A survey of injuries sustained in falls from ladders among patients at an inner-city trauma centre

To the Editor: Recent media reports related to Ian “Molly” Meldrum1 are a timely reminder, once again, of the risk of physical injury posed by a fall from a ladder. We carried out a survey of injuries sustained in falls from ladders among patients presenting to the Royal Prince Alfred Hospital (RPAH), an inner-Sydney major trauma centre, between January 2009 and December 2011. We linked data from the hospital trauma registry with data from the New South Wales Department of Health Centre for Epidemiology and Research. The trauma registry routinely collects data on all injury-related admissions and trauma team activations. NSW Health provided data from a free-text search for the term “ladder” within the presenting problems, triage text and diagnoses in the electronic medical records of all patients who presented to the RPAH emergency department (ED) during the period studied. For comparison, we also constructed a survey of injuries sustained by pedestrians struck by a motor vehicle. We used trauma registry data, from a previous study of patients with such injuries, for 409 consecutive patients admitted during 2008–2010. The study was approved by the Sydney Local Health District Ethics Review Committee (RPAH zone).

We identified 331 ED presentations related to any ladder incident. Of these, 136 were available in the trauma registry for analysis. The mean age of patients was 54 years (SD, 17 years; 95% CI, 51–57), and a significant proportion (37; 27%) were 65 years or older. No inpatient deaths were reported. The most common body regions injured were upper limb (54; 40%) and head (41; 30%). Severe head injuries were sustained by 14 patients (10%) (Box).

Although the proportion of patients with major trauma (injury severity score, > 15) was consistent with previous trauma registry reports,2,3 the proportion with head injury was much higher and may be related to the older age in this cohort. One recent study suggested that the incidence of major injury from ladder falls is increasing, particularly among older people.4 Many presentations for minor injury were not captured by the trauma registry; however, unlike previous reports, we included all patients requiring initial assessment by the trauma team.

The proportions with severe head injury (head Abbreviated Injury Scale score, ≥ 3), intensive care admission and major trauma were similar between patients who fell from ladders and pedestrians who were struck by motor vehicles (10% v 12%, P = 0.50; 10% v 9%, P = 0.79; 12% v 15%, P = 0.30, respectively).

Based on the significant proportion of people sustaining severe head injury, new ladder-safety initiatives are required, particularly targeting those aged 65 years and over.