Mortality from fall: A descriptive analysis of a multicenter Indian trauma registry

Published:September 29, 2022DOI:


      • Fall is the second leading cause of unintentional injury mortalities worldwide.
      • Isolated TBI and TBI associated with other injuries are the major contributors of mortality in injuries associated with fall.
      • Mortality is directly proportional to age and ISS in patients with history of fall.



      Fall is the second most common mechanism of trauma worldwide after road traffic injuries. Data on fall predominantly comes from the high-income countries (HICs) and mostly includes injuries in children and elderly. There are very few studies from low- and middle-income countries(LMICs) that describe fall related injuries other than fragility fractures in elderly. This study describes the profile of poly-trauma patients admitted with a history of ‘fall’ and assesses the variables associated with mortality.


      We analyzed data from the ‘Towards Improved Trauma Care Outcome’ (TITCO) database which prospectively collected data of poly-trauma patients admitted to four major tertiary care hospitals of India between 2013 to 2015. Patients across all age groups admitted to hospital with the history of ‘fall’; were included in our study. Single bone fractures were excluded.  The Kaplan Meier survival analysis was used to estimate the survival probability in different age groups.


      A total of 3686 patients were included in our study. The median age of the patients was 28 years (IQR: 9, 47) with the majority being males (73.6%). Almost one-third of the patients were within the age group of 0-14 (30.4%). Most of the patients (79.9%) had a diagnosis of traumatic brain injury (TBI). The overall in-hospital mortality was 18% (664), but higher at 39.0% among patients over 65 years of age. Probability of survival decreased with increase of age.


      Falling from height is a common injury mechanism in India, occurring more in young males and usually associated with TBI. Isolated TBI and TBI associated with other injuries are the main contributors of mortality in fall injuries. Mortality from these injuries increased with age and ISS.


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        • Guirguis-Blake J.M.
        • Michael Y.L.
        • Perdue L.A.
        • Coppola E.L.
        • Beil T.L.
        • Thompson J.H.
        Interventions to prevent fall in community-dwelling older adults: a systematic review for the U.S. preventive services task force.
        Agency for Healthcare Research and Quality (US), RockvilleMD2018
      1. Falls. World Health Organization. World Health Organization; 2021 [cited 2022Oct8]. Available from:

        • James S.L.
        • Lucchesi L.R.
        • Bisignano C.
        • Castle C.D.
        • Dingels Z.V.
        • Fox J.T.
        • et al.
        The global burden of fall: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017.
        Injury Prev. 2020; 26: i3-i11
        • Ha V.A.T.
        • Nguyen T.N.
        • Nguyen T.X.
        • Nguyen H.T.T.
        • Nguyen T.T.H.
        • Nguyen A.T.
        • et al.
        Prevalence and factors associated with fall among older outpatients.
        Int J Environ Res Public Health. 2021; 18: 4041
        • Ahmed N.
        • Greenberg P.
        Examining outcomes in cases of elderly patients who fell from ground level at home with normal vital signs at the scene: an analysis of the National Trauma Data Bank.
        J Trauma Acute Care Surg. 2019; 87: 672-677
        • DeGrauw X.
        • Annest J.L.
        • Stevens J.A.
        • Xu L.
        • Coronado V.
        Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older, United States, 2006-2011.
        J Saf Res. 2016; 56: 105-109
        • Hollis S.
        • Lecky F.
        • Yates D.W.
        • Woodford M.
        The effect of pre-existing medical conditions and age on mortality after injury.
        J Trauma. 2006; 61: 1255-1260
        • Jindal H.A.
        • Duggal M.
        • Jamir L.
        • Sharma D.
        • Kankaria A.
        • Rohilla L.
        • et al.
        Mental health and environmental factors associated with fall in the elderly in North India: a naturalistic community study.
        Asian J Psychiatry. 2019; 39: 17-21
        • Ayoung-Chee P.
        • McIntyre L.
        • Ebel B.E.
        • Mack C.D.
        • McCormick W.
        • Maier R.V.
        Long-term outcomes of ground-level fall in the elderly.
        J Trauma Acute Care Surg. 2014; 76: 498-503
        • Mahalakshmy T.
        • Dongre A.R.
        • Kalaiselvan G.
        Epidemiology of childhood injuries in rural Puducherry, South India.
        Indian J Pediatr. 2011; 78: 821-825
        • Niven D.J.
        • Kirkpatrick A.W.
        • Ball C.G.
        • Laupland K.B.
        Effect of comorbid illness on the long-term outcome of adults suffering major traumatic injury: a population-based cohort study.
        Am J Surg. 2012; 204: 151-156
        • Shrestha R.
        • Shrestha S.K.
        • Kayastha S.R.
        • Parajuli N.
        • Dhoju D.
        • Shrestha D.
        A comparative study on epidemiology, spectrum and outcome analysis of physical trauma cases presenting to emergency department of Dhulikhel Hospital, Kathmandu university hospital and its outreach centers in rural area.
        Kathmandu Univ Med J (KUMJ). 2013; 11: 241-246
        • Joshi S.K.
        • Shrestha S.
        A study of injuries and violence related articles in Nepal.
        JNMA J Nepal Med Assoc. 2009; 48: 209-216
        • Bhuvaneswari N.
        • Prasuna J.G.
        • Goel M.K.
        • Rasania SK.
        An epidemiological study on home injuries among children of 0-14 years in South Delhi.
        Indian J Public Health. 2018; 62: 4-9
        • Fayyaz J.
        • Wadhwaniya S.
        • Shahzad H.
        • Feroze A.
        • Zia N.
        • Mir M.
        • et al.
        Pattern of fall injuries in Pakistan: the Pakistan national emergency department surveillance (Pak-NEDS) study.
        BMC Emerg Med. 2015; 15: S3
        • Jagnoor J.
        • Suraweera W.
        • Keay L.
        • Ivers R.Q.
        • Thakur J.S.
        • Gururaj G.
        • et al.
        Childhood and adult mortality from unintentional fall in India.
        Bull World Health Organ. 2011; 89: 733-740
        • Bachani A.M.
        • Ghaffar A.
        • Hyder A.A.
        Burden of fall injuries in Pakistan–analysis of the national injury survey of Pakistan.
        East Mediterr Health J. 2011; 17: 375-381
        • Mehmood A.
        • Razzak J.A.
        Trauma registry–needs and challenges in developing countries.
        J Park Med Assoc. 2009; 59: 807-808
        • Babu A.
        • Rattan A.
        • Ranjan P.
        • Singhal M.
        • Gupta A.
        • Kumar S.
        • et al.
        Are fall more common than road traffic accidents in pediatric trauma? Experience from a Level 1 trauma centre in New Delhi, India.
        Chin J Traumatol. 2016; 19: 75-78
        • Peden M.
        • Oyegbite K.
        • Ozanne-Smith J.
        • Hyder A.A.
        • Branche C.
        • Rahman A.
        • Rivara F.
        • Bartolomeos K.
        World Report on Child Injury Prevention.
        World Health Organization, Geneva2008
        • Jagnoor J.
        • Keay L.
        • Ganguli A.
        • Dandona R.
        • Thakur J.S.
        • Boufous S.
        • Cumming R.
        • Ivers R.Q.
        Fall related injuries: a retrospective medical review study in North India.
        Injury. 2012; 43: 1996-2000
        • Fikadu A.
        • Sultan M.
        • Michael M.
        • Workina A.
        Pattern and outcomes of fall injuries and associated factors in emergency department at Addis Ababa Burn.
        Emergency Trauma Hosp. 2021; 13: 381-389
        • Janeway H.
        • O'Reilly G.
        • Schmachtenberg F.
        • Kharva N.
        • Wachira B.
        Characterizing injury at a tertiary referral hospital in Kenya.
        PLoS One. 2019; 14e0220179
      2. NHFD 2022 annual report . The National Hip Fracture Database. Royal College of Physicians; 2018 [cited 2022Oct8]. Available from:

      3. TITCO collaborators (2017). TITCO dataset version 1. Available from

        • World Health Organization
        ICD-10: international statistical classification of diseases and related health problems: Tenth revision. 2nd ed. World Health Organization, 2004
        • Bolorunduro O.B.
        • Villegas C.
        • Oyetunji T.A.
        • Haut E.R.
        • Stevens K.A.
        • Chang D.C.
        • et al.
        Validating the Injury Severity Score (ISS) in different populations: ISS predicts mortality better among Hispanics and females.
        J Surg Res. 2011; 166: 40-44
        • Jain S.
        • Iverson L.M.
        Glasgow coma scale. 2021 Jun 20.
        StatPearls. StatPearls Publishing, Treasure Island (FL)2022
        • Gerdin M.
        • Roy N.
        • Dharap S.
        • Kumar V.
        • Khajanchi M.
        • Tomson G.
        • et al.
        Early hospital mortality among adult trauma patients significantly declined between 1998-2011: three single-centre cohorts from Mumbai, India.
        PLoS One. 2014; 9: e90064
        • R Core Team
        R: a language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2020 (Available from)
        • James S.L.
        • Castle C.D.
        • Dingels Z.V.
        • Fox J.T.
        • Hamilton E.B.
        • Liu Z.
        • et al.
        Global injury morbidity and mortality from 1990 to 2017: results from the global burden of disease study 2017.
        Inj Prev. 2020; 26: i96-i114
        • Mekkodathil A.
        • El-Menyar A.
        • Kanbar A.
        • Hakim S.
        • Ahmed K.
        • Siddiqui T.
        • et al.
        Epidemiological and clinical characteristics of fall-related injuries: a retrospective study.
        BMC Public Health. 2020; 20: 1186
        • Wadhwaniya S.
        • Alonge O.
        • Ul Baset M.
        • Chowdhury S.
        • Bhuiyan A.
        • Hyder A.
        Epidemiology of fall injury in rural Bangladesh.
        Int J Environ Res Public Health. 2017; 14: 900
        • Khorgami Z.
        • Fleischer W.J.
        • Yuen-Jing A.C.
        • Mushtaq N.
        • Charles M.S.
        • Howard C.A.
        Ten-year trends in traumatic injury mechanisms and outcomes: a trauma registry analysis.
        Am J Surg. 2018; 215: 727-734
        • Roy N.
        • Gerdin M.
        • Schneider E.
        • Veetil D.K.K.
        • Khajanchi M.
        • Kumar V.
        • et al.
        Validation of international trauma scoring systems in urban trauma centres in India.
        Injury. 2016; 47: 2459-2464
        • Akkoca M.
        • Tokgöz S.
        • Yılmaz K.B.
        • Güler S.
        • Akıncı M.
        • Balas Ş.
        Mortality determiners for fall from height cases.
        Ulus Travma Acil Cerrahi Derg. 2018; 24: 445-449
        • Cheng P.
        • Wang L.
        • Ning P.
        • Yin P.
        • Schwebel D.C.
        • Liu J.
        • et al.
        Unintentional fall mortality in China, 2006-2016.
        J Glob Health. 2019; 9010603
      4. International Osteoporosis Foundation: IOF. International Osteoporosis Foundation. INTERNATIONAL OSTEOPOROSIS FOUNDATION; 2022 [cited 2022Oct8]. Available from:

        • Yokota M.
        • Fujita T.
        • Nakahara S.
        • Sakamoto T.
        Clarifying differences in injury patterns between ground-level falls and falls from heights among the elderly in Japan.
        Public Health. 2020; 181: 114-118
        • Peeters W.
        • van den Brande R.
        • Polinder S.
        • Brazinova A.
        • Steyerberg E.W.
        • Lingsma H.F.
        • et al.
        Epidemiology of traumatic brain injury in Europe.
        Acta Neurochir (Wien). 2015; 157: 1683-1696