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Stair-related injuries treated in United States emergency departments
Abstract
Objective:
To investigate the characteristics of stair-related injuries among individuals of all ages and estimate national injury frequencies and rates using a representative sample of patients treated in United States emergency departments.
Methods:
Data from the National Electronic Injury Surveillance System were analyzed for patients treated for stair-related injuries in United States emergency departments from 1990 through 2012.
Results:
An estimated 24,760,843 patients were treated in emergency departments for a stair-related injury during the 23-year study period, averaging 1,076,558 patients annually, or 37.8 injuries per 10,000 United States residents. The annual rate of stair-related injuries decreased by 12.6% (p<0.001) during 1990-1996, followed by an increase of 24.0% (p<0.001) during 1996-2012. Although the highest injury rates occurred among younger children and older adults, the majority (67.2%) of emergency department visits for stair-related injuries was by individuals 11-60years old. Most patients were female (62.4%), who also had a higher injury rate (46.5 vs. 29.1 per 10,000) than males. Sprains and strains (32.3%), soft tissue injuries (23.8%), and fractures (19.3%) were the most common types of injury. The body regions most frequently injured were the lower extremities (42.1%) and head/neck (21.6%). Patients ≤10years old experienced more head/neck injuries. Older adult patients more frequently sustained fractures than younger age groups.
Conclusions:
Stairs are a common source of injury among individuals of all ages and the frequency and rate of stair-related injuries are increasing. This underscores the need for increased prevention efforts, particularly those related to stair design and construction.
... Studies in other disciplines focus more on stair users and the biomechanics, kinematics, and kinetics of stair walking. Epidemiologic and ergonomic studies report that stair falls affect all users, with median ages reported at 35 years [10], and 67% of stair fall patients are 11-60 years of age [3]. Risky behavior is widespread, and 91% of young adults and 57% of older adults self-report being less than careful on stairs [59]. ...
... There is, however, general agreement that some categories are more vulnerable. In UK coroners' reports, 60% of total fall-related deaths were of infirm persons [7], while higher injury rates occur among children and older adults [3,10]. Females appear to be more at risk, and they represent 62% of stair fall patients in US emergency departments [3]. ...
... In UK coroners' reports, 60% of total fall-related deaths were of infirm persons [7], while higher injury rates occur among children and older adults [3,10]. Females appear to be more at risk, and they represent 62% of stair fall patients in US emergency departments [3]. However, it is also reported that in the 0-75 years-of-age group, there are more male fall victims. ...
Stairs are among the key elements in architectural composition, both aesthetically and spatially. They are also one of the main innovations in architecture and building, allowing pedestrians to bridge considerable height differences with relative efficiency. It is, therefore, surprising that, in spite of all stair regulations in building codes, stairs are responsible for a huge number of accidents—second only to motorcars. The extent of safety failures suggests that user interaction with stairs is poorly understood by designers and policy makers. This is not unrelated to the lack of research into the design and use of stairs. Templer’s seminal work is the exception, but it dates from 1992, and since then, little has been done to understand the relation between architectural design and stair performance, including safety. The paper reviews the literature on stairs in multiple domains and proposes that to redress poor stair performance, research and practice should build on affordance-based analyses of stair climbability, which establish a clear connection between the form of a stair and the perception of both action possibilities and dangers by all kinds of users. By doing so, affordances establish a comprehensive and consistent framework for the analysis of architectural designs, which utilizes both domain and psychological knowledge, including as a foundation for computational applications.
... Of these, approximately 32% of these were sprains and strains, 24% soft-tissue injuries and 19% fractures. In roughly 42% of the cases, the injuries were in the lower extremities and in almost 22% in the head and neck [3]. Other sources report more than 1.23 million non-fatal injuries on stairs in 2009-10, resulting in 12,000 deaths, with a total cost exceeding US $ 92 billion. ...
... The theory of affordances argues that an environment presents specific action possibilities to a particular animal, which are perceived directly, without mediation of mental representations, so that they can be acted upon automatically [26,27]. Users perceive the climbability affordance of a stair (the how is discussed in a later section) and proceed to walk on it without consciously thinking how their feet land on the steps or their hands glide along the handrails, 3 so preserving their precious cognitive capacities for higher matters, such as the purpose of their going from A to B. Affordances can be positive or negative: stairs allow us to walk up and down considerable heights but also are hazardous because they contain a great number of hard edges in sequences that make falls more painful and dangerous than falls on level surfaces. We normally perceive both positive and negative affordances (also as a gradient: the closer to the edge, the greater the danger [26]), which explains why walking speed on stairs is significantly lower than on level walkways: 30 m/min in ascent and 37 m/min in descent, which would be shuffling speed on a level walkway, where free flow is at 91 m/min [6]. ...
... Studies in other disciplines focus more on stair users, the biomechanics, kinematics and kinetics of stair walking. Epidemiologic and ergonomic studies report that stair falls affect all users, with median ages reported at 35 years [10] and 67% of stair fall patients being between 11 and 60 years of age [3]. Risky behaviour is widespread: 91% of young adults and 57% of older adults self-report to be less than careful on stairs [59]. ...
Stairs are among the key elements in architectural composition, both aesthetically and spatially. They are also one of the main innovations in architecture and building, allowing pedestrians to bridge considerable height differences with relative efficiency. It is therefore surprising that, in spite of all stair regulations in building codes, stairs are responsible for a huge number of accidents – second only to motorcars. The extent of safety failures suggests that user interaction with stairs is poorly understood by designers and policy makers. This is not unrelated to the lack of research into the design and use of stairs. Templer’s seminal work is the exception but it dates from 1992 and since then little has been done to understand the relation between architectural design and stair performance, including safety. To redress this, we can build on affordance-based analyses of stair climbability, which establish a clear connection between the form of a stair and the perception of action possibilities and dangers by all kinds of users. By doing so affordances establish a comprehensive and consistent framework for the analysis of architectural designs, which utilizes both domain and psychological knowledge, including as a foundation for computational applications.
... Falls on stairs occur across the lifespan [14][15][16]; average injury rate of stair-related falls in the United States demonstrates a trimodal distribution with peaks at � 3 years of age, young adults in their 20's, and adults � 85 years [16]. Higher injuries could result from physiological factors (e.g., decreased strength in older adults [17]), and/or behavioral factors (e.g., not using the handrail [18]). ...
... Falls on stairs occur across the lifespan [14][15][16]; average injury rate of stair-related falls in the United States demonstrates a trimodal distribution with peaks at � 3 years of age, young adults in their 20's, and adults � 85 years [16]. Higher injuries could result from physiological factors (e.g., decreased strength in older adults [17]), and/or behavioral factors (e.g., not using the handrail [18]). ...
... While both men and women demonstrated a peak in injury rate in their 20's, there are two observations that emphasize that young women are particularly susceptible to injury on stairs. First, the injury rate for young women is approximately 80% higher than the rate for young men [16]. Second, the injury rate is highest for women in their 20's relative to all other age decades (for both sexes) with the exception of women � 81 years [16]. ...
Injuries commonly occur on stairs, with high injury rates in young adults, especially young women. High injury rates could result from physiological and/or behavioral differences; this study focuses on behaviors. The purposes of this observational study were (1) to quantify young adult behaviors during stair descent and (2) to identify differences in stair descent behavior for young adult men versus women. Young adult pedestrians (N = 2,400, 1,470 men and 930 women) were videotaped during descent of two indoor campus staircases, a short staircase (2 steps) and a long staircase (17 steps). Behaviors during stair descent were coded by experimenters. Risky behaviors observed on the short staircase included: No one used the handrail, 16.1% used an electronic device, and 16.4% had in-person conversations. On the long staircase: 64.8% of pedestrians did not use the handrail, 11.9% used an electronic device, and 14.5% had in-person conversations. Risky behaviors observed more in women included: less likely to use the handrail (long staircase), more likely to carry an item in their hands (both staircases), more likely to engage in conversation (both staircases), and more likely to wear sandals or heels (both staircases) (p≤0.05). Protective behaviors observed more in women included: less likely to skip steps (both staircases), and more likely to look at treads during transition steps (long staircase) (p≤0.05). The number of co-occurring risky behaviors was higher in women: 1.9 vs 2.3, for men vs women, respectively (p<0.001). Five pedestrians lost balance but did not fall; four of these pedestrians lost balance on the top step and all five had their gaze diverted from the steps at the time balance was lost. The observed behaviors may be related to the high injury rate of stair-related falls in young adults, and young women specifically.
... Stairways are a common fall location and can lead to significant injuries or death. 4 Many factors can contribute to the severity of stairway fall incidents, including sex, 5 age, 6,7 environment, 8,9 movement disorders or gait instability, 10,11 craniomaxillofacial impact, 12 and whether the patient was ascending, descending, standing, or walking near a stairway entry. 13,14 Cyclical falling patterns have been observed and can be used to predict and prevent falls in individual patients. ...
... 15 The frequency and rate of stairrelated injuries are increasing, underscoring the need for increased prevention efforts. 4 One study showed that between 1990 and 2012, an estimated 24,760,843 patients were treated in emergency departments for stair-related injuries, averaging 1,076,558 patients annually, or 37.8 injuries per 10,000 United States residents. 4 In this analysis, the stair-related injury rate was tri-modal with peaks among children aged 3 years, young adults in their 20s, and adults aged 85 years old, with the highest rates at the extremes of the age spectrum. ...
... 4 One study showed that between 1990 and 2012, an estimated 24,760,843 patients were treated in emergency departments for stair-related injuries, averaging 1,076,558 patients annually, or 37.8 injuries per 10,000 United States residents. 4 In this analysis, the stair-related injury rate was tri-modal with peaks among children aged 3 years, young adults in their 20s, and adults aged 85 years old, with the highest rates at the extremes of the age spectrum. Soft-tissue injuries, strains and sprains, and fractures were the most common diagnosis in children, older children and adults, and older adult patients, respectively. ...
Abstract
Background
Injuries due to falls represent one of the most common etiologies of traumatic injury in the United States. Stairway-related falls in particular can lead to significant morbidity, mortality, and concomitant long-term disability and economic costs. Our study aims to evaluate the outcomes of patients presenting to a rural academic trauma center after experiencing a fall down stairs.
Methods
This was a single institution retrospective analysis of data extracted from our trauma registry. The study was considered exempt by Ballad Health Institutional Review Board. The data included patients aged 18 years or older who presented to the emergency department after a fall down stairs between January 1, 2017, and June 17, 2022. Patients who experienced falls other than those involving stairs were excluded.
Results
Of the 439 patients evaluated for falls down stairs, 259 (58.9%) were aged ≥65 years. Compared with younger patients, older patients required significantly longer hospital admissions (4.8 vs 3.6 days, P < .003), had significantly higher injury severity scores (9.1 vs 6.8, P < .05), and were more likely to be discharged to a posthospital care facility (51% vs 14.9%, P < .05). There was no difference in length of intensive care unit stay (3.8 vs 3.6 days, P < .72), ventilator days (3.3 vs 3.3 days, P < .97), or mortality (7% vs 3%, P < .08). When considering sex, male patients had significantly worse outcomes in injury severity score (9.0 vs 7.6, P < .02) and mortality (10% vs 2%, P < .0002) but no difference in hospital (4.5 vs 4.0 days, P < .20), intensive care unit (3.8 vs 3.5 days, P < .59) or ventilator days (2.8 vs 4.3 days, P < .27) when compared with female patients.
Conclusion
Patients aged 65 years or older who experience a fall down stairs are more severely injured and require more posthospital care. Our findings demonstrate that males have an elevated risk of mortality and increased injury severity compared to female patients. Previous findings from our institution examining injuries from falls, including a sub-analysis on ground-level falls, have shown similar sex disparity. This study shows the necessity of preventing stair-related falls, especially in the older population.
... This increase in the incidence and severity of UE fracture injuries is consistent with existing literature pertaining to the overall incidence of both fragility fractures and stair-related injuries in the United States and other developed countries over the past several decades [5,9,13,14]. A 2018 study by Blazewick et al. found that stair-related injuries across all age categories increased by 24% in the US from 1996 to 2012 [15]. Among these injuries, the stair-related injury rate was highest in adults over the age of 60 years. ...
... This is consistent with existing literature indicating that most falls among older adults and most fragility fractures occur at home [3]. The majority of stair-related injuries across all age groups also occur at home, according to Blazewick et al., who postulated that women are more likely to sustain stair-related injuries because they statistically spend more time at home [15]. Additionally, as more people stayed in their homes during the COVID-19 pandemic, this may contribute to the rising incidence of UE stair-related fractures seen near the end of the study period. ...
... People tend to not fall sideways on stairs as the typical movement pattern required is forwards with side walls or railings preventing sideways falls. Evidence-based strategies to improve stair safety include installing handrails that allow the hand to grip all the way around the railing, maintaining uniform stair pattern and geometry, increasing the length of the horizontal surfaces between stair ledges, improving the lighting around stairs, and removing stairway clutter [15]. In addition, policymakers should consider revising home and building codes to maximize compliance with stair-safety recommendations. ...
Unlabelled:
Upper extremity (UE) fractures are prevalent age-related fractures, and stair-associated falls are a common mechanism for these injuries. Our study has identified an increasing incidence of stair-related UE fractures and associated hospitalization rates among the older United States population between 2012-2021. Targeted prevention efforts should be implemented by health systems.
Introduction:
To analyze United States (US) emergency department trends in upper extremity stair-related fractures among older adults and investigate risk factors associated with hospitalization.
Methods:
We queried the National Electronic Injury Surveillance System (NEISS) for all stair-related fracture injuries between 2012 and 2021 among adults 65 years or older. The US Census Bureau International Database (IDB) was analyzed to calculate incidence rates. Descriptive analysis, linear regression analysis, and multivariate regression analysis were used to interpret the collected data.
Results:
Our analysis estimated 251,041 (95% CI: 211,678-290,404) upper extremity stair-related fractures among older adults occurred between 2012 and 2021. The primary anatomical locations were the humeral shaft (27%), wrist (26%), and proximal humerus (18%). We found a 56% increase in injuries (R2 = 0.77, p < 0.001), 7% increase in incidence per 100,000 persons (R2 = 0.42, p < 0.05), and an 38% increase in hospitalization rate (R2 = 0.61, p < 0.01) during the 10-year study period. Women sustained the majority of fractures (76%) and most injuries occurred in homes (89%). Advanced age (p < 0.0001), males (p < 0.0001), proximal humerus fractures (p < 0.0001), humeral shaft fractures (p < 0.0001), and elbow fractures (p < 0.0001) were associated with increased odds of hospitalization after injury.
Conclusion:
Stair-related UE fracture injuries, incidence, and hospitalization rates among older adults are increasing significantly, particularly among older females. Improving bone health, optimizing functional muscle mass, and "fall-proofing" homes of older age groups may help mitigate the rising incidence of these injuries.
... Falls on stairs occur across the lifespan [14][15][16]; average injury rate of stair-related falls in the United States demonstrates a trimodal distribution with peaks at � 3 years of age, young adults in their 20's, and adults � 85 years [16]. Higher injuries could result from physiological factors (e.g., decreased strength in older adults [17]), and/or behavioral factors (e.g., not using the handrail [18]). ...
... Falls on stairs occur across the lifespan [14][15][16]; average injury rate of stair-related falls in the United States demonstrates a trimodal distribution with peaks at � 3 years of age, young adults in their 20's, and adults � 85 years [16]. Higher injuries could result from physiological factors (e.g., decreased strength in older adults [17]), and/or behavioral factors (e.g., not using the handrail [18]). ...
... While both men and women demonstrated a peak in injury rate in their 20's, there are two observations that emphasize that young women are particularly susceptible to injury on stairs. First, the injury rate for young women is approximately 80% higher than the rate for young men [16]. Second, the injury rate is highest for women in their 20's relative to all other age decades (for both sexes) with the exception of women � 81 years [16]. ...
... In recent decades, the number of stair-associated falls has steadily increased, regardless of the patient age [5]. In the course of demographic change, older patients are more frequently affected by stair falls due to their frailty and dwindling muscle strength as well as general multimorbidity. ...
... In line with these findings, we were able to show that, with an increasing number of steps, the incidence of TBI and intracranial bleeding increased. Even though TBIs are a common pattern of injury after stair falls in other studies, in our study, TBIs are particularly prevalent, accounting for more than 80% of cases [5,23]. The high rate of TBI in our study might be due to the fact that all patients included in this study were primarily admitted via our trauma room, indicating that a severe trauma was assumed a priori in the preclinical setting. ...
... Comparison between patients under the influence of alcohol and patients not under the influence of alcohol.5 ...
Falling down a staircase is a common mechanism of injury in patients with severe trauma, but the effect of varying fall height according to the number of steps on injury patterns in these patients has been little studied. In this retrospective study, prospectively collected data from a Level 1 Trauma Center in Germany were analyzed regarding the injury patterns of patients admitted through the trauma room with suspicion of multiple injuries following a fall down a flight of stairs between January 2016 and December 2019. In total 118 patients were examined which where consecutively included in this study. More than 80% of patients suffered a traumatic brain injury, which increased as a function of the number of stairs fallen. Therefore, the likelihood of intracranial hemorrhage increased with higher numbers of fallen stairs. Fall-associated bony injuries were predominantly to the face, skull and the spine. In addition, there was a high coincidence of staircase falls and alcohol intake. Due to a frequent coincidence of staircase falls and alcohol, the (pre-)clinical neurological assessment is complicated. As the height of the fall increases, severe traumatic brain injury should be anticipated and diagnostics to exclude intracranial hemorrhage and spinal injuries should be performed promptly to ensure the best possible patient outcome.
... Recent research has demonstrated that falls are a serious concern not only for older adults, but also for young adults [1][2][3][4][5][6]. The total cost of fall-related injuries for adults aged 18-24 in the US exceeded $7 billion in 2010 [6]. ...
... Examining sexrelated differences in falls in young adults is especially important as young females (aged 20-29 years) had a 25% increase in fall-related fractures in the 10 year period from 2000 to 2010, while in males of the same age, the increase was 5% (not statistically significant) [1]. Furthermore, females had a higher fall-related injury rate on stairs at all ages except � ten years [3], and the proportion of fall-related injuries on stairs was highest among young females [2]. ...
... The differences are likely due to the approach (prospective daily online survey vs retrospective report from past two years; retrospective reports are less accurate [17][18][19][20]), and the narrower range of ages observed here (18-27 vs 20-45 years). Overall, the results support the growing contention that falls are a serious concern for young adults [1][2][3][4][5][6]. ...
Falls are a major public health issue not only for older adults but also young adults, with fall-related injuries occurring more frequently in adult females than males. However, the sex differences in the frequency and circumstances of falls in young adults are understudied. This research quantified the frequency and circumstances of falls as a function of sex, physical activity, and prescription medications in young adults. For 16 weeks, young adult participants (N = 325; 89 males; 19.9±1.1 years) responded to a daily email asking if they had slipped, tripped, or fallen in the past 24 hours. Falls and fall-related injuries were not uncommon in young adults: 48% fell at least once, 25% fell more than once, and 10% reported an injury. The most common activities at the time of the fall for females were walking (44%) and sports (33%), and for males, sports (49%) and walking (37%). A zero-inflated Poisson model revealed that higher number of falls were associated with the following: higher levels of physical activity (p = 0.025), higher numbers of medications (p<0.0001), and being male (p = 0.008). Regarding circumstances of falling, females were more likely to be talking to a friend at the time of the fall (OR (95% CI): 0.35 (0.14–0.73); p = 0.01). For slips and trips without a fall, males and females reported the same number of slips (OR (95% CI): 0.885 (0.638–1.227) p = 0.46), but females reported more trips (OR (95% CI): 0.45 (0.30–0.67); p<0.01). Only females reported serious injuries such as concussion and fracture. In conclusion, the rate of falls in young adults was affected by physical activity levels, number of medications, and sex. Quantifying and understanding these differences leads to increased knowledge of falls across the lifespan and is instrumental in developing interventions to prevent falls.
... Overall, the opposite effect of sensory interference on foot placement is interesting: closer trail foot placement for younger adults and farther trail foot placement for older adults. This observation may be especially relevant for stair-related falls, which are common in both younger and older adults, as stairs require accurate foot placement [63,64]. The role of sensory interference should be considered when developing interventions to counter the high rate of falls and fall-related injuries observed in younger adults [28,30,32,63,65,66]. ...
... This observation may be especially relevant for stair-related falls, which are common in both younger and older adults, as stairs require accurate foot placement [63,64]. The role of sensory interference should be considered when developing interventions to counter the high rate of falls and fall-related injuries observed in younger adults [28,30,32,63,65,66]. When younger adults are visually distracted by other tasks, such as using electronic devices, they may be at greater risk of impaired locomotor behavior. ...
When older adults step over obstacles during multitasking, their performance is impaired; the impairment results from central and/or sensory interference. The purpose was to determine if sensory interference alters performance under low levels of cognitive, temporal, and gait demand, and if the change in performance is different for younger versus older adults. Participants included 17 younger adults (20.9±1.9 years) and 14 older adults (69.7±5.4 years). The concurrent task was a single, simple reaction time (RT) task: depress button in response to light cue. The gait task was stepping over an obstacle (8 m walkway) in three conditions: (1) no sensory interference (no RT task), (2) low sensory interference (light cue on obstacle, allowed concurrent foveation of cue and obstacle), or (3) high sensory interference (light cue away from obstacle, prevented concurrent foveation of cue and obstacle). When standing, the light cue location was not relevant (no sensory interference). An interaction (sensory interference by task, p<0.01) indicated that RT was longer for high sensory interference during walking, but RT was not altered for standing, confirming that sensory interference increased RT during obstacle approach. An interaction (sensory interference by age, p<0.01) was observed for foot placement before the obstacle: With high sensory interference, younger adults placed the trail foot closer to the obstacle while older adults placed it farther back from the obstacle. The change increases the likelihood of tripping with the trail foot for younger adults, but with the lead limb for older adults. Recovery from a lead limb trip is more difficult due to shorter time for corrective actions. Overall, visual sensory interference impaired both RT and gait behavior with low levels of multitask demand. Changes in foot placement increased trip risk for both ages, but for different limbs, reducing the likelihood of balance recovery in older adults.
... A large proportion of falls that require medical care in the general population involve stairs. An estimated 2949 ED visits associated with stair injuries occur daily in the United States (US) overall, resulting in over one million visits annually (Blazewick et al., 2018). ...
... Hazards play a large role in the occurrences of falls (Blazewick et al., 2018;Dunning et al., 2003Dunning et al., , 2010; 18.9% of our total cases mentioned a specific hazard that contributed to the stair-related injury. Wet and icy conditions were the most commonly mentioned hazard, which has implications for obstetricians and other healthcare providers who care for pregnant women to caution women, particularly during winter months or periods of increased rain. ...
Objectives
Falls are one of the leading causes of trauma during pregnancy, and most falls occur on stairs. The purpose of this study was to describe stair-related falls among pregnant women who were treated in United States emergency departments during a 10-year period.
Methods
This study utilized a cross-sectional analysis of National Electronic Injury Surveillance System (NEISS) data, 2008–2017. Emergency department visits by pregnant women aged 12 years and older were identified using case narratives.
Results
From 2008 to 2017, 1466 cases of pregnant women who had sustained stair-related falls were reported to NEISS, equating to a national estimate of 57,512 over the 10-year study period. Variables examined included age, body part injured, location of injury, discharge disposition, gestation, mechanism of injury, and other fall-associated hazards and symptoms. Most injuries involved contusions or abrasions, other injuries commonly reported were sprains/strains and contusions/abrasions. Wet/icy conditions represented hazards associated with 4.1% of all injuries. Severe obstetric symptoms, such as decreased fetal movement and vaginal bleeding, were described in study narratives.
Conclusions
Falls are a leading cause of injury among women of childbearing age and stair-related falls comprise a large proportion of maternal falls. Physiological changes associated with pregnancy can put gravid women at greater risk for falls. Healthcare providers can provide women anticipatory guidance that may reduce their risk for falls as they progress in pregnancy.
... Stairway falls are a major public health problem, accounting for over one million stair-related injuries each year in the United States (Blazewick et al., 2018), and 10% of fall-related deaths in Canada (Parachute, 2015). Approximately half of falls during stair descent are in the forward direction (Templer, 1995), and are often attributed to missteps, oversteps or trips. ...
... The high magnitude group was also more likely to execute incomplete recovery steps, which may reflect the higher forward COM velocity requiring quicker compensatory stepping and more recovery steps to control the COM with respect to the feet. One possible consequence is that incomplete or inadequate stepping may increase the risk of contacting the step at an awkward angle or with high plantarflexion, and the high downward velocity increases the demands on lower limb muscles while stepping (Blazewick et al., 2018;Reeves et al., 2008;Samuel et al., 2011). It is also important to note that the treads in this study were a fixed length of 11" (28 cm), which exceeds the minimum requirements of many codes and standards. ...
Falls during stair descent pose a major health concern. A stronger understanding of recovery from balance loss during stair descent is needed to guide fall prevention strategies and environmental design. We characterized balance recovery strategies, trunk and center-of-mass (COM) kinematics, and handrail use following unexpected forward balance loss during stair descent, and the effect of perturbation magnitude on these outcomes. Eighteen young adults experienced a rapid platform translation during stair descent to disrupt balance. Deception was used to reduce anticipation. All participants used compensatory stepping to recover balance, and most applied forces to the handrail in multiple directions. Higher perturbation magnitude resulted in higher COM velocity and handrail forces, more frequent incomplete steps, and quicker step contact time. Our findings provide a foundation for understanding balance recovery on stairs. The findings emphasize the importance of designing stairways that enable compensatory stepping, and handrails that permit adequate force generation in multiple directions to facilitate balance recovery on stairs.
... In the UK approximately 10 fatalities per week are linked with stair falls (Roys, 2013). Although older adults are at the highest risk of serious injury from a stair fall (70% of fatal stair falls) (BSI, 2010), younger persons are also reported to have a high injury rate (Blazewick et al., 2018). The mechanisms behind stair falls are multifactorial and still to be properly understood. ...
... Older adults are generally at a greater risk of stair falls than younger adults (Blazewick et al., 2018;BSI, 2010), but it is not known whether they respond to stair inconsistencies in a different way. The ageing-associated deteriorations in vision, as well as musculoskeletal function and motor control (Startzell et al., 2000), may make older adults less able to detect inconsistencies and modify their behaviour to the environment appropriately, and be less able to respond to a loss of balance putting them at a greater risk of a fall. ...
Stairs are associated with falls, especially when step dimensions are inconsistent. However, the mechanisms by which inconsistencies cause this higher risk are mostly theoretical. In this experimental study we quantified the effect of inconsistent rise heights on biomechanical measurements of stepping safety from younger (n = 26) and older adults (n = 33). In ascent, both groups decreased foot clearance (~9 mm) over the inconsistently higher step (F(1,56) = 48.4, p < 0.001). In descent, they reduced foot contact length on the higher step by 3% (F(1,56) = 9.1, p < 0.01). Reduced clearance may result in a toe-catch potentially leading to a trip, while reduced foot contact lengths increase the risk of overstepping which may also lead to a fall. These effects occurred because participants did not alter their foot trajectories, indicating they either did not detect or were not able to adjust to the inconsistent rise, increasing the likelihood of a fall. Consistent stair construction is vital, and existing inconsistencies should be identified and safety interventions developed.
... In America, the number of people injured as a result of stair accidents is more than 984.000 (Accident Facts, 1998). Blazewick et al. analyzed more than 24 million stair related injuries treated in emergency departments between 1990 and 2012 (Blazewick, Chounthirath, Hodges, Collins, & Smith, 2018). According to this research, cause of accident rates can be seen Figure 4. ...
... Age weight of stair accidents in America(Blazewick, Chounthirath, Hodges, Collins, & Smith, 2018)In British Columbia, stairs were involved in approximately %8.2of all hospitalizations and %68 of these accidents happened in houses. For British Columbia, stair related accidents cost $17 million during 2013/2014 fiscal year(Discharge Abstract Database, 2013). ...
Stair accidents occur very often and are the cause of serious health issues. When the literature examined, it is observed that, serious number of people injured or even dead due to stair related accidents. Fiscal perspective of stair accidents is another imported issue. For instance, cost of stair related accidents in terms of health is more than 17$ million annually for British Columbia of Canada. Accordingly, the importance of designing safer and effective stairs is obvious. In this perspective, design related injuries and fatalities are evaluated and design necessities for a safer stair is discussed.
Key Words: Stair Accidents, Safety, Stair Design, Turkey
... This finding is supported by Blazewick et al, who investigated stair-related injuries querying a national database from 1990 to 2012. 36 The authors found that over 1,000,000 stair-related injuries occurred every year, with injuries most commonly occurring in patients 11-60 years-old. Moreover, other investigations have reported similar findings that stairs are a common source of severe injury. ...
Introduction
Nerve injuries and resultant pain are common causes of emergency department (ED) visits in the United States. Injuries often occur either due to activity (ie sports related injury) or due to consumer products such as stairs or bedframes. We investigated the incidence of consumer product-related nerve injuries (CPNIs) in patients who presented to the ED in the United States.
Materials and Methods
The National Electronic Injury Surveillance System was queried to identify patients presenting to US EDs between 2012 and 2021 with CPNIs. The cohort was categorized by age: 1) 0–17-year-olds, 2) 18–64-year-olds, 3) and 65+ year-olds. The primary outcomes were the type of injury and the location of injury.
Results
A total of 14,410 CPNIs were reported. There was an increase in yearly CPNIs (β = 4763, (95% confidence interval 1940–7586); P = 0.004). The majority (11,547/14,410, 80.1%) of injuries were among adults. Elderly females encountered more CPNIs than males (52.5% vs 47.8%, P = 0.002). Stairs were most involved in nerve injuries among adults (8.21%) and children (3.96%) whereas beds or bedframe injuries were most frequent (12.0%) among the elderly. Sciatica was the most common diagnosis (≥60%) followed by radiculopathy (≥20%) in adults >18 years of age. Among adults aged 18 to 29, the upper trunk, lower arm, and wrist was more frequently involved, while these areas were less commonly involved in adults aged 40 to 49. Compared to adults, the pediatric and elderly patients presented with more traumatic spinal cord injuries.
Conclusion
Sciatica, radiculopathy, and traumatic spinal cord injury were the most common diagnoses following CPNIs. Children and the elderly tended to present with more severe CPNIs than the general adult population. Further investigations exploring interventions to lower the burden of CPNIs, improve consumer product safety, and reduce potentially chronic and debilitating injuries are necessary.
... This may be attributed to the fact that this particular demographic is predominantly composed of individuals aged sixty and over. As public buses are more easily accessible for this age group than RRT, which requires going up and down, this factor likely plays a role in their preference for the former (Blazewick et al., 2018). ...
This study contributes to environmental research by establishing a four-step research framework for analyzing city tourists’ low-carbon travel intentions and developing a low-carbon travel promotion (LTP) index. The purpose is to explore how perceived convenience of various low-carbon transport modes impacts low-carbon travel intentions of tourists with different travel styles, and provide a new tool to help cities reduce carbon emissions. Theoretically, this study establishes a framework for analyzing low-carbon travel intentions, highlighting the role of perceived convenience in promoting low-carbon transport among tourists. The framework explains how perceived convenience of transport in city destinations affects low-carbon travel intentions of tourists with different durations of stay and various amounts of monetary spend. The findings reveal a correlation between tourists’ length of stay and the amount of money they spend at a destination, and how this affects tourists’ perceived convenience of different transport modes and their low-carbon travel intentions. Methodologically, the study develops a LTP index that is validated on four types of tourists in 47 Chinese cities. Practically, this study provides recommendations for urban and transportation planners on how to promote climate-benign tourist mobility.
... Falls are a major health problem for older adults worldwide. The incidence and number of falls in elderly women were about twice as high as those in males in the United States (Blazewick et al., 2018). Falls can result in severe injuries, particularly in postmenopausal female adults with a risk of osteoporosis, such as soft tissue injuries, craniocerebral injuries, as well as fractures, and death among older adults (Mateen and Király, 2016). ...
Purpose: This study aimed to investigate the lower limb inter-joint coordination and variability during Tai Chi movements compared with normal walking in older adults.
Methods: A total of 30 female Tai Chi practitioners (70.9 ± 5.2 years) were recruited in this study. Herein, each participant performed three trials of the normal walking and Tai Chi movements. The lower limb kinematics data were collected with Vicon 3D motion capture system. The continuous relative phase (CRP) includes both spatial and temporal information of two adjacent joints, which was calculated to assess the inter-joint coordination of lower limbs. Coordination amplitude and coordination variability were assessed with mean absolute relative phase (MARP) and deviation phase (DP). MANOVOA was used to analyze inter-joint coordination parameters between different movements.
Results: The CRP values of hip-knee and knee-ankle segments in the sagittal plane of the Tai Chi movements changed frequently. The MARP values of the hip-knee (p < 0.001) and knee-ankle segments (p = 0.032) as well as the DP values of the hip-knee segment (p < 0.001) were significantly lower in Tai Chi than in normal walking.
Conclusion: More consistent and stable inter-joint coordination patterns of Tai Chi movements found in this study may be one of the critical factors that Tai Chi could be a suitable coordinated exercise for older adults.
... For affordances this means that many of relevant features and relations are ignored, with persisting bad performance as a result. For example, too many accidents occur on stairs (Blazewick et al. 2018), even though stairs are both heavily regulated and points of attention in designing. ...
Categorization of technologies by the order of their inbetweenness is a useful device for parsing complex structures info fundamental parts and understanding the application of a technology. This promises a coherent foundation for explaining how we deploy technologies in design, in particular with respect to the affordances they create. By connecting the categorization of technologies to the matching of user effectivities to features of the environment in affordances, the paper proposes an approach to the transparent description of the assemblages produced by design in terms of which technologies are involved and how they connect to each other, to the wider environment and to users. For affordances, this improves specificity concerning the features of the environment that are directly relevant to an interaction and the connections between these features and the rest of the environment. With respect to technologies, it helps understand not only why a technology may be used under certain circumstances but also abuse and underperformance. Finally, it supports design by providing means for parsing complex situations into chains of technologies between animals and environments. This helps explain how technologies modify effectivities, environments or relations between the two and how this affects design performance.
... Falls on staircases contribute significantly to the burden of fall-related injuries, with an annual estimate in excess of 1 million emergency department (ED visits annually in the USA. 6 While much of the focus on staircase fall injuries has been on the older adult population, 7-9 a few studies have examined younger populations and the role of alcohol use. [10][11][12][13][14][15] Alcohol has been found to be associated with TBI among persons who were injured falling on stairs. ...
Introduction
Falls are a leading cause of head injury in the USA. Stair-related fall injuries are common and often more serious than same level falls. Alcohol is a known contributor to unintentional injuries, and often associated with fall-related injuries, specifically falls occurring on stairs. The objective was to examine the association between alcohol use and head injuries (traumatic brain injuries (TBIs) or craniomaxillofacial (CMF) injuries) among persons aged 15–64 presenting to an emergency department (ED) with an injury resulting from a fall on stairs.
Methods
Using the 2019 National Electronic Injury Surveillance System, US ED records were examined. Injuries due to falling on stairs were retrieved, with the role of alcohol in the outcome of TBI and CMF injuries examined. Prevalence ratios (PR), adjusted for covariates (blood alcohol level screening, patient demographics, drug use, disposition) were obtained from average marginal predictions derived from logistic regression models.
Results
An estimated 687 902 patient visits related to falls on stairs occurred during the study period. Patients who presented with alcohol intoxication had a higher prevalence of TBI (PR 2.7 95% CI 2.3 to 3.1) and CMF injuries (PR 2.5; 95% CI 2.3 to 2.8). PRs were more pronounced among patients with blood alcohol concentration ≥0.1, as was hospital admission.
Conclusions
Stair-related falls represent a common cause of ED visits for falls in the USA. Alcohol intoxication had a detrimental effect on the prevalence of TBI and CMF. A multimodal treatment approach may be beneficial given the complex interrelationship between the injury type and alcohol.
... As a result, the item may not re ect the real home environment. C9 (the living environment needs to go up and down steps): the steps in the living environment (indoor or outdoor) are easy to cause the older people to fall [14] . However, since this item does not describe the contexts in detail, the older people often judge whether they need to go up and down steps at home, which may not re ect the real living environment. ...
Background: Fall is a common accidental injury of the older people, which seriously threatens their physical and mental health. The occurrence of fall often due to the interaction of multiple risk factors. The Fall Risk Self-Assessment Scale (FRSAS) is a multi-dimensional fall risk assessment tool. Pre-experiments have shown that the first version of FRSAS can be used for assessing the fall risks of the older people in communities, with strong operability and good reliability and validity. This study aims at further optimizing the items of the Scale through large sample survey, and assessing the reliability and validity of the revised FRSAS.
Methods: This study is a cross-sectional study, using the convenient sampling method. A total of 500 older adults aged 65 and above were recruited from four health service centers in Beijing from October 2021 to March 2022. Among whom, 489 subjects completed FRSAS as required, and the effective response rate of the Questionnaire was 97.8%; 44 subjects completed the repeated survey with the repeated measurement rate of 8.8%. The items of FRSAS were analyzed and screened to form the final version of the Scale with the comprehensive screening method, and the reliability and validity of the final version of the Scale were tested.
Results: The items of the Scale were compared and analyzed with the comprehensive screening method, of which, six items, namely D1, P12, C3, C9, C10 and H11, with two or more screening methods prompt to be deleted. After discussion by the experts, they agreed to delete the above 6 items and adjust the structure of the final FRSAS to 35 items and 4 dimensions. The Cronbach's α coefficient of the final FRSAS was 0.783 and the test-retest reliability was 0.98. Taking whether the subjects had a history of fall in the past year as the grouping variable, the total score of the Scale was tested by T test, and the difference between both groups was statistically significant (P =0.000).
Conclusion: The revision of the final version of FRSAS meets the actual needs of the older people in communities, with simple items and better reliability and validity. FRSAS can be used as an important reference tool for assessing the risks of fall in the older people in communities.
Trial registration: Registration number: ChiCTR2000038856; Date of registration:7 Oct 2020.
... The tasks of ascending and descending the steps of a staircase show the importance of adapting to varied terrain. Falls occurring on stairs present a signi cant public health risk to people of all ages [1]- [3], are responsible for over 1,000,000 visits to United States emergency departments annually [4], and represent a major cause of traumatic brain injury in adults [2]. Stairs can be particularly hazardous for the elderly, who must contend with age-related changes in mobility [5]- [8] and are more likely to experience potentially-fatal bone fractures following a fall [1], [3]. ...
Human ambulation is typically characterized during steady-state isolated tasks (e.g., walking, running, stair ambulation). However, general human locomotion comprises continuous adaptation to the varied terrains encountered during activities of daily life. To fill an important gap in knowledge that may lead to improved therapeutic and device interventions for mobility-impaired individuals, it is vital to identify how the mechanics of individuals change as they transition between different ambulatory tasks, and as they encounter terrains of differing severity. In this work, we study lower-limb joint kinematics during the transitions between level walking and stair ascent and descent over a range of stair inclination angles. Using statistical parametric mapping, we identify where and when the kinematics of transitions are unique from the adjacent steady-state tasks. Results show unique transition kinematics primarily in the swing phase, which are sensitive to stair inclination. We also train Gaussian process regression models for each joint to predict joint angles given the gait phase, stair inclination, and ambulation context (transition type, ascent/descent), demonstrating a mathematical modeling approach that successfully incorporates terrain transitions and severity. The results of this work further our understanding of transitory human biomechanics and motivate the incorporation of transition-specific control models into mobility-assistive technology.
... 5 Falling during stair descent accounts for three quarters of the stair-related falls. 6 Stiffness regulation is the first protective mechanism of motor nerve response while various emergencies occurring, 7 and it plays an important role in neuromuscular control and motor performance during locomotion. Many studies have reported leg stiffness or joint stiffness during locomotion. ...
Objective:
Lower limb stiffness strategies and work mode changes between young and older adults during stair descent are unclear. This study investigated the effect of aging on the lower limb stiffness, moments and joint work mode during stair descent.
Design:
Twenty young adults and Twenty older adults were recruited from the local community for stair descent test. Kinematics and kinetics data were collected by Vicon system and Kistler force plate. The lower limb stiffness, moments and work mode were calculated and assess between groups.
Results:
No significant differences in gait parameters were detected between groups. Compared with young adults, older adults have decreased leg stiffness, knee and ankle stiffness, increased peak hip extension moment, hip stiffness and ankle work contribution.
Conclusion:
The older adults actively reduce the lower limb stiffness to reduce the risk of injury during stair descent. The hip joint strategy reduces the risk of forwarding falls, and ankle joint compensation work mode to make up for the lack of knee extension strength. This provides a reference for the focus of exercise intervention and rehabilitation strategies for older adults.
... Approximately 3,000 people injure themselves daily falling on stairs every year in the United States, contributing to annual fallrelated medical costs of approximately $92 billion [1]. Moreover, individuals who have experienced one such fall are prone to fall again thus increasing the likelihood of serious injury [2]. ...
Falls on stairs occur frequently and pose a significant health and financial risk. Laboratory research has found that fall frequency can be reduced through contrast enhancement of the stairs by applying vinyl striping to the first and last steps' faces, and all the steps' top edges. Here we sought to determine if such step contrast enhancement can reduce the probability of fall-related events such as loss of balance, slips, trips, and falls in public university stairways. Cameras were used to capture stair users' ascent and descent on contrast enhanced ('striped') and control stairways. Observed age group, observed gender, traverse direction (ascent, descent), fall-related events, and walking speed (m/s) were recorded. Fall-related events were reduced for the striped stairway compared to the control stairway (odds ratio=2.87, average marginal effect=0.002, p=.023) when controlling for observed gender, age category, and traverse direction. These results suggest contrast enhancement of first and last steps' face and all steps' edges may reduce fall-related events in public settings. Adding contrast enhancement to public stairways is a simple and cost-effective way to reduce the loss of balance, slips, and trips that could lead to catastrophic falls on stairs as well as the health and financial burden associated with such falls.
... This may be attributed to the fact that this particular demographic is predominantly composed of individuals aged sixty and over. As public buses are more easily accessible for this age group than RRT, which requires going up and down, this factor likely plays a role in their preference for the former (Blazewick et al., 2018). ...
... Verghese et al (2008) demonstrated that while difficulties in ascending stairs occur more often, difficulties in descending stairs are associated with a wider range of limitations in activities of daily living (Verghese et al, 2008). Additionally, while descending is less metabolically demanding than ascending, descending is potentially more hazardous given that accidents seem to occur more often during descending (Startzell et al, 2000;Blazewick et al, 2018). Therefore, measurements of stair-climbing performance should distinguish between ascending and descending performance (Pancieri et al, 2010;Donath et al, 2014). ...
Background/Aims
The ability to climb stairs is an important prerequisite for activities of daily living and social participation in older adults, and is therefore an important part of rehabilitation. However, there is no consensus on how to measure stair-climbing ability. The aim of this study was to investigate the test–retest reliability of the measurement of stair-climbing speed (steps per second) as a parameter for functional ability in older adults.
Methods
A total of 57 participants who were in hospital and 56 participants who were community-dwelling and did not have any limitations in activities in daily living, all aged 60 years and over, ascended and descended a set of 13 stairs twice. The halfway point of the staircase was marked in order to split the time required for both the ascending and the descending actions. Additional measurements consisted of the Functional Reach Test, the Timed Up and Go Test, walking ability using the GAITRite walkway system and the isometric strength of four muscle groups of the lower extremities using a handheld dynamometer.
Results
Test–retest reliability of the first and second half of the stair-climbing for both ascending and descending showed excellent results for the group of hospitalised participants (intraclass correlation coefficient, [ICC] 0.87, 95% confidence interval [CI] 0.79–0.93 to 0.94, 95% CI 0.9 – 0.97 for comparison of first vs second half of stair climbing; ICC 0.9, 95% CI 0.83-0.94 to ICC 0.95, 95% CI 0.92–0.97 for comparing first vs second measurement)) and moderate to excellent results for the group of community-dwelling participants with no limitations (ICC 0.58, 95% CI 0.37–0.73 to ICC 0.76, 95% 95% CI 0.63-0.85 for comparison of first vs second half of stair climbing; ICC 0.82, 95% CI 0.71-0.89 to 0.92, 95% CI 0.87–0.95 for comparing first vs second measurement). As expected, hospitalised participants took significantly longer descending than ascending stairs (t(56)=6.98, P<0.001, d=0.93). A general and significant trend of increasing speed while descending could be observed in both groups (performing paired sample t-tests).
Conclusions
The results indicate that stair-climbing speed is not constant and that different patterns exist in older adults who have no limitations and in those who are hospitalised. The use of stair-climbing speed as an assessment tool should include both stair ascent and descent, because differences in these speeds seem to be indicators of stair-climbing ability.
... In a prospective study evaluating ladder-related falls and ED visits of 177 patients, the authors reported most falls occurring due to slips or missteps with about 45% of injuries occurring in patients ages 60 and older (Cabilan et al., 2018). Also consistent with our findings, bathrooms and in-or outdoor stairs or steps have been identified as high risk for fall-related injuries (Blazewick et al., 2018;Bleijlevens et al., 2010;Hanba et al., 2017), as well as having a cane or walker (Luz et al., 2017). ...
Falls are the leading cause of injuries and death among the elderly in the United States (U.S.). This study examined unintentional fall related-injuries and potential associations between various consumer products. Data was analyzed from the National Electronic Injury Surveillance System (NEISS) of hospital emergency department (ED) visits for unintentional injuries among the elderly between 2007 and 2017. Multiple logistic regression was used to examine the association between consumer products and fall-related injury ED visits. A total of 537,703 injury-related ED visits were analyzed. Two-thirds of visits were fall-related. Of those, 33% were among those 85 years and older, 62.5% occurred at home, 37.6% had head trauma, and 28.7% resulted in hospitalization. Flooring materials accounted for 29.1% of injuries. Ladders were significantly associated with fall-related injuries (adjusted odds ratio [AOR] 5.48, 95% confidence interval [CI] 4.72–6.36), followed by flooring materials (AOR 3.09, 95% CI 2.60–3.67), and porches and balconies (AOR 2.61, 95% CI 2.30–2.96). Several common consumer products are associated with fall-related injuries among the elderly. Increased awareness and education are critical.
... Overall, staircase descent is a precarious activity and is associated with the risk of trips, missteps, and falls [23]. A longitudinal study covering 1990-2012 revealed that approximately 1.07 million people per year in the United States visited the emergency department due to stair-related injuries [24]. Additionally, Canadian statistics determine that in 2010, falls from stairs were the leading cause of fall-related deaths, and were second to falls on level ground in hospitalizations, emergency visits and permanent disability [25]. ...
Movement on stairs is a crucial factor that influences people’s ability to evacuate from buildings in fire emergencies. In fact, the accessibility of stairs during multilevel evacuations is considered to be a criterion for the tenability of a building. Biomechanical analyses of pedestrian staircase descent add nuance by characterizing factors relevant to safe movement on stairs, such as foot placement, use of handrails, and balance. While these factors are not traditionally captured by evacuation analyses and models, their inclusion can point to areas of particular risk during evacuation from physiological, environmental, design, and engineering standpoints. This systematic review presents relevant biomechanical aspects, with a particular focus on factors that influence downward movement on stairs for evacuation purposes. The review begins with findings on walking speeds, gait analysis (e.g., cadence and foot clearance), as well as changing demographics are summarized. Then, research on balance control (vision, proprioception, and limb coordination) is presented, followed by findings on fatigue and grasping. Implications of the empirical findings are then considered for evacuation modelling, safer and more efficient evacuation procedures, as well as building design. Finally, limitations of the review itself and future research needs are explored.
... T he estimated annual average number and rate of stairrelated injuries have been highest in young adults. 1 Stair walking is a dangerous and challenging task and approximately 75% of stair falls occur during stair descent. 2 This situation could result in serious head injuries and fractures. 3 costs of injuries resulting from stair descent are extremely high for individual families and the healthcare system. ...
Background:
Stair descent is one of the most common and challenging daily activities for several populations, particularly under dual-task conditions. This study investigated the effects of cognitive or manual task on kinematics and kinetics during stair descent.
Methods:
A total of 37 participants performed stair descent under three conditions: stair descending only, stair descending while performing a cognitive task and stair descending while performing a manual task. Kinematic and kinetic data were collected. Multivariate analysis of variance with repeated measures was conducted to test the significant differences among the three conditions.
Results:
The gait performance, loading rate, lower limb joint moments and powers were significantly lower under the two dual-task conditions compared with stair descending only. The participants had lower knee flexion/extension range of motion, loading rate, peak hip flexion moment, first peak knee extensor moment, second peak ankle plantar flexion moment, first knee power absorption and less stride width under the manual task compared with the cognitive task.
Conclusions:
Dual tasks during stair descent had a significant impact on the kinematics and kinetics of motion, and the effect was more significant while performing a concurrent manual task in healthy young adults. Further studies could focus on the complexity level of dual tasks on the biomechanical parameters during stair walking.
... Taking the stairs is common in daily life; 10% of home accidents [1], 14% of occupational injuries related to work surfaces [2], and 26% of self-reported falls occur on stairs [3]. The continuously increasing number of the stair-related injuries [4] has made stairs one of the most hazardous locations for fall accidents [5] and the leading cause of accidental death for the elderly [3]. Stair descending accounts for 75% of falls among the elderly in communities [6]. ...
Stairs are among the most hazardous locations, and stair descending contributes to a high risk of falls among the elderly under dual-task (DT) conditions. The purpose of this study was to determine whether the practitioners of Tai Chi (TC), one type of mind-body exercise, have lower fall risks under DT conditions during stair descending, compared with their no-exercise (NE) counterparts. Fifteen TC practitioners with at least 10 years of experience in TC and fifteen NE participants were recruited in this study. They were asked to descend a six-step staircase under single-task (ST) and DT conditions. An eight-camera motion analysis system and two force plates were used for data collection. Results showed group by DT interactions in walking velocity (p = 0.016) and center of mass–center of pressure inclination angle (COM–COP IA) in the anteroposterior directions (p = 0.026). Group effects observed with foot clearance (p = 0.031), trunk (p = 0.041) and head (p = 0.002) tilt angles, and COM–COP IA in the mediolateral (p = 0.006) directions. Significant DT effects only detected in foot clearance (p = 0.004). Although both groups of participants adopted a more cautious gait strategy under the dual-task condition, the TC practitioners were less influenced by the DT paradigm than their NE counterparts. Our observations indicated that TC practitioners have lower fall risks under DT conditions during stair descending.
... Our findings can inform handrail design recommendations that support effective handrail use in demanding, balance recovery scenarios. Falls on stairs cause over 1 million emergency room visits each year in the United States (Blazewick et al., 2018). Handrail use is a common strategy for recovering from balance loss (Gosine et al., 2021(Gosine et al., , 2019King et al., 2011). ...
Handrails have been shown to reduce the likelihood of falls. Despite common use, little is known about how handrail shape and size affect the forces that people can apply after balance loss, and how these forces and the corresponding ability to recover balance depend on age. Following rapid platform translations, 16 older adults and 16 sex-matched younger adults recovered their balance using seven handrail cross-sections varying in shape and size. Younger adults were able to withstand higher perturbations, but did not apply higher forces, than older adults. However, younger adults achieved their peak resultant force more quickly, which may reflect slower rates of force generation with older adults. Considering handrail design, the 38mm round handrails allowed participants to successfully recover from the largest perturbations and enabled the highest force generation. Conversely, tapered handrails had the poorest performance, resulting in the lowest force generation and withstood perturbation magnitudes. Our findings suggest that the handrail cross-sectional design affects the magnitude of force generation and may impact the success of recovery. Our findings can inform handrail design recommendations that support effective handrail use in demanding, balance recovery scenarios.
... Focusing on study-related commuting accidents, the vast majority of accidents happened outside. Only twelve accidents happened on the stairs inside a building which stands in contradiction to the quite high number of reported injuries and deaths by stair-related accidents in the general population [32,33]. The relatively low number of only twelve reported stair-related accidents in 6 years might be due to two reasons. ...
Einleitung
Als wichtigste bildungspolitische Institution Deutschlands bilden Hochschulen die Lebenswelt des Studierens [1]. Schon im Jahr 1997 hat die Weltgesundheitsorganisation (WHO) dem Setting Hochschule vielfältige Möglichkeiten zugesprochen, auf die gesundheitlichen Belange von Studierenden einzuwirken. Im Wintersemester 2018/19 waren deutschlandweit knapp 2,9 Mio. Studierende an den 429 Hochschulen eingeschrieben [2].
Aufgrund ihrer erheblichen Konsequenzen für die Gesundheit, stellen Unfälle eine zentrale Herausforderungen für das Gesundheitssystem dar [3]. Allein in Deutschland finden in der Allgemeinbevölkerung jährlich rund 10 Mio. Unfälle statt [4]. Trotz steigender Studierendenzahlen stellen Unfälle von Studierenden ein epidemiologisches Dunkelfeld dar. Zudem liefern die wenigen bekannten Studien heterogene Ergebnisse [5–7].
Das im Rahmen des Präventionsgesetzes geförderte Modellvorhaben „Healthy Campus Mainz – gesund studieren“ adressiert dieses Dunkelfeld.
Methoden
Retrospektive Analyse aller an die Unfallkasse Rheinland-Pfalz (UKRLP) gemeldeten Unfälle von Studierenden der Universität Mainz zwischen 12/2012 und 12/2018. Inferenzstatistische Verfahren wurden verwendet, um zu überprüfen, ob sich die relative Häufigkeit von Arbeits- und Wegeunfällen stratifiziert nach Fachbereichen von der relativen Unfallverteilung auf Arbeits- und Wegeunfälle der Gesamtanzahl an gemeldeten Unfällen, signifikant unterscheidet.
Ergebnisse
Insgesamt wurden 1.285 Unfälle gemeldet, davon waren 71,8% (n=922) Arbeitsunfälle. Studierende der Fakultät 04–Medizin (p=0,003), der Fakultät 09–Chemie, Pharmazie, Geographie und Geowissenschaften (p<0,001) sowie Teilnehmer*innen des Allg. Hochschulsports (p<0,001) erlitten signifikant häufiger einen Arbeitsunfall als einen Wegeunfall. Häufigste Ursache für einen Arbeitsunfall an der medizinischen Fakultät waren Nadelstichverletzungen mit 66,5%.
Die meisten der 363 Wegeunfälle fanden mit dem Fahrrad (n = 226; 40.5%) statt und lediglich zwölf (3,3%) passierten beim Treppengehen innerhalt eines Universitätsgebäudes.
Diskussion
An der Universität Mainz haben sich drei Bereiche mit einem erhöhten Risiko für Arbeitsunfälle herauskristallisiert. Nadelstichverletzungen bei Medizinstudierenden scheinen von besonderer Relevanz zu sein. Die Ursachen für diese Unfälle auf Personen- und Bedingungsebene gilt es im Rahmen von Folgestudien zu untersuchen, um mittels gezielter Präventionsmaßnahmen das Unfallrisiko reduzieren zu können.
... Focusing on study-related commuting accidents, the vast majority of accidents happened outside. Only twelve accidents happened on the stairs inside a building which stands in contradiction to the quite high number of reported injuries and deaths by stair-related accidents in the general population [32,33]. The relatively low number of only twelve reported stair-related accidents in 6 years might be due to two reasons. ...
Background:
Universities represent an important setting of everyday life for health promotion. The aim of the present study was to assess whether university students of specific disciplines might have an increased risk for having a study-related work accident and to analyze what types of study-related work accidents occur most frequently. Furthermore, knowledge regarding study-related commuting accidents will be provided by identifying places where study-related commuting accidents might occur most frequently and on potential types of commuting (walking vs. biking) which might be associated with an increased risk for having a study-related commuting accident.
Methods:
Retrospective analyses of a dataset provided by the Accident Insurance Fund of Rhineland-Palatinate, Germany, including all accidents that happened at the University of Mainz (JGU) between December 2012 and December 2018 were performed. Binominal tests were computed to reveal whether the frequency of study-related work accidents in students affiliated with a specific faculty or institution differs significantly from the expected frequency of all reported study-related work accidents.
Results:
Overall, 1285 study-related accidents were analyzed-of which, 71.8% were work and 28.2% commuting accidents. Students of 'Faculty-Medicine' (80.5%; p = 0.003), 'Faculty-Chemistry, Pharmaceutical Sciences, Geography and Geosciences' (90.7%; p < 0.001), and students that participated in study-related sports activities (97.4%; p ≤ 0.001) had a significantly increased risk for the occurrence of a study-related work accident. Needlestick and sharps injuries (NSIs) as well as lab accidents play a pivotal role. Furthermore, above 40% of the study-related commuting accidents were cycling accidents.
Conclusions:
There is a call for prevention in order to decrease the number of NSIs among medical students, lab accidents as well as sport-related accidents. Concrete implications for prevention are discussed in the present paper. In addition, given that students are among the most likely to bicycle, and given that most bicycle-related accidents involve fatal injuries, cycling safety campaigns need to be initiated on campus.
... considerably with ageing and falls can lead to serious injury, hospitalisation and even death (Blazewick, Chounthirath, Hodges, Collins, & Smith, 2018, Public health Agency of Canada, 2014. In Canada, falls are the leading cause of injuries among seniors and it is estimated that between 20 and 30% of older adults fall each year (Public health Agency of Canada, 2014). ...
Background:
Older adults are at greater risk of falls while descending stairs. Cognitive deficits can further influence one's ability and mild cognitive impairments (MCI) specifically affect visual attention and dual tasking behavior. The present study aimed at comparing the attentional costs at different points during the approach to and descent of a staircase between older adults with and without MCI.
Methods:
Eleven older adults with MCI and twenty-three healthy older individuals without cognitive impairments were recruited. Neuropsychological tests were carried out. In addition, participants approached and descended a 5-step staircase while a simultaneous visual Stroop dual-task was randomly introduced during the approach, transition or steady state descent phases across trials. Three-dimensional kinematics and accuracy on the Stroop task were analyzed and dual task costs were calculated.
Results:
The MCI group showed deficits for visuo-spatial attention, memory and multi-tasking abilities, as well as balance and decreased confidence for falls efficacy, but not for daily activity scores. Despite such changes, this group of community-dwelling individuals with MCI presented a functional capacity to descend stairs even during divided visual attention. However, there were subtle, but significant, group differences for movement fluidity and performance on the simultaneous cognitive task, particularly during the approach and transition to descent phases. The MCI group also tended to descend slower while using the handrails more than healthy older adults.
Conclusion:
The present cohort of community-dwelling older adults with MCI were functional, but appeared to prioritize locomotor demands over the simultaneous cognitive task in a possible "posture first" strategy to descend stairs. The present findings should be considered for developing more ecologically based clinical assessments of mobility deficits following cognitive impairments, with the approach and transition phases during stair descent as key points of focus.
Purpose
The demographics of the world’s population have changed over time. Previous research demonstrated the high rate of falls among elderly people living in rural areas in their own houses. This study aimed to use the Thai-Home Fall Hazard Assessment Tool (Thai-HFHAT) to look into the environmental factors inside and outside of residential homes connected to falls among elderly living in rural Thailand.
Methods
Data was gathered between August and October 2023 using a questionnaire to obtain demographic data and the 44-question Thai-HFHAT survey. The survey was divided into seven sections covering the areas inside and outside the elderly home facility. Descriptive statistics were used in the data analysis, and statistical tests, including Fisher’s exact test and the Chi-square test, were used to examine the relationship between environmental factors and falls in elderly people.
Results
The study found that issues with an elderly rural home included split-level flooring in the living room, bathroom, and bedroom, an insecurely attached carpet in the kitchen and bedroom, and a shower area not separated from the toilet. The environmental factors linked to falls among the elderly encompass insufficient lighting in the living room, bathroom, bedroom, and parking garage, debris and obstacles such as wires along the path in the living room and parking garage, and the poor condition of the staircase, characterized by inconsistent step heights or a slippery surface.
Conclusion
Community agencies should consider the living conditions of elderly people in rural areas to effectively reduce the occurrence of falls among this population.
Properly designed and installed interior stairs provide safe and convenient access to all residents of the house, including children and elderly people. While safety considerations are paramount for stair design and placement decisions in a two-storey single-family house, sustainability becomes another important factor in these deliberations. Nevertheless, safety and sustainability of the interior stairs can be seen as conflicting objectives in decision-making processes (i.e., while a larger staircase area positively affect residents’ climbing ability, it also causes higher energy consumption and material usage). Therefore, increased awareness of stair-project selection processes is required when multi-objective tasks are involved. Seven criteria affecting stair safety and sustainability in a single-family house are identified in this paper. The integrated AHP-MEREC criteria-weighting approach is proposed, to determine their weights in decision-making processes. Four different multi-criteria decision-making (MCDM) approaches, ARAS, SAW, TOPSIS and PROMETHEE, were used to determine alternative evaluations. Since the selection of the most suitable MCDM method is full of uncertainties, the novel combined-decision-making approach formally called CORST (COmbining MCDM appRoaches using method STability coefficient) is proposed in this paper. The new method stability coefficient is used to determine the stability and reliability of the specific MCDM approach. Nine U-shaped inside-staircase projects dedicated to a single-family house were evaluated, to test the effectiveness of the CORST approach.
Falls on stairs are commonly claimed to be caused by slipping on the tread nosing, but few studies have explored specific foot kinematics at initial contact during stair descent. Further understanding of such kinematics can aid forensic incident investigations. We investigated foot posture at initial contact with the tread surface of seven participants while descending stairs to determine: a) foot posture variability across participants, and b) the effects of foot posture with respect to the nosing on foot placement. We calculated foot posture as the angle at initial contact relative to the horizontal plane using two consistent landmark points on the subjects’ shoes. Our preliminary results demonstrated inter-subject and intra-subject significant differences in foot posture (P<0.05) for both legs. These results demonstrate that further exploring this at specific instances of the gait cycle during stair descent is crucial to better understand fall events during forensic investigations.
Mechanical falls occur because of environmental factors rather than medical conditions. However, persons with medical disorders are more vulnerable to falls because of environmental conditions. Efforts to create a safer home environment can reduce the fall rate in high-risk individuals by 38%. Since vision plays a role in maintaining balance, walking in darkness and without a night-light contributes to falls. Most falls occur in the bathroom but can occur anywhere and are related to losing balance because of slipping on a slick floor or tripping over an obstacle blocking access to the toilet, bath, or shower. Falls occur when grab bars and mats are unavailable or not used. Other causes of falls include not using the handrails on stairs, tripping over an uneven surface or wrinkled carpet, falling from a ladder, and not using a walker, cane, or wheelchair appropriately. Standing too quickly can cause light-headedness and result in a fall. The factors contributing to falling outdoors include improper footwear, not using hiking sticks, and neglecting uneven surfaces on the trail.
Objectives
Falls are the leading cause of non-fatal injury among young children. The aim of this study was to identify and quantify the circumstances contributing to medically attended paediatric fall injuries among 0–4 years old.
Methods
Cross-sectional data for falls among kids under 5 years recorded between 2012 and 2016 in the National Electronic Injury Surveillance System was obtained. A sample of 4546 narratives was manually coded for: (1) where the child fell from; (2) what the child fell onto; (3) the activities preceding the fall and (4) how the fall occurred. A natural language processing model was developed and subsequently applied to the remaining uncoded data to yield a set of 91 325 cases coded for what the child fell from, fell onto, the activities preceding the fall, and how the fall occurred. Data were descriptively tabulated by age and disposition.
Results
Children most often fell from the bed accounting for one-third (33%) of fall injuries in infants, 13% in toddlers and 12% in preschoolers. Children were more likely to be hospitalised if they fell from another person (7.4% vs 2.6% for all other sources; p<0.01). After adjusting for age, the odds of a child being hospitalised following a fall from another person were 2.1 times higher than falling from other surfaces (95% CI 1.6 to 2.7).
Conclusions
The prevalence of injuries due to falling off the bed, and the elevated risk of serious injury from falling from another person highlights the need for more robust and effective communication to caregivers on fall injury prevention.
Fractures are common in children. Fractures may occur before, during and after birth. Fractures due to birth trauma occur infrequently and mostly are fractures of the clavicle. An overview of fractures due to birth trauma is given in this chapter. Accidental fractures due to trauma after birth are common with approximately one-third of children sustaining a fracture before the age of 17 years. In a large Swedish study, the overall annual incidence of fractures in children was 2.1% (2.6 for boys; 1.7 for girls). In this chapter, the different accidental trauma scenarios (short and long distance falls, medical procedures and sporting activities) are discussed and illustrated with examples.KeywordsTrauma during birthTrauma after birthShort-distance fallsLong distance fallsTrauma due to medical proceduresTrauma due to sporting activities
Human ambulation is typically characterized during steady-state isolated tasks (e.g., walking, running, stair ambulation). However, general human locomotion comprises continuous adaptation to the varied terrains encountered during activities of daily life. To fill an important gap in knowledge that may lead to improved therapeutic and device interventions for mobility-impaired individuals, it is vital to identify how the mechanics of individuals change as they transition between different ambulatory tasks, and as they encounter terrains of differing severity. In this work, we study lower-limb joint kinematics during the transitions between level walking and stair ascent and descent over a range of stair inclination angles. Using statistical parametric mapping, we identify where and when the kinematics of transitions are unique from the adjacent steady-state tasks. Results show unique transition kinematics primarily in the swing phase, which are sensitive to stair inclination. We also train Gaussian process regression models for each joint to predict joint angles given the gait phase, stair inclination, and ambulation context (transition type, ascent/descent), demonstrating a mathematical modeling approach that successfully incorporates terrain transitions and severity. The results of this work further our understanding of transitory human biomechanics and motivate the incorporation of transition-specific control models into mobility-assistive technology.
Objective: This study aims to evaluate the test–retest reliability of kinematics and kinetics during single and dual-task stair walking in the elderly.
Methods: Fifteen healthy elderly adults were recruited. Kinematic and kinetic parameters were measured using an infrared motion analysis system (Vicon, Oxford Metrics Ltd., Oxford, United Kingdom) and force platforms (Switzerland, Kistler 9287BA and 9281CA). Participants were tested under single-task and dual-task (serial 3 subtractions or carrying a cup of water) conditions. Each participant completed two sessions on two separate days with a 1-week interval. Intraclass correlation coefficients (ICC), Pearson correlation coefficient (r), and Bland–Altman plot were used to assess the reliability of stair walking.
Results: When ascending stairs, the ICC of kinematics and kinetics ranged from fair to excellent (ICC = 0.500–0.979) in the single and dual tasks, except for step length (ICC = 0.394) in the single task. The r value of kinematics and kinetics ranged from 0.704 to 0.999. When descending stairs, the ICC of kinematics and kinetics ranged from good to excellent (ICC = 0.661–0.963), except for min hip moment (ICC = 0.133) and min ankle moment (ICC = 0.057) in the manual task. The r value of kinematics and kinetics ranged from 0.773 to 0.960 in the single and dual tasks. In the Bland–Altman plots, all the zero values and most of the dots fell in the 95% confidence interval, and the mean difference was found to be close to zero for all the parameters during stair walking.
Conclusion: These results obtained from this study show the good test-retest reliability of step cadence, step speed, and step width during single- and dual-task stair walking in the elderly, and the poor reliability of step length during ascending stairs. All the kinetic parameters, including min hip moment, max knee moment, and min ankle moment, had good test-retest reliability during single- and dual-task stair walking, but min hip moment and min ankle moment had poor reliability during manual-task descending stair. These results may help researchers in the assessment of biomechanics of dual-task stair walking in the elderly and to interpret the effect of interventions in this population.
Serious falls occur frequently on stairs with inconsistent dimensions. Inconsistent smaller goings are thought to reduce user's foot clearances and foot contact lengths since individuals do not detect and alter their behaviour prior to the inconsistency, increasing the risk of a trip, heel-catch or over-step and potential slip on the stairs. So far, these mechanisms for a stair fall remain theoretical only. The aim of this paper was to identify the underlying mechanisms by which steps with inconsistent going size increase the risk of falls. For this study twenty-seven younger adults (24 ± 3 y, 1.74 ± 0.09 m, 71.41 ± 11.04 kg) and thirty-three older adults (70 ± 4 y, 1.68 ± 0.08 m, 67.90 ± 14.10 kg) ascended and descended a seven-step instrumented staircase in two conditions: 1) consistent dimensions with 200 mm risers and 250 mm goings and 2) inconsistent going dimensions where the going of the third step was reduced by 10 mm, and consequently the going of the second step was larger by 10 mm. Five repeated trials on the inconsistent stairs were performed to assess if there was an adaptation effect after first exposure.
In descent in the first inconsistent trial, foot contact lengths were not significantly different between conditions for the younger and older adults on the inconsistently shorter step (∼1%, p = .121). Foot trajectories were pulled further back in the last 22% of swing before contact (p = .025), contradicting previous expectations. Younger adults then had reduced clearances over the next step (∼5 mm, p = .027), which was inconsistently longer, increasing the risk of a heel-catch, whereas foot clearances for older adults were not different. With repeated inconsistent trials the foot contact length of older adults reduced on the shorter step (p = .024).
In ascent, in the first inconsistent trial, interaction effects were detected between groups and conditions on three steps: the inconsistently longer step (p = .003), the shorter step (p = .004), the next step (p = .006), as well as on the walkway (p = .048). Older adults positioned themselves further away from the stairs on the walkway compared to younger adults and then had a reduced foot contact length on the inconsistently shorter step (∼2.8%, p = .026), increasing the chances of under-stepping and slipping off the shorter step. Whereas younger adults were positioned closer to the stairs on the walkway, had increased foot contact lengths on the inconsistently longer step and contact lengths that were not different on the inconsistently shorter step. With repeated inconsistent trials, foot contact lengths were reduced on the longer step (p = .006) and then on the shorter step (p = .018).
These findings contradict previous assumptions that individuals do not adapt to inconsistent goings on stairs. In descent on the first trial, both groups adjusted their stepping behaviour late in the swing prior to contact with the first inconsistent step. In ascent younger adults made changes to their position and stepping behaviour before stepping on the stairs. These behaviours to mitigate the risk of the inconsistent step, did not persist in the repeat trials. Future investigations should establish the magnitude at which inconsistencies are detectable and can be acted upon and should include a wider range of individuals. This type of research could help inform future initiatives to prevent serious stair falls.
Tam metnine https://www.guvenplus.com.tr/imagesbuyuk/70758MVMY.pdf adresinden erişilebilir.
Endüstri 4.0 ile birlikte iş yaşamında köklü değişimler meydana gelmiş olup halen uygulanmakta olan İş Sağlığı ve Güvenliği (İSG) tekniklerinde ve risklerinde önemli değişiklikler meydana getirmiştir. Üre tim olgusundaki bu değişimler ile birlikte iş yerlerinde günümüz İSG tekniklerinin yetersiz kalacağı değerlendirilmektedir. Gelinen aşamada robotlar, giyilebilir destek kıyafetleri (eksoskeletonlar), Yapay Zekâ (YZ) tabanlı izleme, akıllı Kişisel Koruyucu Donanım (KKD) ve iş birlikçi robotların (cobotlar) iş yerlerinde artan bir oranda kullanılması ile yeni iş risklerinin ortaya çıkacağı değerlendirilmektedir. Tüm bu değişimler İSG’ nin daha karmaşık ve yönetilmesi zor bir süreç olmasına neden olabilecektir. Bu nedenle, diğer disiplinlerde olduğu gibi, İSG alanında da YZ uygulamalarının kullanılarak başarılı ve yüksek doğrulukta risk analizi, kaza analizi ve tahmini yapılarak güvenli işyerlerinin oluşturulabileceği değerlendirilmektedir. Bu çalışmada İSG alanında YZ teknikleri kullanılarak geliştirilen araştırmalar ve iyi uygulama örnekleri değerlendirilmiştir. Bu derleme çalışması sonucunda İSG alanında YZ çalışmalarının uzman sistemler, makine öğrenmesi ve veri madenciliği alt başlıkları altında toplandığı görülmüştür. Alan bazında yapılan çalışmalarla birlikte piyasada da satışa sunulan YZ uygulamalarının mevcut olduğu tespit edilmiştir. Sonuç olarak; yapılan çalışmalar neticesinde risk değerlendirmesinin daha kısa zamanda ve insan ha tasında arındırılmış olarak yapıldığı, kaza tahmin modellerinin yüksek doğrulukta tahminlerde bulunduğu, kaza kök nedenlerinin oldukça et kin olarak tespit edilebildiği ve geliştirilen modellerin oldukça başarılı sonuçlar verdiği görülmüştür. Sağlıklı çalışan ve güvenli iş yerlerinin oluşturulabilmesi günümüz endüstriyel şartlarında YZ uygulamalarının kullanılarak daha etkili sağlanabileceği tahmin edilmekte olup ilerleyen süreçte daha fazla kullanım alanı bulacağı değerlendirilmektedir.
Handrails have been shown to reduce the likelihood of falls. Despite common use, little is known about how handrail shape and size affect the forces that people can apply after balance loss, and how these forces and the corresponding ability to recover balance depend on age. Following rapid platform translations, 16 older adults and 16 sex-matched younger adults recovered their balance using seven handrail cross-sections varying in shape and size. Younger adults were able to withstand higher perturbations, but did not apply higher forces, than older adults. However, younger adults achieved their peak resultant force more quickly, which may reflect slower rates of force generation with older adults. Considering handrail design, the 38mm round handrails allowed participants to successfully recover from the largest perturbations and enabled the highest force generation. Conversely, tapered handrails had the poorest performance, resulting in the lowest force generation and withstood perturbation magnitudes. Our findings suggest that the handrail cross-sectional design affects the magnitude of force generation and may impact the success of recovery. Our findings can inform handrail design recommendations that support effective handrail use in demanding, balance recovery scenarios.
Purpose
The purpose of this study is to determine what potential factors are associated with increased risk of hospital admission among the geriatric population who suffer stairway falls.
Materials and methods
This is a 10-year cross-sectional study that was conducted using the National Electronic Injury Surveillance System (NEISS). Entries whose primary product was categorized under the code 1239 (stairs or steps) were included in this study. Reports were excluded if the injury did not occur within the craniomaxillofacial region. The principal outcome variable was admission rate. Patient and injury characteristics were compared using chi-squared and independent sample t tests.
Results
Admission rates were significantly associated with sex (P < 0.01) age group (P < 0.01), race (P < 0.05), craniomaxillofacial region (P < 0.01), and primary diagnosis (P < 0.01). Relative to the females, males (OR, 1.458; P < .01) were independently associated with an increased odds of admission. Relative to patients aged 65-69 years old, patients aged 70-79 (OR, 1.247; P < .01), 80-89 (OR, 1.438; P < .01), and 90 & over (OR, 1.569; P < .01) were each independently associated with an increased odds of admission. Relative to white patients, black patients (OR, 1.238; P < .01) were each independently associated with an increased odds of admission. Relative to mouth injuries, eyeball injuries (OR, 4.574; P < .01) and head injuries (OR, 4.105; P < .01) were independent risk factors for admission. Relative to abrasions, fractures (OR, 6.013; P < .01) and internal organ injuries (OR, 4.814; P < .01) were each independently associated with an increased odds of admission.
Conclusions
Age, gender, craniomaxillofacial region, type of injury, and primary diagnosis are all independent risk factors for hospital admissions. Preventative measures need to be taken to safeguard the older geriatric population from craniomaxillofacial trauma associated with stairway falls.
Stair descent imposes a significant challenge for dynamic stability among young adults. The effect of a concurrent text-based math task on dynamic stability control remains unclear during stair descent when considering the influence of gait velocity. Twenty-six participants performed three successful stair descent trials under TEXTING or NO-TEXTING conditions at their preferred speed. Synchronous kinematics and kinetics were collected by an eight-camera Vicon infrared motion capture system and two force platforms. Repeated measures analysis of covariance and Wilcoxon signed rank test were used to analyze the differences between the two different task conditions with gait velocity as a covariate. The outcomes indicated that under TEXTING condition, sagittal margin of stability increased at right-foot-landing; step cadence, double-support percentage, sagittal and frontal joint moment decreased; and sagittal and frontal joint angles were also modified. It is concluded that concurrent TEXTING impaired sagittal and frontal stability control during stair descent despite slowing down the step cadence. Knee and ankle joint adjustment strategies were mainly adopted in response to stability control in the sagittal plane with the interference of TEXTING, whereas the hip joint adjustment strategy was adopted in the frontal plane. In conclusion, texting behaviors on mobile phones should be minimized during stair descent.
Aims
To investigate the incidence and pattern of injury in patients with a diagnosis of a fall from a stairlift.
Methods
Data was analysed from the Trauma Audit and Research Network (TARN) database from 2000 to 2018 for those recorded suffering stairlift related injuries between the ages of 40-100 years. Patient demographics, injury mechanism and pattern, mortality rate and height of fall were analysed.
Results
1069 patients were identified in the initial search with 651 having an eligible mechanism of injury. The mean age was 82 (range 41.4-100.1) years. The most common site of injury was the limbs (49.2%) with the most severe injuries to the head (mean AIS 3.1). The mean ISS was 12.5 (Range 1-75). There was no relationship between height of fall and ISS (rs 0.054 p= 0.4). Individuals were 78% more likely to have an ISS score of 15 or more if they had a head injury, (OR: 0.12; 95% CI: 0.06-0.24) and 79% more likely to have sustained an injury to the thorax (OR: 0.21; 95% CI: 0.11-0.41). Injury to the head was 95% more likely in individuals with an ISS score greater than 25 points or more (OR: 0.05; 95% CI: 0.01-0.16) and 69% more likely for those who sustain injury to the thorax. Individuals with an ISS score of 25 points or more were 18 times more likely to have sustained injury getting off their stair lift compared to any other method of falling from their stair lift. Mortality was associated with injuries to the thorax in those aged 70 years or below, injuries to the face, spine and limb for those aged 71 to 85 years and with head injury in those over 85 years. The overall mortality rate was 15.7%.
Conclusion
Falls from stairlifts commonly result in limb injuries and most severe injuries are sustained to the head. When patients fall getting off from astairlift, have injuries to their head or thorax they have a higher ISS. The overall mortality is 15.7%. Given the increasing use of stairlifts in our ageing population, strategies should be considered to make these safer.
Falling from the stair is widely seen throughout the world and is often associated with severe injuries. In America, approximately 2100 deaths are caused by stair accidents and 1.3 million admission to emergency departments of hospitals are related with stair accidents. For Turkey, there is no statistical data on death and injuries caused by falling from stairs. In this context, the news reflected in the media have been examined in Turkey and 11 mortal accidents have been seen in the last 10 years (2009-2019). When the results are examined, the stair is seen one of the most accident related building elements. In these accidents, multiple injuries are likely to be seen in the fall of the stair. In this study, the rate of injury and mortality in the stairs studied by media news for Turkey.
Key Words: Stair Accidents • Safety • Stair Design • Turkey
Daily stair activities have become increasingly challenging for older adults with deterioration in physical and cognitive capabilities. However, the dynamic stability of older adults during stair descent under a concurrent dual-task condition remains undetermined. The gait and dynamic stability variables of 40 healthy older adults were measured under single- and dual-task conditions during stair descent. The step length, step width, and single support time did not significantly increase ( p > .05) under the dual-task condition during stair descent. The medial–lateral center of mass velocity significantly increased ( p < .003), whereas the medial–lateral margin of dynamic stability value significantly decreased ( p < .006) at the landing and initial single support under the dual-task condition during stair descent. The self-regulatory ability of healthy older adults under the dual-task condition during stair descent was underestimated. Dual tasking displayed a positive impact on the anterior–posterior dynamic stability of healthy older adults.
https://journals.humankinetics.com/view/journals/mcj/aop/article-10.1123-mc.2018-0113.xml
We used body-worn inertial sensors to quantify differences in semi-free-living gait between stairs and on normal flat ground in older adults, and investigated the utility of assessing gait on these terrains for predicting the occurrence of multiple falls. 82 community-dwelling older adults wore two inertial sensors, on the lower back and the right ankle, during several bouts of walking on flat surfaces and up and down stairs, in between rests and activities of daily living. Derived from the vertical acceleration at the lower back, step rate was calculated from the signal's fundamental frequency. Step rate variability was the width of this fundamental frequency peak from the signal's power spectral density. Movement vigor was calculated at both body locations from the signal variance. Partial Spearman correlations between gait parameters and physiological fall risk factors (components from the Physiological Profile Assessment) were calculated while controlling for age and gender. Overall, anteroposterior vigor at the lower back in stair descent was lower in subjects with longer reaction times. Older adults walked more slowly on stairs, but they were not significantly slower on flat surfaces. Using logistic regression, faster step rate in stair descent was associated with multiple prospective falls over 12 months. No significant associations were shown from gait parameters derived during walking upstairs or on flat surfaces. These results suggest that stair descent gait may provide more insight into fall risk than regular walking and stair ascent, and that further sensor-based investigation into unsupervised gait on different terrains would be valuable.
Falls are the leading cause of fatal and nonfatal injuries among adults aged ?65 years (older adults). During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized.* To estimate the numbers, percentages, and rates of falls and fall injuries among older adults by selected characteristics and state, CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. In 2014, 28.7% of older adults reported falling; the estimated 29.0 million falls resulted in 7.0 million injuries. Known effective strategies for reducing the number of older adult falls include a multifactorial clinical approach (e.g., gait and balance assessment, strength and balance exercises, and medication review). Health care providers can play an important role in fall prevention by screening older adults for fall risk, reviewing and managing medications linked to falls, and recommending vitamin D supplements to improve bone, muscle, and nerve health and reduce the risk for falls.
Aim:
To investigate risk and protective factors for stair falls in children aged <5 years.
Methods:
Multicentre case-control study at hospitals, minor injury units and general practices in and around four UK study centres. Cases were children with medically attended stair fall injuries. Controls were matched on age, sex, calendar time and study centre. A total of 610 cases and 2658 controls participated.
Results:
Cases' most common injuries were bangs on the head (66%), cuts/grazes not requiring stitches (14%) and fractures (12%). Parents of cases were significantly more likely not to have stair gates (adjusted OR (AOR) 2.50, 95% CI 1.90 to 3.29; population attributable fraction (PAF) 21%) or to leave stair gates open (AOR 3.09, 95% CI 2.39 to 4.00; PAF 24%) both compared with having closed stair gates. They were more likely not to have carpeted stairs (AOR 1.52, 95% CI 1.09 to 2.10; PAF 5%) and not to have a landing part-way up their stairs (AOR 1.34, 95% CI 1.08 to 1.65; PAF 18%). They were more likely to consider their stairs unsafe to use (AOR 1.46, 95% CI 1.07 to 1.99; PAF 5%) or to be in need of repair (AOR 1.71, 95% CI 1.16 to 2.50; PAF 5%).
Conclusion:
Structural factors including having landings part-way up the stairs and keeping stairs in good repair were associated with reduced stair fall injury risk. Family factors including having stair gates, not leaving gates open and having stair carpets were associated with reduced injury risk. If these associations are causal, addressing these factors in housing policy and routine child health promotion could reduce stair fall injuries.
The incidence of stairway falls and related injuries remains persistently high; however, the risk of stair injuries could be reduced through improved stairway design. The current study investigated dynamic balance control during stair descent and the effects of varying the step geometry. Data were collected from 20 healthy young and 20 older adults as they descended three staircases (riser heights of 7, 7.5 and 8 inches (178, 190 and 203 mm, respectively)). At each riser height, the tread run length was varied between 8 and 14 inches (203 mm and 356 mm) in one-inch (25 mm) increments. Kinematic data provided measures of segmental and whole-body dynamic control. Results demonstrated that older adults had greater lateral tilt of the upper body than young adults, but actually had larger margins of stability than the young in the antero-posterior direction as a result of their slower cadence. Nonetheless, for both age groups, the longer run lengths were found to provide the largest margins of stability. In addition, increase in run length and decrease in riser height tended to reduce forward upper body tilt. These results help to explain the underlying biomechanical factors associated with increased risk of falls and the relationship with step geometry. Considering the importance of stair ambulation in maintaining independence and activity in the community, this study highlights the definite need for safer stair design standards to minimize the risk of falls and increase stair safety across the lifespan.
Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.
http://www.sciencedirect.com/science/journal/00036870
Falls near the bottom of a flight of stairs have resulted from an illusion that the person was stepping off onto the bottom landing when the person was still two treads or more above the landing. The illusion is caused by poor lighting and design defects built into the stairway. The poor lighting may be attributed to a building code that allows inadequate lighting near the bottom of external stairs in private residences. The design defect of truncating handrails before they reach the bottom tread may be due to confusion between "guards" and "handrails" and this confusion also appears to be promulgated by building code.
Background: Products under the purview of the Consumer Product Safety Commission are involved in a large share of injuries and injury costs in the USA.
Methods: This study analyses incidence data from the National Electronic Injury Surveillance System (NEISS) and cost data based on the Injury Cost Model, integrated with the NEISS. We examined the magnitude of nonfatal consumer product related injury, the distribution of products involved in these injuries and the cost of these injuries. We compared these findings with an earlier identical study from 2000.
Results: In 2008–2010, 43.8% of the annual 30.4 million non-fatal injuries treated in hospital emergency departments involved consumer products. Of these consumer product related injuries, in 2009–2010, just three product groups accounted for 77% of the $909 billion annual cost: sports and recreation; home structures and construction materials; and home furnishings and fixtures. Sports and recreation was a leading cause of injury costs among 5–24-year-olds, particularly football, basketball, bicycling, baseball/softball and soccer. Since 1996, football surpassed basketball in becoming the number one cause of injury costs for children aged 10–19 years and the fifth ranked cause of product related injury costs overall. Among those over age 30 years, stairs and floors were a leading cause of consumer product related injury costs, in particular among those over age 70 years where they were responsible for over one-fifth of costs.
Conclusions: The findings of this study highlight priority areas for intervention and generate questions for future research.
The purpose of this study was to describe fractures sustained by children and to analyze the associated costs when a caretaker falls down stairs while holding a child.
Between 2004 and 2012, 16 children who sustained a fracture after a fall down stairs while being carried by a caregiver were identified. Parents/caregivers were interviewed to see how the fall occurred, and a cost analysis was performed.
The average age of the patients was 14.5 months (7-51 months). The lower extremity was involved in 15 of 16 fractures, with 8 involving the femur. The majority were buckle fractures, but all diaphyseal femur fractures were spiral. Three patients required a reduction in the operating room. All fractures healed with cast immobilization. Five patients underwent skeletal surveys, as the treating physicians were concerned about potential child abuse. The average cost of treatment was 948-45,876). Detailed histories from the caregivers showed that they "missed a step" due to the child being carried in front of the caregiver, obscuring their vision.
A fall in a caregiver's arms while going down stairs can result in multiple orthopedic injuries. The costs of treating these injuries are not insignificant, and the suspicion of child abuse can be both costly and unnecessary in the case of a true accident. While descending the stairs with a child in their arms, the caregiver should hold the child to the side so as not to obscure their vision of the step with one arm, ideally holding the handrail with the other.
IV case series.
The objectives of this population based cohort study of 3997 women was to determine the incidence of falling and risk factors related to falls during pregnancy. Birth certificate data identified women who had delivered a child within the previous 2 months. Subjects were reached either by phone, internet or mailed surveys. The women were asked about health issues and activities at the time of the fall. Of the 3997 participants, 1070 reported falling at least once (27%) during their pregnancy. Of those 1070 35% fell two or more times, 20% sought medical care and 21% had two or more days of restricted activity. Women aged 20-24 years had an almost two fold risk of falling more than those over 35 years (odds ratio 1.9; 95% confidence interval 1.4, 2.7). Characteristics of falls included: indoors (56%), on stairs (39%) and falling from a height greater than three feet (9%) (not mutually exclusive). Though 27% of women fell while pregnant, 10% experienced two or more falls. Pregnant women should be aware of the risk factors of and situations related to falls. There is an urgent need for primary prevention in this high risk group.
The Dynamic Gait Index (DGI) was developed as a clinical tool to assess gait, balance and fall risk. Because the DGI evaluates not only usual steady-state walking, but also walking during more challenging tasks, it may be an especially sensitive test. The present investigation evaluated the DGI and its association with falls, fear of falling, depression, anxiety and other measures of balance and mobility in 278 healthy elderly individuals. Measures included the DGI, the Berg Balance Test (BBT), the Timed Up and Go (TUAG), the Mini-Mental State Exam (MMSE), the Unified Parkinson's Disease Rating Scale (UPDRS) motor part, the Activities-specific Balance Confidence (ABC) scale and the number of annual falls. The DGI was moderately correlated with the BBT (r=0.53; p<0.001), the TUAG (r=-0.42; p<0.001) and the ABC (r=0.49; p<0.001). Fallers performed worse on the DGI compared to non-fallers (p=0.029). Scores on the DGI were near perfect in men (23.3+/-1.2), but among women, there was a small, but significant (p<0.001) decrease (22.5+/-1.6). The reduction in the DGI score in women was due to stair climbing performance, with many women (65%) choosing to walk while holding a handrail, compared to only 39% of men. Scores on the BBT, the TUAG, the UPDRS and the MMSE were similar in men and women. Conversely, ABC scores and fall history were different. These findings suggest that the DGI, although susceptible to ceiling effects, appears to be an appropriate tool for assessing function in healthy older adults.
It is likely that many stair accidents result from a trip during stair negotiation, yet few studies have examined the exact nature of balance loss during falls on stairs. The purpose of this study was to investigate potential age-related differences in the minimum clearance of the foot during stair descent, and to explore whether the minimum foot clearance was affected by the available ambient lighting. Twelve young adults (24+/-3.3 years) and 10 older adults (73.7+/-1.9 years) participated in the study. The older adults had significantly greater within subject coefficients of variation compared to the young adults, and had a significantly larger number of minimum foot clearances which fell below 5 mm. While the young subjects increased their minimum clearance by 3.6 mm on average in response to a decrease in ambient lighting, the older adults maintained the same clearance over all stairs except one. These results suggest that the variability of minimum foot clearance, and lack of precautionary increases in foot clearance under reduced lighting may contribute to falls on stairs by the elderly.
Stair falls are common among young children and are also common false histories in cases of child abuse. When a child presents with a femur fracture and a stair-fall history, a judgment of plausibility must be made. A lack of objective injury and biomechanical data makes plausibility determination more difficult. Our objective was to characterize key features associated with femur fractures from reported stair falls, to develop a model for assessing injury plausibility (IP).
Children 2 to 36 months of age who presented with a femur fracture from a reported stair fall were studied prospectively. Detailed history recording, examinations, fracture characterization, and injury scene analyses were conducted, and biomechanical measures associated with injury prediction were calculated. With our proposed IP model, all cases were then scored for the detail of history, biomechanical compatibility of fracture morphologic features, time to seeking care, and presence of other injuries.
Twenty-nine children were diagnosed with a femur fracture resulting from a reported stair fall. The IP model made a clear distinction between 2 groups, designated plausible and suspicious. Significant differences were observed for the detail of history, biomechanical compatibility of fracture, time to seeking care, presence of other injuries, and total IP scores. In the plausible group, the minimal linear momentum associated with a transverse fracture was almost 10-fold greater than that for spiral or buckle fracture types.
This study adds new information to the current body of knowledge regarding injury biomechanics and fractures among children. The IP model provides an objective means of assessing plausibility of reported stair-fall-related femur fractures and identifies key characteristics to facilitate decision-making.
Falls on stairs, kerbs and footpaths are a major cause of morbidity in older female adults. This investigation examined the stepping responses made by 48 elderly (mean age 67 years, S.D. 5.4 years) and 48 young (mean age 20 years, S.D. 2.4 years) healthy, community-dwelling adult females to approach and accommodate known surface height changes. The surface was designed to simulate an object like a kerb or step in the walking path. For ascent, the surface was 9 m long (height, 15 cm) with a 13 m ground-level approach. For descent, it was 15m long (height, 15 cm) with a 7 m ground-level departure. These tasks (particularly descent) perturbed the gait of the elderly more than the young. The elderly exerted more control or were more cautious. They made earlier and larger step adjustments (p<.05), primarily employed a short step crossing strategy (elderly, 60%; young, 19%), exhibited less footfall variability (p<.05), moved slower across the step (p<.001) and spent more time in double foot support while crossing the step. In descent, the elderly preferred to land on the forefoot (p<.001). In both conditions, the elderly placed the feet closer to the step and cleared it by a lesser margin. Step descent appears to be particularly hazardous for older females since foot clearances were small and foot placement was closer to the step.
This article is based on a portion of one chapter in a forthcoming book by Jake Pauls and John Fruin, People Movement in Buildings and Public Places: Design, management and safety for individuals and crowds. The chapter on handrails addresses several handrail topics in addition to the graspability topic of this article. subjects covered include stair railings mechanics of stair falls, appropriate shape, size and surface, railing costs, and others.
Falls on stairways continue to be a leading cause of accidental injury and death in the United States. Most of these falls occur when people lose their balance while descending stairs. In support of a litigation case for which I was retained as a forensic human factors expert witness, I conducted an empirical study of lateral and vertical stairway clearances. Results indicate that stairway users generally clear slight uplifts on steps and usually walk within an arm's reach of the handrail, so they can at least attempt to break a fall if a loss of balance occurs. In this article, I discuss the study and its human factors/ergonomics implications.
Falls are the most common cause of injury-related hospitalization in children younger than 5 years old. Most anticipatory guidance surrounding falls is around falls from windows or stairs; however, falls from furniture also are important causes of morbidity. The purpose of this study was to compare the number of children injured, ages of injured children, and injuries sustained in falls from furniture and falls from stairs in hospitalized children younger than 5 years.
All records of individuals from 0 year through 4 years, hospitalized at our institution for a fall from furniture or stairs between January 1, 1996, and December 31, 2006, were retrospectively reviewed. A standard data set was abstracted from each chart. Frequencies were used to characterize the study population. χ and t tests were used to determine differences between groups.
A total of 171 patients were hospitalized for falls from stairs and 318 for falls from furniture. There were no differences between the groups with regard to age, sex, race, type of insurance, length of stay, Injury Severity Score, or total cost. The most common pieces of furniture from which children fell were beds (33.0%), couches (18.9%), and chairs (17.9%). Children who fell from stairs were significantly more likely to have injuries to their head (64.3% vs. 38.1%); those that fell from furniture were more likely to sustain arm injuries (33.3% vs. 9.9%). There were significantly more skull fractures in those that fell from stairs (39.8% vs. 20.1%) and humerus fractures in those that fell from furniture (30.8% vs. 9.4%) (p < 0.001). Falls from furniture increased during the study period, while falls from stairs fell; the difference was not statistically significant, however.
Falls from furniture and stairs are important causes of morbidity in children. More children were hospitalized for falls from furniture than from stairs. Falls down stairs are decreasing while falls off furniture are increasing. More anticipatory guidance should be developed and given to families regarding falls from furniture to help prevent these injuries.
Prognostic/epidemiologic study, level III.
The purpose of this study was to examine dynamic stability control in older and younger adults while descending stairs. Thirteen older (aged 64-77years) and 13 younger (aged 22-29years) adults descended a staircase at their preferred speed. A motion capture system and three force plates were used to determine locomotion mechanics. Dynamic stability was investigated by using the margin of stability, calculated as the instantaneous difference between anterior boundary of the base of support and extrapolated centre of mass. At the initiation of the single support phase, older adults demonstrated a more negative (p<.05) margin of stability value. The component responsible for the lower margin of stability in the elderly was the higher velocity of the centre of mass (p<.05). Before the initiation of the single support phase, the older adults showed a lower (p<.05) ankle and knee joint angular impulse compared to the younger ones. We found a significant correlation (r=.729, p<.05) between centre of mass velocity and joint angular impulse. These results indicate that older adults are at greater risk of falls while descending stairs potentially due to a reduced ability to generate adequate leg-extensor muscular output to safely control the motion of the body's centre of mass while stepping down.
Objective: To study the demographics of patients who sustained serious injuries from falling down stairs.
Method: This study is a retrospective analysis of all patients who presented to an urban hospital with an injury severity score of equal to or greater than 16 after falling down stairs during the period January 1992 to December 1996. Patient demographics, stair location and number, severity and anatomical nature of injuries, serum ethanol levels, patient referral characteristics and mortality rates were examined.
Results: A total of 113 patients were studied; 74% were male. Sixty-five per cent of falls occurred at the patient’s place of residence. Ethanol may have been a contributing factor in 55% of injuries. Ninety-five per cent of victims had an injury severity score of equal to or less than 30. Head injuries were common with acute subdural haematoma occurring in 57% of patients. Head-injured patients had a significantly higher mortality rate than non-head-injured patients (P = 0.02). Increasing age and higher injury severity score correlated with poor outcome in all patients. Thirty-nine of the 113 stairway-fall patients (35%) died in hospital compared with 207 of 1091 non-stairway-fall patients (19%) during the same period (P < 0.001).
Conclusion: In the adult population, falls down stairs may result in serious injuries, particularly head trauma. In the present study, this group of patients had a significantly higher mortality than other trauma patients.
In previous studies of stairway handrails, data were derived from static experiments which characterized the influence of the handrail design on ability to generate stabilizing force. This paper describes a novel and safe experimental approach developed to study the biomechanical efficacy of handrail use under dynamic conditions, wherein support-surface motion is used to perturb the balance of the subject who stands on a small (three step), heavily padded mock staircase. A primary objective of this initial study was to determine the influence of factors such as perturbation magnitude, stance leg (left or right), proximity to the handrail, initial hand position (on or off the rail), and ability to complete a step while grabbing the rail. The study was also intended to address a more basic issue: is it even possible to grab a handrail with sufficient speed and accuracy to prevent a fall after losing balance on a stairway? Testing of four healthy young adults demonstrated that sizeable stabilizing handrail force can be generated very quickly (up to 60% of body weight in less than 1 second) in response to loss of balance. Furthermore, these grabbing responses were clearly of functional significance, resulting in a marked reduction in the incidence of ‘falls’ (i.e. landing on the padded surface) compared to trials where the handrail was absent. The most consistent aspect of the force generation was the tendency to exert a forward axial force along the rail. An unexpected finding was that this force often appears to be exerted through a pulling, rather than pushing, action, because of the posterior location of the grip relative to the body. Although most of the force components tended to increase with perturbation magnitude, the lateral forces appeared to be most dependent on whether a step was taken. Stance leg had few effects, but variation in proximity to the rail was found to influence the angle at which the hand approached the rail. Gripping the rail prior to perturbation led to a greater tendency to pull upwards. Implications of these findings for safer handrail design are discussed.
The objective of this study was to investigate the epidemiologic characteristics and secular trends of stair-related injuries among children aged <5 years treated in US emergency departments.
A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission from 1999 through 2008 by using sample weights to estimate national numbers and rates of stair-related injuries.
An estimated 931 886 children aged <5 years were treated for stair-related injuries from 1999 through 2008, averaging 93 189 injuries per year and 46.5 injuries per 10 000 population annually. The number of injuries per year decreased significantly by 11.6% from 1999 to 2008. The rate of stair-related injuries also decreased significantly from 53.0 to 42.4 per 10 000 population from 1999 to 2008. Soft tissue injuries accounted for 34.6% of cases. Approximately three-fourths (76.3%) of children had injuries to the head and neck region, and 2.7% of patients were hospitalized. Children who were being carried at the time of injury accounted for 24.5% of injuries among children <1 year and were more than 3 times more likely to be hospitalized than children injured by other mechanisms.
Stair-related injuries are on the decline but still represent an important source of injury to young children. Increased prevention efforts are needed, including parental education and improved stairway design, to decrease stair-related injuries among young children.
Age-based differences in fall type and neuroanatomy in infants and toddlers may affect clinical presentations and injury patterns.
Our goal is to understand the influence of fall type and age on injuries to help guide clinical evaluation.
Retrospectively, 285 children 0-48 months with accidental head injury from a fall and brain imaging between 2000 and 2006 were categorized by age (infant ≤1 year and toddler=1-4 years) and fall type: low (≤3 ft), intermediate (>3 and <10 ft), high height falls (≥10 ft) and stair falls.
Clinical manifestations were noted and head injuries separated into primary (bleeding) and secondary (hypoxia, edema). The influence of age and fall type on head injuries sustained was evaluated.
Injury patterns in children <4 years varied with age. Despite similar injury severity scores, infants sustained more skull fractures than toddlers (71% vs. 39%). Of children with skull fractures, 11% had no evidence of scalp/facial soft tissue swelling. Of the patients with primary intracranial injury, 30% had no skull fracture and 8% had neither skull fracture nor cranial soft tissue injury. Low height falls resulted in primary intracranial injury without soft tissue or skull injury in infants (6%) and toddlers (16%).
Within a given fall type, age-related differences in injuries exist between infants and toddlers. When interpreting a fall history, clinicians must consider the fall type and influence of age on resulting injury. For young children, intracranial injury is not always accompanied by external manifestations of their injury.
Falls down stairs are a common presentation to the paediatric emergency department. The pattern of injury associated with this mechanism of injury has not been described for the UK population. A retrospective analysis of attendances to the Emergency Department of Sheffield Children's Hospital was carried out.
Overall 90% (216/239) of patients sustained one or more injuries; 69% (165/239) sustained minor head and facial injuries; 12% (29/239) sustained minor soft tissue injuries of other regions; 10% (23/239) had limb fractures, of which 60% (14/23) were of the upper limb (nine clavicle fractures, one supracondylar fracture of the elbow and four wrist fractures) and 40% (9/23) were of the lower limb (four femoral fractures and five tibial fractures). Two per cent (5/239) had skull fractures (all were in the group of children dropped while being carried on the stairs). Injuries to more than one body part occurred in only 3% (8/239) of cases.
The results suggest that children who fall down the stairs are mainly toddlers and in general sustain only minor injuries, the commonest being a minor head injury. Severe truncal and extremity injuries or injuries involving multiple body regions should provoke further questioning looking for evidence of non-accidental injury. There is no correlation between the number of stairs fallen down and the likelihood or severity of injury.
Infants who fall down stairs with their carer or are dropped while being carried down stairs require an especially close evaluation.
Chen et al.1 found that the rates of success which 24 healthy younger and 24 healthy older adults achieved in not stepping on fixed and suddenly appearing virtual obstacles was adversely affected by reducing their available response time. This paper reports the gait strategies used by those 48 subjects in avoiding the obstacles and the factors associated with falls by four of the subjects. Differences among gait parameters were analysed with respect to age, gender, available response time, and avoidance strategy. Both short- and long-step strategies were used to avoid stepping on the obstacles, but age differences in strategy choice were not significant. The short-step strategy was used more often with shorter available response times. To avoid a fized obstacle gait was seldom adjusted more than two steps before reaching it; the older adults, however, adjusted their stepping pattern one step earlier than did the younger adults. As the available response time was shortened, the results suggest that older adults had more difficulty than did younger adults in employing the long-step strategy. Although the short-step strategy is easier to employ at short available response times, it becomes a highly risky strategy when combined with a fast walking speed and resulted in actual falls. The results show that in both young and old healthy adults, tripping does not necessarily originate from contacts with a physical obstacle; it can be self initiated. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/31348/1/0000258.pdf
Few data are available about the epidemiology and injury characteristics in staircase falls. The available literature mainly concerns children and autopsy studies.
To describe the epidemiology and injury characteristics of staircase falls, and to identify high-risk groups for these falls.
All patients who reported to an academic Accident & Emergency (A&E) department in 2005 after a staircase fall were selected in the Dutch Injury Surveillance System These data were linked to the hospital Trauma Registry database.
Four hundred and sixty-four patients (42% male, p=0.001), with a median age of 35 years were included. Children under five suffered significantly more head injuries. Male patients showed significantly more thoracic injuries than female patients. Spinal column fractures were only seen in patients over 25 years of age. Older patients tended to accumulate more rib fractures and lower extremity fractures and were admitted more frequently than the younger patients. Sixty-one patients (13%) required admission. Two patients, both with severe traumatic brain injury (TBI), died. National data on staircase falls were comparable with our hospital data. However, in comparison to the national population data, senior citizens in this study had an incidence that was markedly higher than in the younger patients.
Injuries due to staircase falls occur in all age groups, however, children under five years are relatively over-represented with higher rates of head injury. Senior citizens showed a markedly higher incidence than younger patients. Most injuries occur to the distal extremities and are relatively mild.
This paper summarizes research performed to evaluate the impact of handrail profile dimensions on graspability. It reports on research performed to determine the forces that stairway users exert on handrails when they fall, tests demonstrating the forces persons with various hand sizes can exert on handrails with different profiles, and comparisons of the probability of loss of grip by stairway users when they attempt to arrest a fall by grasping a handrail. The recommendations based on this work include specific definitions of the shapes of handrails that are deemed to be sufficiently graspable to constitute functional handrails.
Falls associated with tripping over an obstacle can be devastating to elderly individuals, yet little is known about the strategies used for stepping over obstacles by either old or young adults. The gait of gender-matched groups of 24 young and 24 old healthy adults (mean ages 22 and 71 years) was studied during a 4 m approach to and while stepping over obstacles of 0, 25, 51, or 152 mm height and in level obstacle-free walking. Optoelectronic cameras and recorders were used to record approach and obstacle crossing speeds as well as bilateral lower extremity kinematic parameters that described foot placement and movement trajectories relative to the obstacle. The results showed that age had no effect on minimum swing foot clearance (FC) over an obstacle. For the 25 mm obstacle, mean FC was 64 mm, or approximately three times that used in level gait; FC increased nonlinearly with obstacle height for all subjects. Although no age differences were found in obstacle-free gait, old adults exhibited a significantly more conservative strategy when crossing obstacles, with slower crossing speed, shorter step length, and shorter obstacle-heel strike distance. In addition, the old adults crossed the obstacle so that it was 10% further forward in their obstacle-crossing step. Although all subjects successfully avoided the riskiest form of obstacle contact, tripping, 4/24 healthy old adults stepped on an obstacle, demonstrating an increased risk for obstacle contact with age.
Children frequently injure themselves falling down stairways, but the characteristics of these injuries are not well described. A total of 363 consecutive patients seen in a pediatric emergency department were studied. The majority of patients had minor superficial injuries. Bony injuries occurred in 7% of patients. Head and neck injuries occurred in 73% of patients, extremity injuries, which were predominantly distal, in 28%, and truncal injuries in 2%. Children younger than 4 years of age were more likely to sustain head trauma than children older than 4 years of age (P less than .005). Injury to more than one body part occurred in only 2.7% of patients. Children who fell down more than four steps had no greater number or severity of injury than those who fell down less than four steps (P = .67). Patients were admitted to hospitals in 3% of cases. No patient had life-threatening injuries and no patients required intensive care. When multiple, severe, truncal, or proximal extremity injuries are noted in a patient who reportedly fell down stairs, a different mechanism of injury should be suspected.
Although stairs are generally recognized as prime locations for accidents in buildings it is only recently that statistical and aetiological studies have identified the magnitude of the stair-accident problem and major contributing factors including stair design and use. Reviews of such work in Great Britain, Canada, Japan, Sweden and the U.S.A. are referenced and a short description provided of Canadian field and. laboratory studies which have particular relevance to stair-handrail design. Emphasis is given to quantitative design features, features that have been among the first to be considered in revisions of building codes and design standards in the U.S.A. where responsiveness to research findings has been greatest.
In the words of M. Candau, accidents rate as “the world's third worst killer”, and in the industrialized society, with increasing hazards to life and health, it is of the utmost importance to find ways to reduce their number as well as their deadly and crippling effects. Accident research will undoubtedly reap great benefits from the epidemiological approach, formerly regarded as primarily a means for the study of infectious diseases. The author is at present specializing in the study of fall accidents, using epidemiological methods. Here he gives an account of his epidemiological accident study of falls on stairs, which constitutes the socio-medical part of a broad investigation project, a survey made by sections at the Lund and Stockholm Institutes of Technology in collaboration with medical institutions at Lund University. The results reveal facts of great interest concerning prevention, and it is to be hoped that accident researchers in general will pay more attention to the value of epidemiological methods, in order to obtain a flexible foundation for our increasing knowledge of feasible preventive measures.
To identify the pattern and severity of injury associated with stairway-related falls in children.
During a 2-year period, all children less than 5 years of age presenting to the University of Virginia Pediatric Emergency Department with a stairway-related injury were prospectively studied. At the time of the emergency department visit, demographic and epidemiologic information was obtained. Injuries were assigned E codes and N codes. A Modified Injury Severity Scale (MISS) score was calculated for each child. Excluded from the study were children with suspected intentional trauma and children with walker-related stairway injuries.
Sixty-nine children were enrolled in the study. The median age was 2 years. Head and neck injuries occurred in 90% of the patients, extremity injuries in 6%, and truncal injuries in 4%. Injury to more than one body region did not occur. The majority of injuries were minor. Ninety-six percent had a total MISS score < or = 2. Fifteen patients (22%) suffered significant injuries, including concussion in 11 (16%), skull fracture in 5 (7%), cerebral contusion in 2 (3%), subdural hematoma in 1 (1%), and a C-2 fracture in 1 (1%).
The majority of stairway-related injuries are minor. Injuries to the head and neck region predominate. Injuries to multiple body regions are rare. However, significant stairway-related injuries may be more common than previously reported.
Fatal falls down stairs in south-east Scotland were studied using prospectively collected data between 1992 and 1997. 51 individuals, comprising 27 men and 24 women with mean age 68.9 years, died following falls down stairs, 30 (59%) of which were unwitnessed. 43 (84%) individuals died following falls within their own homes. Overall, 27 (53%) fatal falls resulted in death at the scene of the accident. Analysis of injuries according to the Abbreviated Injury Scale yielded injury severity scores (ISS) of between 5 and 75, but only four individuals had injuries recognised to be unsurvivable (ISS = 75). Injury to the brain and/or spinal cord was responsible for the vast majority of most severe injuries. The results demonstrate that stairs represent a significant hazard for the elderly. Most of the deaths in the pre-hospital setting appeared to be more the result of the fact that the victim was alone and unable to summon assistance, rather than as a result of unsurvivable injuries. Consideration needs to be given to both how the safety of stairs can be improved and whether a particular elderly person can safely cope with stairs.
Falls in older individuals are a major public health issue because of the financial cost of surgery and re habilitation and the human cost of associated pain and disability. Older individuals are most likely to fall when negotiating an obstacle or obstruction during locomotion. This research was aimed at investigating lower limb motion while a subject negotiated a raised surface.
The gait of six healthy young (Y) women (mean age 23.1 years) and six healthy older (O) women (mean age 67.6 years) were analyzed with a PEAK motion analyzer and a dual-force-platform system during unobstructed walking and when the subjects were stepping on and off a raised surface of 15 cm. The effect of age on foot clearance and force platform variables was analyzed.
During stepping on, the young women cleared the step by the lead foot by a significantly greater margin than the older subjects did (Y = 10.6 cm, O = 9.1 cm; p < .05) but trail-foot clearance was not significantly different (Y 9.4 cm, O = 8.8 cm). Foot clearance in stepping off was low compared with that of ascent, and the older individuals had a significantly higher lead (Y = 1.5 cm, O = 3.3 cm, p < .05) and trail (Y = 1.0 cm, O = 2.1 cm) vertical clearance. Older individuals positioned both the lead and the trail foot relatively farther from the step edge on ascending a raised surface, respectively, Y = 87% and O = 93% of the step cycle and Y = 29% and O = 34%. Foot placement in descent was qualitatively similar for the two groups. The force and the impulse data under the lead and the trail feet confirm modulations consistent with the foot clearance data.
In negotiating a raised surface older individuals appear to use a nonoptimal foot placement strategy in which, compared with that of young subjects, the trail foot is placed a long way from the edge of the step. The older subjects allowed very little correction time and little latitude in foot placement beyond the edge of the step, suggesting that the approach to the obstacle may be a critical determinant of safety.
Coroners' reports of 1035 deaths possibly related to building features were examined to assess their usefulness in identifying the cause of slip, trip and fall (STF) fatalities. Of the total, falls accounted for over 80%. Of the STF deaths, 61.4% related to falls on stairs, 6.7% to falls from steps or ladders, and 5.5% to falls from windows or roofs. About 60% of total fall fatalities involved infirm persons; alcohol was involved in 60% of the falls in the under-50 age group. Information in coroners' reports is generally insufficient to link building features to injuries; better approaches to data collection are required.
An estimated 2.5 million injuries, and a further 4000 deaths in the UK in 1995 were due to home accidents. About 230,000 of these injuries and 497 deaths resulted from falls on stairs. When exposure is taken into account, stairs are one of the most hazardous locations in buildings. Of these falls, those where the person falls forward are most likely to cause severe injuries. One aspect of stair design, the "going" (the horizontal distance between two consecutive nosings) can be changed to decrease the potential number of serious trip accidents. Builders should therefore be encouraged to build stairs with larger goings.
Research on fall injuries in older persons generally does not examine different types of falls separately. (The main types are same level, from one level to another, and on or from stairs and steps.) There is no a priori reason to believe that various types of falls have similar demographic risk factors and consequences. Therefore, we examined patterns in types of falls, place of falls, and consequences of fall injuries as Californians move through their later decades.
We analyzed all computerized patient discharge records for all adults 20 years and over hospitalized with a fall as the principal external cause of injury in California nonfederal acute care hospitals, from 1995 through 1997 (N = 242,166). Older-adult age groups were compared with all younger adults. Place of fall, hospital charges, and disposition at discharge were analyzed by type of fall.
The three main types of fall injury increase with age, but each type shows variation by age and sex. Women have the highest rates for the main types but not for the less common types. Hospitalized falls vary by place of fall. Mean hospital charges (19,632). Disposition at discharge does not vary by type of fall.
We found significant variation in demographic factors, place of fall, and mean hospital charges for falling by type of fall, suggesting that future research should focus on individual types of falls rather than on aggregated falls.
Stair descent is an inherently risky and demanding task that older adults often encounter in everyday life. It is believed that slip between the foot or shoe sole and the stair surface may play a role in stair related falls, however, there are no reports on slip resistance requirements for stair descent. The aim of this study was to determine the required coefficient of friction (RCOF) necessary for safe stair descent in 12 young and 12 older adults, under varied illuminance conditions. The RCOF during stair descent was found to be comparable in magnitude and time to that for overground walking, and thus, with adequate footwear and dry stair surfaces, friction does not appear to be a major determinant of stair safety. Illuminance level had little effect on the dependent variables quantified in this study. However, the older participants demonstrated safer strategies than the young during stair descent, as reflected by differences in the ground reaction forces and lower RCOF.
To examine specific behaviors used by older adults while ascending and descending stairs and to assess the relationships between confidence and stair performance.
Cross-sectional.
Center for Locomotion Studies, The Pennsylvania State University.
Sixteen male (mean age=82.7, range= 77-89) and 16 female (mean age=82.2, range=77-87) community-dwelling adults.
A stair self-efficacy (SSE) test was created to assess individuals' confidence in their safety on stairs. Observational stair performance measures, measures of walking speed on stairs, and the total SSE score were examined for differences due to sex, and the relationships between SSE and specific stair behaviors were assessed.
There was a significant relationship between SSE and the safety precautions taken during stair negotiation. Those with lower SSE were more likely to ascend and descend the stairs at a slower speed, use the handrail to a greater extent, and position themselves closer to the rail. The women had lower domain-specific SSE and tended to use the handrail to a greater extent than men even though there were no sex differences in self-reported functional ability or general falls and mobility confidence. A small group of subjects exhibited characteristics of instability, particularly during stair descent, yet most of this group had high SSE scores and failed to use the handrail.
It appears that confidence related to stair negotiation plays a major role in determining risk-taking propensity during stair use in older adults.
Falls in the older adults are a major public health concern. The growing population of adults 65 years or older, advances in medical care and changes in the costs of care motivated our study of the acute health care costs of fall-related injuries among the older adults in the United States of America.
The Market Scan Medicare Supplemental database 1998 was used to estimate reimbursed costs for hospital, emergency department (ED), and outpatient clinic treatments for unintentional falls among older adults.
A fall on the same level due to slipping, tripping, or stumbling was the most common mechanism of injury (28%). Mean hospitalisation cost was 17,483 US dollars(S.D.: 22,426 US dollars) in 2004 US dollars. Femur fracture was the most expensive type of injury (18,638 US dollars, S.D.: 19,990 US dollars). The mean reimbursement cost of an ED visit was 236 US dollars and 412 US dollars for an outpatient clinic visit.
The magnitude of the economic and social costs of falls in older adults underscores the need for active research in the field of falls prevention.
Here we describe the epidemiologic characteristics and secular trends of infant walker-related injuries among children who are younger than 15 months in the United States.
A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, 1990-2001. Sample weights that were provided by the National Electronic Injury Surveillance System were used in all analyses to adjust for the inverse probability of case selection and make national projections regarding infant walker-related injuries.
An estimated 197200 infant walker-related injuries occurred among children who were younger than 15 months and treated in US emergency departments from 1990 through 2001. Five percent of these children required admission to the hospital. The number of infant walker-related injuries remained relatively constant from 1990 through 1994, averaging 23,000 cases per year. After the introduction in 1994 of stationary activity centers as an alternative to mobile infant walkers and the implementation of the revised American Society for Testing and Materials F977 voluntary infant walker standard in 1997, there was a marked decrease in the number of infant walker-related injuries. Overall, there was a 76% decrease in the number of injuries from 1990 to 2001 from 20,900 injuries in 1990 to 5100 in 2001. Soft tissue injuries and lacerations represented 63% of the injuries. Trauma to the head region occurred in 91% of cases. Skull fractures were the most common (62%) type of fracture. Falls down stairs was the mechanism of injury in 74% of cases.
The adoption of passive injury-prevention strategies, such as use of stationary activity centers as alternatives to mobile infant walkers and redesign of infant walkers to prevent falls down stairs, were associated with a marked decrease in the number of infant walker-related injuries.
Falls are a common and often devastating problem among older people, causing a tremendous amount of morbidity, mortality and use of health care services including premature nursing home admissions. Most of these falls are associated with one or more identifiable risk factors (e.g. weakness, unsteady gait, confusion and certain medications), and research has shown that attention to these risk factors can significantly reduce rates of falling. Considerable evidence now documents that the most effective (and cost-effective) fall reduction programmes have involved systematic fall risk assessment and targeted interventions, exercise programmes and environmental-inspection and hazard-reduction programmes. These findings have been substantiated by careful meta-analysis of large numbers of controlled clinical trials and by consensus panels of experts who have developed evidence-based practice guidelines for fall prevention and management. Medical assessment of fall risks and provision of appropriate interventions are challenging because of the complex nature of falls. Optimal approaches involve interdisciplinary collaboration in assessment and interventions, particularly exercise, attention to co-existing medical conditions and environmental inspection and hazard abatement.
This report presents national estimates of fall injury episodes for noninstitutionalized U.S. adults aged 65 years and over, by selected characteristics. Circumstances surrounding the fall injury and activity limitations and utilization of health care resulting from the fall injury are also presented.
Combined data from the 2001-2003 National Health Interview Surveys (NHIS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS), were analyzed to produce estimates for the U.S. civilian noninstitutionalized population. Data on nonfatal medically attended fall injuries occurring within the 3 months preceding the interview were obtained from an adult family member.
The annualized rate of fall injury episodes for noninstitutionalized adults aged 65 years and over in 2001-2003 was 51 episodes per 1,000 population. Rates of fall injuries increased with age, and were higher for women compared with men. Non-Hispanic white older adults had higher rates of fall injuries compared with non-Hispanic black older adults. Older adults with certain chronic conditions and activity limitations had higher rates of fall injuries compared with older adults without these conditions. The most common cause of fall injuries among older adults was slipping, tripping, or stumbling, and most fall injuries occurred inside or around the outside of the home. Nearly 60 percent of older adults who experienced a fall injury visited an emergency room for treatment or advice. Nearly one-third of older adults experiencing a fall injury needed help with activities of daily living as a result, and over one-half of these persons expected to need this help for at least 6 months. A similar percentage experienced limitation in instrumental activities of daily living as a result of fall injuries.
Fall injuries remain very prevalent among older adults and result in high health care utilization and activity limitations. Rates of fall injuries vary by demographic and health characteristics of older noninstitutionalized adults.
National Intercensal Tables: Intercensal estimates of the United States resident population by age and sex
- Us Census
- Bureau
US Census Bureau. National Intercensal Tables: Intercensal estimates of the United
States resident population by age and sex. https://www.census.gov/data/tables/
time-series/demo/popest/intercensal-national.html; 1990-2000, Accessed date: 17
March 1930.
Annual estimates of the resident population by single year of age and sex for the United States
- Us Census
- Bureau
US Census Bureau. Annual estimates of the resident population by single year of age
and sex for the United States: April 1, 2010-July 1, 2012. https://factfinder.census.
gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk, Accessed date: 17
March 1930.
Fatal falls down stairs
- Wyatt