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Archives
of
Emergency
Medicine,
1991,
8,
263-265
Injuries
due
to
falls
as
a
result
of
uneven
pavements
M.
T.
HUNT,
M.
CHAPMAN
&
G.
LLOYD
Accident
and
Emergency
Department,
King's
College
Hospital,
London
SUMMARY
At
least
one
person
per
day
attending
the
A&E
department
at
King's
College
Hospital
has
sustained
injuries
from
uneven
pavements.
The
injuries
have
a
significant
morbidity
as
well
as
a
mortality
of
1%.
A&E
records
can
be
a
source
of
useful
information
to
aid
local
authorities
in
identifying
areas
associated
with
these
injuries
in
order
to
reduce
their
frequency
and
subsequent
claims
for
compensation.
INTRODUCTION
At
least
one
person
per
day
attending
the
Accident
and
Emergency
(A&E)
depart-
ment
at
King's
College
Hospital
sustains
injuries
due
to
tripping
on
uneven
pavements.
A
survey
was
undertaken
to
investigate
the
type
and
severity
of
these
injuries.
METHODS
In
a
90-day-period
(September-November
1989)
data
were
collected
prospectively
on
100
consecutive
patients
with
injuries
attributed
to
tripping
on
uneven
pave-
ments.
The
nature
of
the
injuries
was
documented
with
details
of
investigation,
treatment
and
follow-up
together
with
the
road
name
in
which
the
injury
occurred.
Correspondence:
Mr
Martin
T.
Hunt,
A&E
Departnient,
The
Royal
Sussex
County
Hospital,
Eastern
Road,
Bmghton
BN2
3EW,
U.K.
263
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264
M.
T.
Hunt
et
al.
RESULTS
Forty-two
men
and
58
women
attended
the
A&E
with
injuries
from
uneven
paving
slabs.
In
patients
under
60
years
injuries
were
distributed
evenly
between
men
and
women,
M:F
1*3:1,
over
60
years
of
age
the
ratio
was
M:F
1:3.
Women
were
injured
most
frequently
during
the
morning
and
afternoon
but
injuries
in
men
occurred
evenly
throughout
the
day.
Twice
as
many
women
as
men
were
carrying
shopping
bags
at
the
time
of
injury.
The
frequency
of
injury
was
constant
throughout
the
week.
Greater
numbers
of
patients
presented
to
A&E
on
Mondays
and
fewer
on
Sundays.
The
frequency
of
injury
did
not
appear
to
be
influenced
by
weather
conditions.
Sixty-eight
patients
presented
with
injuries
within
12h,
a
further
17
within
24h
and
the
remaining
15
up
to
3
weeks
from
the
time
of
injury.
The
severity
of
injury
warranted
radiography
in
79
patients,
40
of
whom
had
a
fracture
or
dislocation.
Seven
patients
required
admission,
six
with
fractures
requiring
operative
fixation
or
manipulation
under
anaesthesia;
one
patient
was
admitted
for
neurological
observations.
Eighteen
patients
required
a
plaster
of
Paris
splint,
four
requiring
manipulation
in
A&E
before
immobilization.
The
remaining
patients
(60)
had
soft
tissue
injuries;
21
only
required advice
on
self-treatment.
In
the
remaining
39
patients
more
than
one
type
treatment
modality
was
required.
Analgesics
were
prescribed
in
90%
of
cases,
supporting
bandages
in
74%,
tetanus
toxoid
in
62%,
suturing
in
49%,
and
antibiotics
in
8%.
Follow
up
was
advised
in
62
patients:
fracture
clinic
(33),
general
practitioner
(18),
A&E
(7)
and
physiotherapy
(4).
Table
1.
Breakdown
of
injuries
received
Injury
site
Radiology
Fracture/disloc
Skull
2
0
Facial
bones
10
2
Chest
2
1
Humerus
8
8
Radial
head
2
2
Wrist
15
6
(Colles)
1
(Scaphoid)
2
(Triquetral)
Hand/digits
7
5
(3
dislocn)
Hip
3
1
Knee
5
3
(3
Patella
fractures,
1
bilateral)
Ankle
13
4
Foot
5
5
79
40
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Injuries
from
uneven
pavements
265
DISCUSSION
A
disparity
of
1.5
cms
in
pavement
level
is
sufficient
to
cause
pedestrians
to
trip
and
sustain
injuries
(1),
and
the
cost
of
injuries
as a
result
of
falls
due
of
uneven
pavements
is
high
in
both
human
and
financial
terms.
The
majority
of
injuries
in
this
study
were
of
a
minor
nature.
Morbidity
occurred
from
soft
tissue
injuries
(60)
in
the
form
of
significant
scarring
(5)
and
residual
pain
at
6
months
(20).
Thirty-
five
of
the
40
patients
who
sustained
a
fracture
had
lingering
discomfort
at
the
fracture
site
together
with
residual
stiffness.
One
patient
who
sustained
a
fractured
neck
of
femur
requiring
fixation
died
post-operatively.
Considering
these
figures
it
is
not
surprising
that
£10
million
(David
&
Freedman,
1990)
in
compensation
was
paid
for
injuries
sustained
due
to
uneven
pavements
in
1987.
These
data
obtained
in
3
months
suggests
yearly
numbers
of
injuries
from
uneven
pavements
in
our
department
are
around
400.
Extrapolation
to
a
national
level
suggests
there
may
be
upwards
of
60000
cases.
As
only
10000
claims
were
lodged
in
1987,
it
appears
that
only
about
17%
of
such
accidents
proceed
to
claims
against
the
local
authority.
To
a
great
extent
these
costs
are
preventable
by
footpath
maintainence.
The
road
names
of
the
accident
sites
were
noted
in
our
study
to
identify
local
high
risk
areas.
Several
roads
in
close
proximity
to
the
hospital
were
identified
but
this
may
be
a
reflection
of
easy
access
to
prompt
treatment
rather
than
an
indication
of
a
dangerous
area.
Excluding
localities
close
to
the
hospital
no
one
site
seemed
more
dangerous
than
another.
The
road
names
have
been
grouped
according
to
post-code
and
sent
to
the
relevant
local
authority.
Although
our
sample
is
small,
similar
studies
in
other
A&E
departments
would
provide
a
better
idea
of
the
general
state
of
the
public
footpaths.
With
com-
puterisation
of
A&E
records
and
the
Home
Accident
Surveillance
Scheme
now
encompassing
leisure
accidents
it
will
be
possible
to
gather
much
larger
samples
providing
epidemiological
data
for
such
injuries.
It
will
also
be
possible
to
identify
those
areas
where
injuries
occur
most
frequently,
assisting
local
authorities
in
maintainence
and
hopefully
reducing
injuries
and
claims.
CONCLUSION
Greater
maintainence
of
public
footpaths
would
result
in
reducing
claims
for
compensation
from
pedestrians
tripping
over.
Hospital
expenses
for
in-patient
stays
and
out-patient
clinics
would
also
be
reduced.
REFERENCES
David
H.
G.
&
Freedman
(1990)
Injuries
caused
by
tripping
over
paving
stones:
an
unappreciated
problem.
British
Medical
Journal
6727
Vol
300.
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pavements.
result of uneven
Injuries due to falls as a
M T Hunt, M Chapman and G Lloyd
doi: 10.1136/emj.8.4.263
1991 8: 263-265 Arch Emerg Med
http://emj.bmj.com/content/8/4/263
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