Traumatic brain injury caused by a fall from stepladders

<p>Objectives: As the incidence of stepladder related fall injury (sLRFI) is increasing in Japan, we retrospectively analyzed our own previous sLRFI cases to investigate the clinical characteristics of sLRFI and to give information about the awareness of stepladder safety and pre­cautions.</p><p>Materials and Methods: From April 2009 to March 2019, we treated 8 sLRFI cases at our institution. The frequency of sLRFI cases in acute head trauma, patient’s age, sex, cause of injury, Glasgow Coma Scale (GCS) on admission, type of head injury, extracranial lesions, neurosurgical treatment method and outcomes in each patient were retrospectively reviewed.</p><p>Results: During the same period, we treated 989 patients with acute head trauma, and determined the sLRFI frequency to be 0.8%. Patients evaluated in the current analysis included 7 males and 1 female, with ages ranging from 52 to 86 years (mean age of 76 years). Mean GCS on admission was 12 points. Cause of injury were non–occupational falls in 7 patients and occupational in 1. Seven out of 8 patients fell from the top of the stepladders or during straddling the stepladders. Type of head injury included acute epidural hema­toma in 3, acute subdural hematoma in 3, cerebral contusion in 3, traumatic intracerebral hematoma in 1, traumatic subarachnoid hemor­rhage in 5, chronic subdural hematoma in 2, pneumocephalus in 1 and skull fracture in 3. Extracranial lesions included clavicular fracture in 1 patient, rib fracture in 2, hemopneumothorax in 2. Neurosurgical procedures were performed in 6 patients. Evacuation of hematoma via craniotomy was carried out in 4 patient, irrigation of hematoma through a burr hole in 2. At the time of discharge, outcomes based on the Glasgow outcome scale were good recovery in 3, moderately disabled in 3, severely disabled in 1, with death occurring in 1.</p><p>Conclusions: Clinical characteristics of sLRFI were evaluated based on our previous cases. The typical patients of sLRFI were male, elderly and non–occupational users. As the trend of stepladder falls has been increasing, preventative strategies should be established to support stepladder safety usage.</p>