Original ContributionStair-related injuries treated in United States emergency departments
Introduction
Stairs are present inside an estimated 49% of homes in the United States (US), not including single-story dwellings that may require stairs for access [1]. Although frequent exposure to these structures may lead many people to underestimate their potential to be associated with injury, such injuries are well-documented in the research literature [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. Most stair-related injuries do not result in serious medical outcomes [2], [3], [4], [5], [6], [11]; however, it is important to note that fatalities do occur [2], [8], [10], [15], [16]. Overall, falls are the leading cause of non-fatal injury in the US, and are associated with significant morbidity and mortality among older adults [16], [17]. Because stairs are so prevalent in society and are a common location for falls to occur, it is important to study stair-related injuries across all age groups.
Previous studies have documented the frequency and characteristics of stair-related injuries among children [3], [4], [5], [6], [11], [12], [13], [18]. There is also existing research describing high rates of stair-related injuries among older adults, as well as the associated morbidity and mortality [2], [8], [10], [14], [19], [20]. Numerous studies have examined gait characteristics of different age groups and their relationship to relative injury rates [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31]. In addition to describing injuries, studies have also investigated the costs associated with stair-related injuries [32], [33], [34], [35]. It is estimated that non-fatal injury-related direct medical and indirect costs are $92 billion annually in the US [35].
The objective of the current study is to investigate the epidemiological characteristics of stair-related injuries among all ages using a nationally representative sample over a multi-year period. Our study also expands upon prior research on this topic to investigate the mechanisms of stair-related injuries and examine trends.
Section snippets
Data source
Data for patients treated in US emergency departments (EDs) for stair-related injuries from January 1, 1990 through December 31, 2012 were obtained through the National Electronic Injury Surveillance System (NEISS). The NEISS, developed in 1972 and maintained by the US Consumer Product Safety Commission (CPSC), provides consumer product-related and sports and recreational activity-related injury data from a stratified probability sample of approximately 100 US hospital EDs that provide 24-h
Theory
This study provides a comprehensive epidemiological analysis of nationally representative emergency department data covering a 23-year period regarding an important source of injury morbidity in the US. In addition, within the context of study findings, this article describes relevant injury prevention strategies.
Overall injury characteristics and trends
An estimated 24,760,843 (95% CI: 20,833,284–28,688,402) individuals were treated in US EDs for stair-related injuries from 1990 through 2012, averaging 1,076,558 stair-related injuries per year or an annual rate of 37.8 per 10,000 US residents (Table 1, Fig. 1). The number of injuries decreased (− 5.8%, m = − 8391.1, p = 0.065) from 951,550 cases in 1990 to 896,769 cases in 1996, before increasing to 1,296,148 cases in 2012 (44.5%, m = 24,925.0, p < 0.001; Fig. 1). This corresponded to a 12.6% (m = − 0.765,
Discussion
There were an average of 1,076,558 stair-related injuries per year during the study period, equaling an average of 2949 injuries daily, and the number and rate of injuries are increasing. The observed 24% increase in the rate of stair-related injuries from 1996 to 2012 was primarily attributable to the 36% increase in the rate among older children and adults 11–60 years of age during 1996 to 2012 and the 20% increase among older adults ≥ 61 years of age during 1995 to 2012. The 32% decline in the
Conclusions
This study demonstrates that stair-related injuries are an important common cause of injury among individuals of all ages. The number and rate of stair-related injuries treated in US EDs are increasing, indicating a need for more effective prevention efforts. Notably, a large proportion of the injury burden occurs to the adult female population. Although the causes for this finding are uncertain, it is an important factor to consider when developing targeted interventions for this injury
Funding source
Author Danielle Herbert Blazewick received a research scholarship stipend from the National Student Injury Research Training Program at Nationwide Children's Hospital, funded by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (grant #1R49CE002106) and Child Injury Prevention Alliance, while she worked on this study. The interpretations and conclusions in this article do not necessarily represent those of the funding organizations.
Financial disclosure statement
The authors have nothing to disclose relevant to this study.
Conflict of interest statement
The authors have no conflicts of interest relevant to this study.
References (47)
- et al.
Staircase falls: high-risk groups and injury characteristics in 464 patients
Injury
(2009) - et al.
Influence of age and fall type on head injuries in infants and toddlers
Int J Dev Neurosci
(2012) - et al.
Fatal falls down stairs
Injury
(1999) Risk factors for severe injury following indoor and outdoor falls in geriatric patients
Arch Gerontol Geriatr
(2016)Slip, trip and fall accidents: relationship to building features and use of coroners' reports in ascribing cause
Appl Ergon
(2001)- et al.
Dynamic stability control in younger and older adults during stair descent
Hum Mov Sci
(2012) - et al.
Age effects on strategies used to avoid obstacles
Gait Posture
(1994) - et al.
Ground reaction forces and frictional demands during stair descent: effects of age and illumination
Gait Posture
(2002) - et al.
Foot clearance during stair descent: effects of age and illumination
Gait Posture
(2005) - et al.
The dynamic gait index in healthy older adults: the role of stair climbing, fear of falling and gender
Gait Posture
(2009)
Stepping responses made by elderly and young female adults to approach and accommodate known surface height changes
Gait Posture
The acute medical care costs of fall-related injuries among the U.S. older adults
Injury
Serious stair injuries can be prevented by improved stair design
Appl Ergon
Age-related differences in dynamic balance control during stair descent and effect of varying step geometry
Appl Ergon
Effect of handrail shape on graspability
Appl Ergon
Efficacy of handrails in preventing stairway falls: a new experimental approach
Safety Science
American Housing Survey
Stairway-related injuries in children
Pediatrics
Things that go bump … bump … bump: an analysis of injuries from falling down stairs in children based at Sheffield Children's Hospital
Emerg Med J
Stairway injuries in children
Pediatrics
Femur fractures resulting from stair falls among children: an injury plausibility model
Pediatrics
Analysis of serious injuries caused by stairway falls
Emerg Med
Falls on stairs: an epidemiological accident study
Scand J Soc Med
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Address where work was done: Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital; 700 Children's Drive; Columbus, OH 43205.