Introduction: Stepladders and ladders are widely used not only in labor but also at home, but there are lots of cases of head injuries caused by falls of them. We retrospectively examined cases of head injuries caused by falls from stepladder or ladder at our hospital.
Method: Of the 913 cases of head trauma with intracranial hematoma that were treated in our hospital from January 2010 to December 2020, 30 cases were caused by falling from stepladder or ladder. The analysis focused on clinical findings.
Results: The age ranged from 26 to 87 years (median 68 years), and the gender was 29 males and 1 female. GCS at admission was 3 to 15 points (median value 12), and the main intracranial hematomas on the image were traumatic subarachnoid hemor- rhage in 6 cases, cerebral contusion in 9 cases, acute subdural hematoma in 12 cases, and acute epidural hematoma in 3 cases. A comparison of the good outcome group (16 cases) and the poor outcome group (14 cases) showed significant differences in age, GCS, ISS, and Ddimer at admission. The causes of poor outcome were 6 deaths due to increased ICP, 2 brain dysfunction due to diffuse axonal injury, and 6 residual focal neurological deficit due to cerebral contusions. There was no significant difference in the fall height between the good outcome group (2.6 m) and the poor outcome group (3.3 m).
Discussion: In the cases of head injuries caused by falls from stepladder and ladder at our hospital, poor outcome factors were elderly, low GCS, high ISS, and high Ddimer at the time of visit. In the elderly, not only intracranial hematoma but also diffuse axonal injury was the cause of poor prognosis. Since the height of the fall did not affect the outcome, it is not possible to take a sufficient defensive posture against an unexpected fall, which is one of the causes of the aggravation of the elderly.