Falls from Trees in Coastal Karnataka: A Neglected Cause of Polytrauma in Lower-Middle-Income Countries of Similar Agroforestry.

Abstract

Introduction: Falls are the second most common cause of injury associated with mortality worldwide and an important type of blunt trauma, which forms a significant percentage of traumatic accidents and emergency department admissions. Falling from a tree is an important problem because of its effect on one's health owing to infirmity caused by injuries, most commonly spinal injuries, and the economic burden that accompanies it.

Methods: A retrospective chart analysis was performed including all the patients with falls from heights who presented to a tertiary care hospital in South India during the summer months of 2018, 2019, and 2020. A structured case record form was used to capture information such as basic demographics, tree species, reason for climbing the tree, and mode of fall, along with the clinical profile, and outcomes from the cases selected from the emergency department registers and cross verified using ICD codes.

Results: Despite the existing lockdown due to COVID, an unusual increase in the number of patients getting admitted to the triage with a fall from tree was noted in the year 2020 compared to 2019 and 2018. The most common type of injuries sustained were spinal injuries. Burst fractures were leading types of fractures in the patients with spinal injury. The second most common type of injuries involved were of extremities, with lower extremities more than upper extremities. Two patients had inhospital mortality within 30 days.

Conclusions: Falls from a tree are a neglected and preventable mechanism of trauma with a significant socio-economic impact, as most of the patients are young or middle aged earning members of their families. The burden of this mode of injury is primarily on rural and agricultural communities. Pre-hospital services in areas with vast agroforestry cultivation require dedicated first response clinics. Lockdowns and geographic isolation during disasters or disease outbreaks must also factor in a supply of essential commodities and warrant treatment on an urgent basis to reduce the need and risk of injury from forestry and agricultural activities.