|Year : 2017 | Volume
| Issue : 2 | Page : 175-179
Epidemiological profile of injuries due to fall reporting to a tertiary care centre in a rural area of Northern India
Bhanu Awasthi1, Sunil Kumar Raina2, Uttam Singh1, Sandeep Kalia1, Lokesh Thakur1
1 Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India
2 Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India
|Date of Web Publication||14-Nov-2017|
Sunil Kumar Raina
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh
Background: Fall is an important contributor to injury and studies conducted over a period of time have established reliable estimates of the incidence of fall-related injury. The current study was aimed at identifying the epidemiological profile of injuries due to fall. Materials and Methods: A hospital-based descriptive study was conducted for a period of 1 year starting June 2014. The study population comprised all consecutive cases of injuries due to fall reporting to the Department of Orthopedics during the study except for those who denied consent to be included in the study. Results: Males and age group 26–45 (n = 222/795, 27.9%) are more prone to injuries due to fall. It is seen that out of 795 cases, most of the participants were students (n = 219/795, 27.5%). The common mode of injuries is fall from stairs 16 (13.2%). It is seen that population educated up to middle standard (n = 155/795, 19.5%) or primary level educated (n = 145/795, 18.2%) had higher incidence of fall events. It is observed that fall occurring outside home (n = 535/795, 67.3%) are higher than fall at home (n = 240/795, 30.2%). Conclusions: Falls are an important contributor to injury affecting the productive and otherwise healthy age group of 15–45 years in majority.
Keywords: Epidemiological profile, fall, injuries
|How to cite this article:|
Awasthi B, Raina SK, Singh U, Kalia S, Thakur L. Epidemiological profile of injuries due to fall reporting to a tertiary care centre in a rural area of Northern India. Trop J Med Res 2017;20:175-9
|How to cite this URL:|
Awasthi B, Raina SK, Singh U, Kalia S, Thakur L. Epidemiological profile of injuries due to fall reporting to a tertiary care centre in a rural area of Northern India. Trop J Med Res [serial online] 2017 [cited 2018 Jun 18];20:175-9. Available from: http://www.tjmrjournal.org/text.asp?2017/20/2/175/218215
| Introduction|| |
A fall is identified as an event which results when a person comes to rest inadvertently on the ground or floor or other lower level. Falls are an important contributor to injury. Studies conducted over a period of time have established reliable estimates of the incidence of fall-related injury.,,, Studies have identified falls from rooftops, balconies, windows, and staircases as common cause of injury. In addition, factors identified as specific to Southeast Asian region (SEAR) countries are falls from trees of workers picking fruits, etc.
Falls are responsible for the largest number of hospital visits for nonfatal injuries, especially for children and young adults in Southeast Asia. This is in stark contrast to Western regions, where falls are most common among elderly. Population aged >70 years contributes to >40% of fall mortality; the rate being 21.7 (70–79 years) and 107.8 (>80 years) per 100,000 population, respectively.
There were about 121,000 estimated deaths due to falls in the SEAR countries during the year 2002. The number of deaths due to falls in India has shown a consistent increase from 6201 in 1998 to 8800 in 2003.
This study aimed to find out the epidemiological profile of injuries of patients admitted with fall-related injuries during the period from June 1, 2014, to May 31, 2015.
| Materials and Methods|| |
The study was conducted in the Department of Orthopedics of a tertiary care institute in a rural of Northwest India. It was a hospital-based descriptive study conducted for a period of 1 year starting June 2014. The study population comprised all consecutive cases of injuries due to fall reporting to the Department of Orthopedics during the study except for those who denied consent to be included in the study.
The selected participants were registered with the Department of Orthopedics. Each registered patient was administered a structured questionnaire which included details on sociodemographic profile such as details on age, sex, occupation, economic status, and types of family to which the participant belonged.
After completing the sociodemographic questionnaire, the history of the patient was recorded. History included details on mode of injury, place of injury, and type of injury. Once the history was completed, further clinical examination was performed which included examining the vitals of the patients and a head-to-toe physical examination. The participants underwent radiological examination (X-ray, computed tomography, magnetic resonance imaging, and ultrasonography) and required blood investigations. If the patient was brought disoriented, the information was obtained from the patient's attendant. In case of a minor (<18 years of age) reporting with musculoskeletal injuries, a detailed history on injury was corroborated by conducting a simultaneous interview with parent/guardian of the minor.
The occupations of all the participants were sought for and classified accordingly. Only a full-time homemaker was regarded as a homemaker while a homemaker who also worked as an agriculturist was classified as agriculturist. For the purpose of the study, all people who possess the Integrated Rural Development Program (IRDP) card issued by concerned gram panchayat were kept under IRDP category.
A database of all registered patients was maintained and entered in Microsoft Excel 2007. The statistical analysis was performed using Statistical Package for Social Sciences Statistics for Windows, version 17.0 (SPSS Inc., Chicago, IL, USA) and results expressed using percentages. Statistical significance was assessed with the help of Chi-square test, and P< 0.05 was taken as statistically significant.
| Results|| |
The age group 16–45 (n = 374/795, 47.04%) is more prone to injuries due to fall than other age groups [Table 1]. Mean age of fall in this study was 35.98. Further, it was observed that in age group up to 15-year fall from height and fall while playing (n = 37/141, 26.2% and n = 36/141, 25.5%), respectively, was most common mode of injury, whereas in rest of the other age groups fall while walking was the most common mode of injury. The association of types of fall with age group was found to be statistically significant (P< 0.05). It is also seen that the most common mode of fall in both sex is fall while walking (n = 361/795, 45.4%). Male sex was involved in 199 (25.0%) and females in 162 (24.4%) cases. Further, it was observed that proportion of the injuries due to fall from stairs in female participants (n = 38/296, 12.8%) was higher compared with male patients (n = 54/499, 10.8%). It was also observed that injuries due to fall from height (excluding fall from stairs and trees) were proportionately high in male patients (n = 102/499, 20.4%) compared to female patients (n = 29/296, 9.7%) [Table 2].
Out of 795 cases, most of the participants were students (n = 219/795, 27.5%). It is observed that students had highest incidence of fall while walking (n = 65/219, 29.6%) and while playing (n = 66/219. 30.1%) followed by farmers (n = 167/795, 21.0%) with maximum number of fall during walking (n = 103/167, 61.6%). In females, especially homemakers (n = 121/795, 15.2%). The common mode of injuries was fall from stairs 16 (13.2%). It is seen that population educated up to middle standard (n = 155/795, 19.5%) or primary level educated (n = 145/795, 18.2%) had higher incidence of fall events. It is also observed that fall while walking (n = 361/795, 45.4%) was most common mode of injury in all educational status group. The association of types of fall with educational status was found to be statistically significant (P< 0.05). It was also observed that non-IRDP patients had more injuries due to fall (n = 682/795, 85.8%) as compared to IRDP patients (n = 113/795, 14.2%). The association of types of fall with economic status was found to be not statistically significant (P > 0.05) [Table 2].
Individuals belonging to joint families (n = 466/795, 58.6%) had more rate of injuries due to fall than individuals belonging to nuclear families (n = 279/795, 35.1%). Further, it is observed that injury due to fall while walking was the most common mode, followed by fall from height (n = 131/795, 16.5%) [Table 3].
Falls occurring outside home (n = 535/795, 67.3%) were more than falls occurring at home (n = 240/795, 30.2%). It is also seen that out of 535 (67.3) cases, in which events of fall occurred outside home, there were 291 (36.6) cases that occurred during walking. Of 240 (30.2%) cases, in which the place of injury was home, maximum fall events occurred due to fall from stairs 81 (10.2%). The association of types of fall with place of injury was to be statistically significant (P< 0.05) [Table 4].
| Discussion|| |
Various studies from different parts of India and the world report of a male predominance in injuries due to fall.,,,,, Our study also suggests a male predominance to fall with a male to female in ratio of 1.69:1. This is because male is more involved in social and outdoor activities. A similar observation was seen in a study conducted by Awasthi et al., in which the male to female patient ratio was 2.02:1.
Studies done in other parts of the world showed different patterns. A study done in a tertiary hospital in Northeast India observed that people in their fourth decade of life are more prone to injuries due to fall followed by those in the third decade., I n a study conducted by Awasthi et al. observed that the most common age group is 16–30, followed by 31–45.
In the present study, age group 26–45 year are more prone to injuries followed by 11–25 year (22.26%), this age group is socially more active and participate in a lot of outdoor activities.
A study conducted in New Delhi observed that persons with primary education had higher injury incidence. In our study, people with middle and primary education are the majority with fall-related injuries, followed by those with secondary education. Similar observations were found in the study conducted by Awasthi et al. and this difference could be attributed to higher school enrollment in Himachal Pradesh. The present study shows a positive association between joint family norm and fall-related injuries. This association might be due to more prevalence of joint families in Himachal Pradesh. A study conducted by Awasthi et al. observed that there is higher incidence of fall among members living in joint families.
A study conducted in New Delhi observed that the individuals belonging to business groups as occupation followed by individuals from the labor class had higher incidence of fall. However, in the present study, students (27.4%) and farmers (20.9%) reported higher incidences of fall-related injuries, followed by homemakers (15.2%). The reason for this may be that Himachal Pradesh is a hilly and rural area, and students in this state are or activities such as working in forests besides acquiring school/college education.
Available literature does not mention any association between socioeconomic status and injuries as injuries affect people of all socioeconomic status. A study conducted by Awasthi et al. in Northern India showed higher prevalence of injuries due to fall in above poverty line (APL). Similar results in our study as patient were divided into two groups IRDP and non-IRDP, where non-IRDP include patients who are APL and patients who are unable to present their IRDP card or who are below poverty line but not had IRDP card. The reason for this is that Himachal Pradesh has lower poverty rate compared to national poverty rate or better accessibility of medical services by non-IRDP group.
A study done by Awasthi et al. in Northern India observed outside home is the most common place of injuries due to fall. In our study, injuries inflicted outside home are predominant in male patients while in female patients, home is most common place for fall, because of outdoor activities such as farming and forestry in geographically difficult terrain in which males are mainly involved.
| Conclusions|| |
Falls are an important contributor to injury affecting the productive group and otherwise healthy age group of 15–45 years in the majority.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997;349:1269-76.
Luukinen H, Koski K, Honkanen R, Kivelä SL. Incidence of injury-causing falls among older adults by place of residence: A population-based study. J Am Geriatr Soc 1995;43:871-6.
Sattin RW, Lambert Huber DA, DeVito CA, Rodriguez JG, Ros A, Bacchelli S, et al
. The incidence of fall injury events among the elderly in a defined population. Am J Epidemiol 1990;131:1028-37.
Kingma J, Ten Duis HJ. Severity of injuries due to accidental fall across the life span: A retrospective hospital-based study. Percept Mot Skills 2000;90:62-72.
Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Järvinen M, et al .
Fall-induced injuries and deaths among older adults. JAMA 1999;281:1895-9.
Celine TM, Antony J, Johnson A. A retrospective study on fall related injuries at a tertiary care level. Saudi J Health Sci 2013;2:137-41.
World Health Organization. World Report on Road Traffic Injury Prevention. Geneva: WHO; 2004.
Peel NM, Kassulke DJ, McClure RJ. Population based study of hospitalized fall related injuries in older people. Inj Prev 2002;8:280-3.
Jha N, Srinivas DK, Roy G, Jagadish S. Injury pattern among road traffic accident cases: A study from South India. Indian J Commonity Med 2003;28:85-90.
Meena RK, Singh AM, Singh CA, Chisthi S, Kumar AG, Langshon R. Pattern of fractures and dislocations in a tertiary hospital in Northeast India. Int J Epidemiol 2013;11:13-5.
Awasthi B, Raina SK, Sharma V, Kumar N. Sociodemographic determinants of traumatic musculoskeletal injuries: A register based study from North-West India. Int J Health Allied Sci 2015;4:54-7. [Full text]
Tandon T, Shaik M, Modi N. Paediatric trauma epidemiology in an urban scenario in India. J Orthop Surg (Hong Kong) 2007;15:41-5.
[Table 1], [Table 2], [Table 3], [Table 4]