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Drugs in fall versus non-fall accidents with major trauma – A population-based clinical and medico-legal autopsy study

Acosta, S. LU ; Andersson, L. ; Bagher, A. LU and Wingren, C. J. LU (2019) In Forensic Science International 296. p.80-84
Abstract

Background: The main aim of the present population-based study was to compare drugs in fall versus non-fall accidents causing major trauma, including both clinical and medico-legal autopsy data. Methods: All individuals with accidents resulting in major trauma, a new injury severity score (NISS) > 15 or lethal outcome was identified at hospital and/or the Department of Forensic Medicine between 2011 and 2013. Modified Downton Fall Risk Index ranged from 0 to 7, and was based on specific pharmaceuticals (max 5 points), previous fall (1 point) and cognitive impairment (1 point). Results: One hundred and four individuals with major traumatic accidents were identified, 38 (36.5%) died. The median modified Downton Fall Risk Index was 2... (More)

Background: The main aim of the present population-based study was to compare drugs in fall versus non-fall accidents causing major trauma, including both clinical and medico-legal autopsy data. Methods: All individuals with accidents resulting in major trauma, a new injury severity score (NISS) > 15 or lethal outcome was identified at hospital and/or the Department of Forensic Medicine between 2011 and 2013. Modified Downton Fall Risk Index ranged from 0 to 7, and was based on specific pharmaceuticals (max 5 points), previous fall (1 point) and cognitive impairment (1 point). Results: One hundred and four individuals with major traumatic accidents were identified, 38 (36.5%) died. The median modified Downton Fall Risk Index was 2 for fall accidents and 0 for non-fall accidents (p < 0.001). Modified Downton Fall Risk Index was an age-independent factor associated with fall accident (p < 0.001). The medico-legal autopsy rate for in-hospital patients was 50% (6/12) for fatal fall accidents in comparison with 92.3% (12/13) for fatal non-fall accidents (p = 0.03). In individuals undergoing medico-legal autopsy, the proportion of individuals with any detected drug was 77% in fall accidents compared to 39% in non-fall accidents (p = 0.036). The presence of sedatives (p = 0.002) and bensodiazepines (p = 0.023) were higher for fall accidents compared to non-fall accidents. Conclusion: This population-based study on accidents with major trauma showed that drugs had high impact on fall accidents with major trauma. It seems warranted from a public health perspective to study if implementation of medication review guidelines at hospital managing polypharmacy issues may prevent fall accident recidivism.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Fall accident, Forensic toxicology, Major trauma, Medico-legal autopsy, New injury severity score
in
Forensic Science International
volume
296
pages
5 pages
publisher
Elsevier
external identifiers
  • scopus:85060702189
  • pmid:30710812
ISSN
0379-0738
DOI
10.1016/j.forsciint.2019.01.012
language
English
LU publication?
yes
id
daf75e72-2ce4-446f-8648-e59d5499ce94
date added to LUP
2019-02-04 14:23:13
date last changed
2019-11-25 09:27:17
@article{daf75e72-2ce4-446f-8648-e59d5499ce94,
  abstract     = {<p>Background: The main aim of the present population-based study was to compare drugs in fall versus non-fall accidents causing major trauma, including both clinical and medico-legal autopsy data. Methods: All individuals with accidents resulting in major trauma, a new injury severity score (NISS) &gt; 15 or lethal outcome was identified at hospital and/or the Department of Forensic Medicine between 2011 and 2013. Modified Downton Fall Risk Index ranged from 0 to 7, and was based on specific pharmaceuticals (max 5 points), previous fall (1 point) and cognitive impairment (1 point). Results: One hundred and four individuals with major traumatic accidents were identified, 38 (36.5%) died. The median modified Downton Fall Risk Index was 2 for fall accidents and 0 for non-fall accidents (p &lt; 0.001). Modified Downton Fall Risk Index was an age-independent factor associated with fall accident (p &lt; 0.001). The medico-legal autopsy rate for in-hospital patients was 50% (6/12) for fatal fall accidents in comparison with 92.3% (12/13) for fatal non-fall accidents (p = 0.03). In individuals undergoing medico-legal autopsy, the proportion of individuals with any detected drug was 77% in fall accidents compared to 39% in non-fall accidents (p = 0.036). The presence of sedatives (p = 0.002) and bensodiazepines (p = 0.023) were higher for fall accidents compared to non-fall accidents. Conclusion: This population-based study on accidents with major trauma showed that drugs had high impact on fall accidents with major trauma. It seems warranted from a public health perspective to study if implementation of medication review guidelines at hospital managing polypharmacy issues may prevent fall accident recidivism.</p>},
  author       = {Acosta, S. and Andersson, L. and Bagher, A. and Wingren, C. J.},
  issn         = {0379-0738},
  language     = {eng},
  pages        = {80--84},
  publisher    = {Elsevier},
  series       = {Forensic Science International},
  title        = {Drugs in fall versus non-fall accidents with major trauma – A population-based clinical and medico-legal autopsy study},
  url          = {http://dx.doi.org/10.1016/j.forsciint.2019.01.012},
  doi          = {10.1016/j.forsciint.2019.01.012},
  volume       = {296},
  year         = {2019},
}