Home Medizin Der Index schätzt das Risiko eines Sturzes auf Eis und orthopädischer Verletzungen

Der Index schätzt das Risiko eines Sturzes auf Eis und orthopädischer Verletzungen

von NFI Redaktion

Researchers have developed a model to assess the risk of slips and falls outdoors in snowy and icy winter conditions. This model takes into account 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 on the same day when there was ice and snow on the ground (P < .001), significantly predicted falls leading to more frequent emergency room visits. Additionally, ice one day before (P = .011), 2 days before (P = .018), and 3 days before (P = .049) also predicted slips and falls.

Photo of Neil White
Neil J. White, MD

„Everything we developed relates to an average October over an 11-year period from January 2008 to December 2018,“ said 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. „Injuries and trauma are subject to seasonality. The extreme situation we consider generalizable is when ice forms on the ground and then snow falls on top. That is, when there is ice present and one is unaware, it can be very dangerous.“

The study was published on February 15 in the Canadian Journal of Public Health.

Gender Disparity Observed

To create the index, researchers examined emergency rooms at four adult hospitals in Calgary from January 2008 to December 2018. They extracted data from the National Ambulatory Care Reporting System and excluded spinal, head, and neck injuries as well as non-injury related issues. The dataset included 14,977 ER presentations for slips and falls on ice or snow.

Women (57.36%, n = 8591) accounted for more presentations than men (42.64%, n = 6386). Additionally, women and men presented at similar frequencies up to the age of 50, but after that point, women had an average of 25.48% more emergency room visits due to slips and falls on ice or snow than men.

Like other indices guiding outdoor behavior related to factors such as pollution exposure, the SFI could help guide behavior in terms of fall risk, said White. „For example, if the air quality index indicates poor air quality and your child has asthma, most parents would change their plans and not take their child to the park,“ White said. „While we would tell a high fall risk citizen ‚Don’t go out,‘ other population groups would consider other options, such as using ice cleats or collapsible hiking poles.“

The staffing in the emergency room does not account for seasonal spikes in injury rates, White said. „We have the same number of resources available every month of the year. Staffing should match the expected volume.“

Some Falls were Missed

Commenting on the results for Medscape Medical News, Alan M. Reznik, MD, chief physician at Connecticut Orthopaedics in Hamden, Connecticut, pointed out that the researchers could not capture falls in patients who did not present to the emergency room.

Photo of Alan M. Reznik
Alan M. Reznik, MD

„People who make it to the emergency room do not represent all falls,“ said Reznik, who is a former member of the Patient Safety Committee of the American Academy of Orthopaedic Surgeons. „Some falls result in minor injuries. Some fallen individuals go to their primary care physician, while others with minor fractures often prefer to be treated at an outpatient center, and these fractures may go unnoticed.“

However, capturing emergency room visits due to slips and falls on ice and snow is an effective way to measure the economic burden, Reznik explained. „It’s a metric for the bulk of the problem, namely actual emergency room visits.“

The index is likely to be most useful for patients with pre-existing conditions, he added. „This index could prove valuable for people with osteoporosis, people with poor vision, people with poor balance, and people with a known condition like syncope or heart arrhythmias.“

One factor the investigators did not account for is the hours of exposure, which could lead to women being underrepresented in emergency room visits, Reznik said. „Are women or men outdoors for more hours, or are they equal? One thing we’ve learned from injuries in high-performance female athletes is that the injury rate thereafter might be double that of men. It’s all about accounting for exposure hours.“

Reznik praised the authors for addressing the issue of resource allocation and staffing in emergency rooms. „They argue that seasonal adjustments in orthopedic care make sense and that we may need better staffing at certain times of 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 Key to a Pain-Free, Active Life and I Fell and Can Get Up Again!

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