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Episode 40: Low Energy Falls and Traumatic Brain Injury

When an individual sustains any fall, a brain injury must be considered.

In the past I’ve discussed falls as the leading cause of traumatic brain damage. These falls are most prevalent in the very young and in the elderly population, but unfortunately many individuals who sustained a fall are not properly evaluated or receive treatment for a traumatic brain injury because the fall was considered low impact or low energy
Individuals injured through what are considered low energy transfer events such as falls from ground level while standing or from low heights are given a low priority of sustaining brain trauma by many medical emergency services and hospital triage teams.

A large new study looking at patient data in 56 acute trauma centers across 18 countries and over 21,000 individuals, has challenged these assumptions and concluded that energy transfer may not be a good predicter of intracranial injury or even death. The study is published in the open access PLOS Medicine Journal on September 14th and is entitled, “The Burden of Traumatic Brain Injury from Low-Energy Falls From 18 Countries”.

The population of patients most likely to sustain a TBI because of a low impact fall were the elderly, more likely to be female, and more likely to be taking pre-injury drugs that prevent blood clotting than then the general population. These findings challenge the assumption that energy transfer predicts brain injury severity.

Falls are the leading cause of TBI in individuals over the age of 65. Not only are the elderly more likely to sustain a low-level fall, but age-related changes to the brain and blood vessels increase the likelihood of a significant intracranial injury and decreased recovery.

Most of these individuals never lost consciousness and were found to have a Glasgow Coma Scale of 15, a notoriously inaccurate predictor of brain injury outcome.

The study concluded those who suffered from a low energy fall were as likely as those suffering from a high energy fall to have an abnormal CT scan and equally likely to sustain significant morbidity and mortality. However, the group who sustained a low impact fall was 50 percent less like to receive critical care or emergency intervention.

These important findings emphasize the need to be more vigilant in screening and assessing all fall victims, and especially the elderly for a traumatic brain injury.

And, of course the best cure for any brain injury is prevention.

Audio version

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