No-occupatioal fall Occupatioal fall showed that place of occurrece was ot specified (coded as other or u i 48% of cases ad activity at the time of ijury was uspecified i 45% of cases, limitig the reliability of both of these data items. Other limitatio of ICD coded data derived from the Natioal Hospital Morbidity Database is the lack of iformatio available regardig the height of the fall from ladders ad the type of ladder as this iformatio is ot captured as part of ICD coded ladder falls. Iformatio regardig the height of the fall would be valuable to uderstad the severity of ladder falls uder differet circumstaces ad iformatio about the type of ladder would assist i developig product safety strategies. Furthermore, legth of stay estimates are uderestimates of the patiet s total period of treatmet as all statistical episode chages ad hospital trasfers were deleted to Home 7, , Residetial istitutio School/public admi area Sports ad athletic area Street ad highway Trade ad service area Idustrial/costructio area 62.8, Farm Missig (other or uspecified place) 9,29 54.% 3, % 6, % % 562 Australia ad New Zealad Joural of Public Health 26 vol. 4 o Public Health Associatio of Australia

5 Falls Falls from ladders i Australia avoid double coutig. For a more accurate estimate of legth of stay perso-liked data would be eeded which is t curretly available at a atioal level. Implicatios A report by Oxley et al. (24) highlights key target areas to reduce ladder-related falls, icludig: improvemet of ladder desig ad icorporatio of safer desigs i stadards ad regulatios; improved buildig desig to accommodate ladder use; improved surfaces for restig ladders o; promotio of the importace of protective equipmet; public awareess campaigs to highlight the risks of ladders; advocatig for alteratives to usig ladders ad provisio of services to assist elderly members of the commuity; cotiued research ad collaboratio across the sector; ad improved data systems for recordig more comprehesive iformatio about ijury circumstaces. This study is the first to update atioal estimates of ladder-related falls i Australia sice the 24-5 report, ad demostrates the sigificat burde that ladder-related falls are cotiuig to have o the commuity, both i the occupatioal ad domestic settig. Ijury prevetio efforts i this area should cotiue to be supported, ad cotiued surveillace of the treds i ladder-related ijuries over time is eeded to evaluate the efficacy of these efforts ad ultimately reduce the burde. Refereces. Bradley C. Ladder-related Fall Ijuries. Natioal Ijury Surveillace Uit Briefig No.:. Catalogue No.: INJCAT 5. Caberra (AUST): Australia Istitute for Health ad Welfare; Bedi H, Goldbloom D. A review of ooccupatioal ladder-related ijuries i victoria: As easy as fallig off a ladder. J Traum. 28;64: Ket A, Pearce A. Review of morbidity ad mortality associated with falls from heights amog patiets presetig to a major trauma cetre. Emerg Med Austrasia. 26;8: Mitra B, Camero P, Gabbe B. Ladders revisited. Med J alia. 27;86: Partridge R, Virk A, Atosia R. Causes ad Patters of Ijury from Ladder Falls. Acad Emergcie. 998;5: Faergema C, Larse L. The mechaism ad severity of ooccupatioal ladder fall ijuries. J Safesearch. 2;32: Tsipouras S, Hedrie J, Silvapulle M. Ladders: accidets waitig to happe. Medstralia. 2;74(): Kool B, Ameratuga S, Hazell W, Ng A. Uitetioal falls at home amog youg ad middle-aged New Zealaders resultig i hospital admissio or death: Cotext ad characteristics. N Z Med J. 2;23(36) (36). 9. Oxley J, Ozae-Smith J, O Her S, Kitchig F. Report o the Reductio of Major Trauma ad Ijury from Ladder Falls. Melboure (AUST): Moash Uiversity Ijury IstituteIstitute;, 24.. Cassell E, Clapperto A. Cosumer Product-related Ijury: Ijury Related to the Use ofadders.. Melbou Australia: Moash Uiversity Accidet Research Cetre Victoria Ijury Surveilch Cetre,; 26.. Miu J, Dih M, Curtis K, Balogh Z. Ladder-related ijuries i New Southes Jourf Australia. 26;24(8): Stepheso S, Heley G, Harriso J, Lagley J. Diagosis-based Ijury Severity Scalig. aloguen: Adelaide (AUST): Australia Istitute for Health elfarew 23 AIHW. 3. Cryer C, Lagley J. Developig valid idicators of ijury icidece for all ijurry Prevetio. 26;2: Figerhut LA, Warer M. The ICD- ijury mortality diagosis maury Prevetio. 26;2: vol. 4 o. 6 Australia ad New Zealad Joural of Public Health Public Health Associatio of Australia