Investigators have developed a model to assess the risk for outdoor falls in snowy and icy winter conditions.
The model considers ice, snow on the ground (per 10 cm), month, and interactions between ice and snow to calculate the Slip and Fall Index (SFI). The investigators found that same-day ice and snow on the ground (P <.001 significantly predicted falls that led to increased emergency room presentations. in addition ice day before days and also slips falls.>
Neil J. White, MD
“Everything we developed is referenced to an average October over an 11-year period from January 2008 to December 2018,” lead author Neil J. White, MD, clinical assistant professor of orthopedic surgery at the University of Calgary in Calgary, Alberta, Canada, told Medscape Medical News. “There is seasonality to trauma and injury…The extreme situation that we think is generalizable is when you get ice formed on the ground and then you get snow on top of it. If there is ice and you are not aware of it, that is very dangerous.”
The study was published on February 15 in the Canadian Journal of Public Health.
Sex Difference Observed
To create the index, the investigators examined ER presentations at four adult hospitals in Calgary from January 2008 to December 2018. They extracted the data from the National Ambulatory Care Reporting System and excluded spine, head and neck, and nontrauma injuries. The data set included 14,977 ER presentations for a slip and fall on ice or snow.
Women (57.36%, n=8591) accounted for more presentations than men (42.64%, n=6386). Moreover, women and men presented at similar rates until age 50 years, but after that point, women accounted for an average of 25.48% more ER presentations due to slips and falls on ice or snow than men.
Like other indices guide outdoor behavior related to factors such as exposure to pollution, the SFI could help guide behavior with respect to the risk for falls, said White. “The example would be if the air quality index says that the air is terrible and your child has asthma, most parents would change their plans and not take their child to the park,” said White. “While we would say, ‘Don’t go out,’ to a high-fall-risk citizen, other options would be considered for different cohorts of the population, such as using ice cleats or collapsible walking poles.”
ER staffing does not account for seasonal peaks in injury rates, said White. “We have the same number of resources available each month of the year. There should be staffing according to the expected volume.”
Some Falls Missed
Commenting on the findings for Medscape Medical News, Alan M. Reznik, MD, chief medical officer at Connecticut Orthopedics in Hamden, Connecticut, pointed out that the investigators could not capture falls among patients who did not present in ERs.
Alan M. Reznik, MD
“People who make it to the ER do not encompass all falls,” said Reznik, who is a former member of the American Academy of Orthopaedic Surgeons patient safety committee. “Some falls end in minor injuries. Some people who have fallen will go to their primary care provider, while other patients with minor fractures often prefer to be seen at a walk-in center, and those fractures would be missed.”
That said, capturing ER visits resulting from slips and falls on ice and snow is an effective way of measuring the cost to the economy, Reznik explained. “It is a measure of the largest part of the problem, which is the actual ER visits.”
It is likely that the index would be most useful for patients who have preexisting conditions, he added. “This index may prove to be more valuable for people with osteoporosis, people who have poor vision, people who have poor balance, and people who have a known disorder like syncope or cardiac arrhythmias.”
One of the factors that the investigators did not consider was hours of exposure, which might lead to the underrepresentation of women among ER presentations, said Reznik. “Are the number of hours outside more for women or men, or are they the same? One thing we have learned from injuries in highly competitive female athletes is that the rate of injury might be twice as high in women, compared with men, after accounting for hours of exposure.”
Reznik commended the authors for addressing the topic of resource allocation and staffing in ERs. “They make the argument that seasonal adjustment in orthopedic care makes sense, that perhaps we should be better staffed at certain times in the year,” he said.
The University of Calgary, the Canadian Orthopaedic Foundation, and the Alberta Strategic Clinical Network funded the research. White is the lead researcher at the South Campus Research Unit for Bone and Soft Tissue at the University of Calgary. Reznik is the author of The Knee and Shoulder Handbook: The Keys to a Pain-Free, Active Life and I Have Fallen and I CAN Get Up!
>>> Read full article>>>
Copyright for syndicated content belongs to the linked Source : Medscape – https://www.medscape.com/viewarticle/index-estimates-risk-fall-ice-and-orthopedic-injury-2024a10004bj
