Wednesday, 9 March 2016

Ladder trauma study reveals danger at every rung

A ground-breaking study by SPHPM and Alfred hospital researchers on presentations of ladder fall-related trauma to the Alfred has revealed a rising trend in ladder fall injuries among older men, who are sustaining traumatic head and spinal injuries from ladder falls at home.

The one-of-a-kind study reporting on the incidence, severity and outcomes of severe ladder-related injuries requiring intensive care unit (ICU) management is pioneering as there have been no critical illness-focused studies like this before.

Every year on average, three patients died after falling from ladders, and they have almost exclusively been men over 55 of age who have fallen three metres or less in a domestic setting, according to research by SPHPM that was recently published in Injury journal.

The ICU ladder trauma study examined admissions to The Alfred hospital over a five year period, and found that the number of serious ladder-related injuries has dramatically risen over the study period. .

Dr Helen Ackland, who led the study, said that of 58 patients who were admitted with extremely serious injuries, only 43 per cent were at home and able to care for themselves a year after the accident.

"The survivors are finding it difficult to return to their normal activities," Dr Ackland said.

In the five years from 2007 to 2011, 584 patients were admitted to The Alfred hospital after falling from ladders. A total of 194 cases were classified as major trauma, and 58 were admitted to ICU where 15 cases tragically ended in death. The majority of deaths were as a result of traumatic brain injury.

Researchers said that anecdotal evidence from discussions with ladder fall patients revealed limited awareness of the potential for serious morbidity and mortality, and sub-optimal knowledge of ladder safety precautions in domestic ladder users. In addition, patients who were familiar with occupational health and safety regulations used in the workplace frequently admitted that they relax these regulations at home.

Dr Ackland believes the rise may be linked to the increased size of the ageing baby boomer population and the rise of do-it-yourself building reality television shows. In addition, balance and mobility may be compromised in older patients, and this may be further exacerbated by medications used to treat chronic illness. The study also showed a seasonal trend in incidence, with a third of admissions occurring from November to January.

“Clearly, the rate of ladder fall admissions will increase without a significant emphasis on public education regarding the potential outcomes and subsequent safety strategies,” Dr Ackland said.

In many cases, ladder activity involved roof repairs, gutter maintenance and garden-pruning, and in some cases, the falls were unwitnessed.

“It’s very important to have someone with you to stabilise the base of the ladder, but also to call for help if a fall does occur” Dr Ackland said.

“Whilst the ultimate method of preventing these injuries is to avoid climbing a ladder altogether, this advice may only be practical for a proportion of the population. Therefore, knowledge and use of basic ladder safety precautions is essential in reducing the rate of ladder falls” Dr Ackland said.

The team of researchers behind the study has released a ladder safety guide, urging those over 55 or inexperienced to take extreme care when using a ladder. The researchers have also strongly recommended that ladder users wear a bicycle helmet to mitigate the risk of severe brain injury.

Since the completion of the data collection period, admissions have increased considerably, and in 2015 alone, there were 242 ladder fall admissions to Alfred Health. In the coming months, the team of researchers behind the study will begin a second, larger study to determine the precise causes of ladder falls, and the reasons for the significant increase in admissions, in order to provide essential background information for a concerted public awareness campaign.

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