Into the wild and on to the table: A western trauma association multicenter analysis and comparison of wilderness falls in rock climbers and nonclimbers

Matthew Bernard, Matthew J. Martin, Josh Corsa, Bryce Robinson, Muhammad Zeeshan, Bellal Joseph, David Morris, William Shillinglaw, Michael Schurr, Terrie Smith, Sabino Lara, Carlos Brown, Kevin Harrell, Robert Maxwell, Allison E. Berndtson, Terry Curry, Krista Kaups, Rachel Dirks, Michael Rott, Thomas SchroeppelZachery Stillman, Zachary Warriner, Kenji Inaba, Clay Burlew, Caitlin Robinson, Rebecca Jackson, Julie Dunn, Trinette Chapin, Alison Wilson, Steve Moulton, Ryan Phillips, Niti Shahi, Shane Urban, Catherine Velopulos, Daniel Davenport, Andrew C. Bernard

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Wilderness activities expose outdoor enthusiasts to austere environments with injury potential, including falls from height. The majority of published data on falls while climbing or hiking are from emergency departments. We sought to more accurately describe the injury pattern of wilderness falls that lead to serious injury requiring trauma center evaluation and to further distinguish climbing as a unique pattern of injury. METHODS: Data were collected from 17 centers in 11 states on all wilderness falls (fall from cliff: International Classification of Diseases, Ninth Revision, e884.1; International Classification of Diseases, 10th Revision, w15.xx) from 2006 to 2018 as a Western Trauma Association multicenter investigation. Demographics, injury characteristics, and care delivery were analyzed. Comparative analyses were performed for climbing versus nonclimbing mechanisms. RESULTS: Over the 13-year study period, 1,176 wilderness fall victims were analyzed (301 climbers, 875 nonclimbers). Fall victims were male (76%), young (33 years), and moderately injured (Injury Severity Score, 12.8). Average fall height was 48 ft, and average rescue/transport time was 4 hours. Nineteen percent were intoxicated. The most common injury regions were soft tissue (57%), lower extremity (47%), head (40%), and spine (36%). Nonclimbers had a higher incidence of severe head and facial injuries despite having equivalent overall Injury Severity Score. On multivariate analysis, climbing remained independently associated with increased need for surgery but lower odds of composite intensive care unit admission/death. Contrary to studies of urban falls, height of fall in wilderness falls was not independently associated with mortality or Injury Severity Score. CONCLUSION: Wilderness falls represent a unique population with distinct patterns of predominantly soft tissue, head, and lower extremity injury. Climbers are younger, usually male, more often discharged home, and require more surgery but less critical care.

Original languageEnglish (US)
Pages (from-to)570-575
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume89
Issue number3
DOIs
StatePublished - Sep 1 2020

Keywords

  • Cliff
  • Climbing
  • Hiking
  • Outdoor

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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