Background: Recent trends in high-income countries indicate a shift in the causes of major trauma, with low-energy transfer mechanisms, particularly falls from less than two metres, becoming increasingly prevalent. This study aimed to compare the demographics, care processes, and outcomes in major trauma patients injured by low and high-energy transfer mechanisms.
Methods: This comparative cohort study utilised anonymised data from patients 18 years and over with Injury Severity Score greater than 15, recorded in the Trauma Audit and Research Network in 2019. Patients were categorised as low energy (falls less than 2 metres) and high energy (road traffic collisions, falls greater than 2 metres, and other mechanisms) groups. Data from 179 English and Welsh hospitals were included.
Results: In 2019, 53.6% (n=16,087) patients were injured by low-falls. They were older (median age 80 vs. 47 years), with a higher incidence of pre-existing comorbidities (90.4% vs. 56.2%) and traumatic brain injuries (74% vs. 49.8%) compared to the high energy cohort. Low-energy fall patients were more likely to be initially treated in Trauma Units rather than Major Trauma Centres and received fewer interventions, such as surgery and critical care admissions. Despite these differences, low-energy fall patients had higher in-hospital mortality rate (16.1% vs. 12.6%).
Conclusions: The increasing burden of major trauma from low-energy falls necessitates a re-evaluation of current trauma systems and injury prevention strategies to better serve this distinct and growing patient population. Future research should focus on oprimising care pathways and improving outcomes for patients injured by low-energy falls.