STUDY DESIGN: Retrospective database analysis. PURPOSE: To identify risk factors that predict mortality following acute spine fractures in geriatric patients of Singapore. OVERVIEW OF LITERATURE: Acute geriatric spinal fractures contribute significantly to local healthcare costs and hospital admissions. However, geriatric mortality following acute spine fractures is scarcely assessed in the Asian population. METHODS: Electronic records of 3,010 patients who presented to our hospital’s emergency department and who were subsequently admitted during 2004–2015 with alleged history of traumatic spine fractures were retrospectively reviewed, and 613 patients (mean age, 85.7±4.5 years; range, 80–101 years; men, 108; women, 505) were shortlisted. Mortality rates were reviewed up to 1 year after admission and multivariate analyses were performed to identify independent risk factors correlating with mortality. RESULTS: Women were more susceptible to spine fractures (82.4%), with falls (77.8%) being the most common mechanism of injury. Mortality rates were 6.0%, 8.2%, and 10.4% at 3, 6, and 12 months, respectively. The most common causes of death at all 3 time points were pneumonia and ischemic heart disease. Based on the multivariate analysis at 1-year follow-up, elderly women had a lower mortality rate compared to men (p<0.001); mortality rates increased by 6.3% (p=0.024) for every 1-year increase in the patient’s age; and patients with an American Spinal Injury Association (ASIA) score of A–C had a much higher mortality rate compared to those with an ASIA score of D–E (p<0.001). CONCLUSIONS: An older age at presentation, male sex, and an ASIA score of A–C were identified as independent factors predicting increased mortality among geriatric patients who sustained acute spine fractures. The study findings highlight at-risk groups for acute spine fractures, thereby providing an opportunity to develop strategies to increase the life expectancy of these patients.
Accidental Falls ; Aged ; Asia ; Asian Continental Ancestry Group ; Cause of Death ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Health Care Costs ; Humans ; Life Expectancy ; Male ; Mortality ; Multivariate Analysis ; Myocardial Ischemia ; Pneumonia ; Retrospective Studies ; Risk Factors ; Singapore ; Spinal Cord Injuries ; Spinal Fractures ; Spinal Injuries ; Spine

This study evaluated the association between falls and the fear of falling (FOF) with the risk of all-cause mortality in Korean adults. The study enrolled 4,386 subjects aged 50 years and over who participated in the Dong-gu Study. Falls in the past year were categorized as yes or no. Injurious falls were defined as falls that resulted in fractures, head injuries, sprains or strains, bruising or bleeding, or other unspecified injuries. FOF was classified as low or high. The associations of falls and fall-related characteristics with mortality were assessed using Cox proportional hazards models. The average follow-up was 7.8 years. During this period, 255 men and 146 women died. In a fully adjusted model, falls in the past year were not associated with an increased risk of all-cause mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.85–1.58), but a history of injurious falls was associated with an increased risk of mortality (HR 1.36, 95% CI 1.04–1.79). Compared with subjects without a FOF, subjects who were moderately or very afraid of falling had a higher mortality rate (HR 1.26, 95% CI 0.97–1.63). In conclusion, injurious falls and a high FOF increased the risk of all-cause mortality in Koreans. This study suggests that injurious falls and FOF can predict mortality in the general population.
Accidental Falls ; Adult ; Cause of Death ; Cohort Studies ; Craniocerebral Trauma ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Mortality ; Proportional Hazards Models ; Sprains and Strains

PURPOSE: Adrenal gland injuries in trauma are rare and usually misdiagnosed or underestimated in an emergency setting because they are asymptomatic and associated with severe abdominal injuries. This paper reviews the clinical characteristics of adrenal injuries. METHODS: A retrospective analysis of trauma patients who visited the authors' emergency center was performed from March, 2010 to December, 2017. The patient demographic data, injury mechanism & associated injuries, injury severity score, hospital stay, and mortality were retrieved and analyzed. RESULTS: Adrenal gland injuries were found in 52 patients: 73.1% (n=38) were males and the mean age was 43.6 years. Of the patients, 84.6% (n=44) had ISS ≥15. Right adrenal gland injuries occurred in 82.7% (n=43). The mechanism of injury was falls in 30.8% (n=16), motor vehicle accidents in 25.0% (n=13), and pedestrian accidents in 23.1% (n=12). Associated injures were liver injury (58.5%), rib fracture (52.8%), kidney injury (24.5%), pelvic bone fracture (20.8%), spine fracture (28.3%), and spleen injury (13.2%). The mean hospital stay was 34.2 days, and the intensive care unit stay was 9 days. The mortality rate was 3.8% (n=2). CONCLUSION: Adrenal gland injuries are common in males and frequent in the right side. Falls are the leading cause of injury. Most injuries have an associated injury at the abdominal or thoracic region. Adrenal injury is accompanied by high injury severity but showed a good prognosis.
Abdominal Injuries ; Accidental Falls ; Adrenal Glands ; Emergencies ; Humans ; Injury Severity Score ; Intensive Care Units ; Kidney ; Length of Stay ; Liver ; Male ; Mortality ; Motor Vehicles ; Pelvic Bones ; Prognosis ; Retrospective Studies ; Rib Fractures ; Spine ; Spleen

This study aimed to analyze changing trends in child injury deaths from 2006 to 2016 and to provide basic data for initiatives to help prevent child injury deaths through improvements in social systems and education. Specific causes of death were analyzed using micro-data of the death statistics of Korea from 2006 to 2016, which were made available by Statistics Korea. Types and place of death were classified according to the KCD-7 (Korean Standard Classification of Diseases and Causes of Death). The data were compared to those of other Organization for Economic Cooperation and Development countries. Changing trends were presented. The number of child deaths by injury was 270 in 2016. The death rate was 8.1 per 100,000 population in 2006, while it was 3.9 in 2016. The death rate of boys was 1.7 times greater than that of girls. Unintentional injury deaths comprised 72.6% of all child injury deaths in 2016, while intentional injury deaths comprised 27.4%. The first leading cause of unintentional injury deaths in infants (less than 1-year-old) was suffocation, while that of children aged 1 to 14 years was transport accidents. The second leading cause of death in infants was transport accidents, that of children aged 1 to 4 was falling, and that of children aged 5 to 14 was drowning. Pedestrian accidents comprised 43.7% of the transport accidents from 2014 to 2016. To prevent child injury deaths by both unintentional and intentional causes, nation-wide policy measures and more specific interventions according to cause are required.
Accidental Falls ; Asphyxia ; Cause of Death ; Child ; Classification ; Drowning ; Education ; Female ; Humans ; Infant ; Korea ; Mortality ; Organisation for Economic Co-Operation and Development ; Republic of Korea ; Self-Injurious Behavior

Posterior fossa epidural hematoma (EDH) is uncommon, but the related clinical deterioration can occur suddenly. Accompanying venous sinus injury and lacerations are associated with 40% to 80% mortality. The authors present one clinical case of a patient with posterior fossa EDH from transverse sinus bleeding. A 57-year-old male was injured after falling while working. He was taken to the hospital, where computed tomography scans of his brain revealed a right posterior temporal and cerebellar EDH with a right temporo-occipital fracture. He underwent a right parieto-occipital craniotomy, incorporating the fracture line. Longitudinal laceration of the right transverse sinus extending to the sigmoid sinus with profuse bleeding was identified. Four gauzes were inserted in the epidural space for tamponade of the injured sinus. Conventional angiography and coil embolization for the injured sinus were immediately performed. Subsequently, the patient was transferred to the operating room, wherein staff members removed the gauzes and remnant hematoma. Based on this experience, the authors recommend that for posterior fossa EDH from transverse sinus bleeding, bleeding control should be performed by gauze packing and endovascular treatment.
Accidental Falls ; Angiography ; Brain ; Colon, Sigmoid ; Cranial Fossa, Posterior ; Craniotomy ; Embolization, Therapeutic ; Epidural Space ; Hematoma ; Hematoma, Epidural, Cranial ; Hemorrhage* ; Humans ; Lacerations ; Male ; Middle Aged ; Mortality ; Operating Rooms

BACKGROUND: This prospective cohort study used nationwide claims data to investigate the incidence of fall and fragility fractures in association with urinary incontinence (UI) in the elderly, and to compare mortality after fragility fractures in elderly patients with or without incontinence. METHODS: A total of 39,854 Korean adults (age, 66–80 years) who participated in health examinations between 2007 and 2012 and were followed up until 2015 were analyzed. Patient and comparison groups were classified according to the presence or absence of UI. The cumulative incidence of osteoporotic fragility fractures and falls in the 2 groups was assessed and compared. Hazard ratios for fragility fractures were calculated for the risk of UI in association with falls using a Cox proportional hazards model. RESULTS: Of 39,854 elderly participants, 5,703 were classified in the UI group, while 34,151 were placed in the comparison group. Fall rates were significantly higher (20.8%) in the incontinence group than in the comparison group (4.7%) (P < 0.001). Women in the incontinence group (13.9%) showed a significantly higher incidence of all types of fragility fractures than those in the comparison group (11.8%) (P=0.005). After adjustment for confounders, UI was not a significant risk factor for fragility fractures in men (P=0.878) or women (P=0.324). CONCLUSIONS: This study demonstrated that elderly women with UI have a significantly higher incidence of osteoporotic fragility fractures. In addition, elderly women are at higher risk for falls.
Accidental Falls ; Adult ; Aged* ; Cohort Studies* ; Female ; Humans ; Incidence ; Male ; Mortality ; Osteoporotic Fractures ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Urinary Incontinence

OBJECTIVE: The injury-related disease burden in South Korea is relatively high compared to that in other nations. This study was conducted to identify the scale and causes of injury by severity, using an injury pyramid and analyzing the sex and age-dependent differences and the basic demographic characteristics. METHODS: Unintentional injury was estimated for each group after classifying injury-related deaths, hospitalizations, and outpatient department (OPD) visits based on their severity. The injury pyramid was calculated by classifying the injury outcomes into deaths, hospitalizations, and outpatient visits. RESULTS: The incidence of unintentional injury included 31.74 deaths, 1,715.27 hospitalizations, and 7,317.55 OPD visits per 100,000 persons. The incidence of injury was higher among males than that among females. There were more hospitalizations and OPD visits than deaths among females. The mortality and hospitalization rates due to injury per 100,000 persons were the highest among those ≥75 years old, and the OPD visit rate was the highest among preschool children aged 0 to 6 years. The injury mechanisms that caused most deaths and hospitalizations in South Korea were injuries related to traffic, falls, poisoning, and burns/fires. CONCLUSION: The scale of unintentional injury varies based on sex, age, and injury mechanism; additionally there are differences in the incidence of injuries between males and females depending on their age and injury mechanism. The high incidence of injury in elderly people could be a factor that increases the burden of injury in South Korea; hence, it is necessary to develop an injury prevention program that targets the elderly.
Accident Prevention ; Accidental Falls ; Aged ; Child, Preschool ; Epidemiology ; Female ; Hospitalization ; Humans ; Incidence ; Korea* ; Male ; Mortality ; Outpatients ; Poisoning

The total fertility rate in South Korea is one of the lowest among the Organisation for Economic Co-operation and Development (OECD) countries. However, the number of advanced maternal age and high risk pregnancies are rising due to delays in marriage and increased infertility rates, resulting in a maternal mortality rate that is higher than the OECD average. The most common cause of maternal mortality has been reported to be obstetric embolism, followed by postpartum hemorrhage. Hemorrhage is a preventable condition that can be solved by expeditious initial management such as transfusion, medication, and prompt transfers to tertiary centers that are capable of managing obstetric emergencies. However, the number of maternity care hospitals in underserved areas has been falling since 2004 due to business losses stemming from low birth rates, inadequate insurance payments for obstetric services, and the shortage of obstetricians. The insufficient maternity care system for high risk pregnant women in Korea has also led to an increase in maternal mortality. Therefore, the Ministry of Health and Welfare has supported the establishment of an ‘Integrated Care Center for High Risk Pregnancy and Neonate’ for high risk maternity and neonatal cases. However, there is no systematic transfer system in place to monitor and support emergency patient transfers in the event of obstetric emergencies. Although the Disaster & Emergency Medical Operations Center is currently carrying out these tasks, it is insufficient to properly manage all obstetric transfers. Our plan is to establish an Emergency Maternal Transport Control Center that is linked with the existing Disaster & Emergency Medical Operations Center at the National Medical Center. To implement this system, cooperation from each maternity and neonatal center will be crucial to share available human and material resources. Successful implementation of this system will allow for communication not only with the regional perinatal centers, but on a nationwide scale to detect and conduct necessary transfers of high risk pregnancy patients in emergency situations. It is anticipated that this system will significantly improve maternal health care as well as obstetric infrastructure, especially in underserved areas.
Accidental Falls ; Birth Rate ; Commerce ; Disasters ; Embolism ; Emergencies ; Female ; Hemorrhage ; Humans ; Infertility ; Insurance ; Korea ; Marriage ; Maternal Age ; Maternal Health ; Maternal Mortality ; Organisation for Economic Co-Operation and Development ; Patient Transfer ; Postpartum Hemorrhage ; Pregnancy ; Pregnancy, High-Risk ; Pregnant Women

OBJECTIVES: Fall is a major cause of morbidity and mortality among older adults. Falls result from many various causes, and dizziness is important risk for falls, especially in the elderly. Research on the relationship between chronic dizziness and falls in elderly people has been rarely performed and these were no studies that analyzed the risk of falls according to subtypes of chronic dizziness. METHODS: We conducted a prospective study of the association between subtypes of chronic dizziness and falls in the elderly between 65 to 75 years. We divided dizzy patients into 5 groups according to the results of symptom, vestibular and autonomic function test. Falls and new events (acute dizziness or other medical conditions) were checked monthly by telephone or out patient department follow-up for 6 months. RESULTS: Thirty-four patients were enrolled and all completed follow-up for 6 months. Nine patients classified as the falling groups and 34 patients as nonfalling group. Whereas the frequencies of orthostatic hypotension (n=6, 67%) and vestibular dysfunction (n=1, 11%) were higher in fall group, psychogenic dizziness (n=12, 35%), and vestibular migraine (n=3, 9%) were more frequent in nonfall group. CONCLUSIONS: The presence of dizziness in the elderly is a strong predictor of fall, especially orthostatic hypotension is an important predictor of fall. In order to lower the risk of falls in the elderly, an approach based on the cause of dizziness is needed.
Accidental Falls ; Adult ; Aged ; Classification ; Dizziness ; Follow-Up Studies ; Humans ; Hypotension, Orthostatic ; Migraine Disorders ; Mortality ; Prospective Studies ; Telephone

In Korea, by 2060, the proportion of the elderly population will be 40.1%, and at least one in three persons will have diabetes. Elderly patients with diabetes mellitus have higher rates of premature death, functional disability, and coexisting illnesses such as atherosclerotic cardiovascular disease than those without diabetes. In addition, the risk of geriatric syndrome, such as depression, cognitive dysfunction, urinary incontinence, falls, pain, and polypharmacy, is much higher in those with diabetes. The functional status of each elderly person varies greatly, such that comprehensive geriatric assessments for medical, psychological, functional, and social domains are needed. The goals and methods of diabetes management should be individualized according to the results of these assessments. In the treatment of vulnerable elderly patients with diabetes, hypoglycemia or overtreatment should be avoided.
Accidental Falls ; Aged* ; Cardiovascular Diseases ; Depression ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Geriatric Assessment ; Humans ; Hypoglycemia ; Korea ; Medical Overuse ; Mortality, Premature ; Polypharmacy ; Urinary Incontinence