Comparison of traumatic brain injury resulting from stair-related falls to falls from standing height -a neurotrauma center cohort

Cathrine Tverdal^1*Andrew Reiner²Eirik Helseth^1,3Torgeir Hellstrøm⁴Unn Sollid Manskow^5,6Mads Aarhus^1,3Karoline Skogen⁷Pål Rønning¹Dag Ferner Netteland^1,3

• ¹Department of Neurosurgery, Oslo University Hospital, Oslo, Nordland, Norway
• ²Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
• ³Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
• ⁴Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
• ⁵Norwegian Centre for E-health Research, Tromsø, Troms, Norway
• ⁶Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Troms, Norway
• ⁷Department of Radiology, Oslo University Hospital, Oslo, Oslo, Norway

Background: Falls are the leading cause of traumatic brain injury (TBI) in high-income countries, and globally, the incidence of fall-related injuries is projected to rise. In this study, we compare TBI resulting from stair-related falls (SRF) to falls from standing height (FSH), analyzing their epidemiology and outcomes.In a single-center, registry-based cohort study using the Oslo TBI Registry -Neurosurgery (OTBIR-N), we identified adults (≥18 years) admitted to Oslo University Hospital with TBI from either SRF or FSH between 2015 and 2022. Epidemiology and outcome measures were compared between the two groups, and a multivariate logistic regression model was used to evaluate the adjusted effect of the fall mechanisms on dichotomized functional outcome (Glasgow outcome score (GOS) 1-3 vs GOS 4-5).Results: A total of 1,432 patients with a median age of 71 years were included. SRF represented 25%, while FSH represented 52% of all fall-related TBI. SRF patients were generally younger and healthier, with a higher frequency of moderate-severe TBI than FSH patients (53% vs 31%; p<0.001). SRF also occurred more often during evenings and nights, in weekends, and were more often related to alcohol influence (58% vs 22%; p<0.001). Both fall types resulted in unfavorable functional outcome (GOS 1-3) for a substantial proportion of patients (37% in SRF and 42% in FSH; p=.066). When adjusting for covariates in the multivariable logistic regression model, there was a tendency of SRF being associated with unfavourable outcome compared to FSH, but the effect was not statistically significant (OR 1.43, 95%CI 0.97 -2.12; p=0.073) Conclusion: SRF represented a considerable proportion of fall-related TBI and was associated with poor outcome in a substantial proportion of patients. Targeted public awareness campaigns addressing the risks associated with staircases, especially when combined with alcohol-influence, seems warranted to prevent such injuries.