Fall height is inversely associated with mortality in geriatric trauma patients undergoing trauma team activation and whole-body CT: A retrospective cohort analysis.

Abstract

Fall height is commonly used as a surrogate marker of trauma severity, yet its prognostic relevance in geriatric major trauma remains unclear. We evaluated the association between fall height, injury severity, injury patterns, and mortality in elderly trauma patients undergoing trauma team activation and whole-body computed tomography (WBCT). This retrospective single-center cohort study included consecutive patients aged ≥ 65 years undergoing trauma team activation and WBCT after fall-related trauma between 2018 and 2024. Falls were categorized as ground-level (<1 m), intermediate (1-3 m), and high (≥3 m). Injury severity (ISS) and characteristics, clinical outcomes, prognostic geriatric trauma outcome (GTOS) and in-hospital mortality were analyzed. Multivariable logistic regression was performed to identify independent predictors of mortality. A total of 349 patients were included (mean age 79.2 ± 8.2 years; 62.5% male). Ground-level falls accounted for 35.2% of cases and were associated with older age, a higher comorbidity burden, and more frequent antithrombotic therapy than higher falls. Injury patterns differed substantially between groups: severe head/cervical spine injuries predominated after ground-level falls, whereas thoracic and extremity injuries were more common after higher falls. However, ISS and GTOS did not differ significantly across fall-height categories. Overall mortality was 27.5% and highest after ground-level falls (35.8% vs. 24.9% vs. 17.0%; p = 0.021). In multivariable analysis, age, ISS, and head/cervical spine injury severity independently predicted mortality, whereas increasing fall height remained associated with lower adjusted mortality (aOR 0.59, 95% CI 0.38-0.94; p = 0.026). Among geriatric trauma patients undergoing trauma team activation and WBCT after falls, fall height was inversely associated with mortality despite similar overall injury severity (ISS) and GTOS values, emphasizing that apparently low-energy mechanisms should not be considered low risk in elderly trauma patients.