Differences in trauma injury patterns and severity between intentional and accidental fall from a height: A Japanese nationwide trauma database study

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The mechanism of injury (intentional or accidental) is an important factor in predicting trauma patterns and severity. We aimed to describe how the severity of injuries in each body region contributes to overall trauma severity and skeletal trauma patterns in intentional and accidental falls. Methods Data were obtained from a nationwide trauma database between January 1, 2004 and May 31, 2019. Patients aged ≥ 18 years and injured by fall from a height were included. The median Abbreviated Injury Scale (AIS) score for the Injury Severity Score (ISS) for each body region (region 1 [head, face, and neck], region 2 [thorax], region 3 [abdomen], region 4 [lower extremity and pelvis], and region 5 [upper extremity]) was investigated. Skeletal injury patterns were classified into four groups: group I (intentional/severe), group II (accidental/severe), group III (intentional/not severe), and group IV (accidental/not severe). Severe trauma was defined as a trauma with an ISS of 16 or more. The comparison between groups was assessed using the chi-square test and Mann–Whitney U test. Results Among the 342,263 patients enrolled in the database, 28,409 met the inclusion criteria: 6,812 in group I, 11,754 in group II, 2,384 in group III, and 7,459 in group IV. The intentional group showed an increase in the AIS score for the lower region (region 4) as the ISS increased, whereas the accidental group showed an increase in the AIS score for the upper region (region 1). Both groups showed an increase in the AIS score for region 2 as the ISS increased. The intentional fall group had a higher proportion of fractures in the lower extremities and pelvis. Conclusions There were differences in trauma patterns and trauma severity levels between patients who experienced intentional and accidental falls from a height. Our findings provide a comprehensive understanding of this topic. Further studies are required to assess the usefulness of our findings for the development of initial treatment strategies at the ED. Fall from a height suicide jumping trauma database injury patterns Figures Figure 1 Figure 2 Background Fall from a height is one of the most common severe traumas observed at emergency departments (EDs), and it is associated with high rates of death and significant disability due to the characteristic distribution of bodily injuries [ 1 , 2 ]. At the ED, patients who fall from a height often require collaborative treatment, involving the expertise of physicians from various departments, such as neurosurgeons, orthopedic surgeons, and thoracic surgeons. Thus, predicting injury patterns as soon as possible at the ED helps trauma team leaders develop an appropriate initial treatment strategy. For this purpose, epidemiological data on the distribution of fractures would be useful. Skeletal injury patterns due to fall from a height have been investigated, focusing on the mechanism of injury (intentional or accidental) [ 2 – 7 ]. Previous studies have reported that intentional falls caused more fractures in lower extremities than unintentional falls [ 2 , 5 , 7 ]. However, these findings should be interpreted with caution owing to the heterogeneity of trauma severity in the intentional and the accidental groups in the previous studies, and to our knowledge, no study had reported the differences in both trauma patterns and overall severity using the Abbreviated Injury Scale (AIS) score and Injury Severity Score (ISS). Small sample sizes and single-center case series design are also some of the limitations of previous studies. Therefore, we aimed to investigate the differences in both skeletal trauma patterns and trauma severity between intentional and accidental falls from a height using a large sample population from a nationwide trauma database. Methods Ethical statement This study adhered to the principles of the Declaration of Helsinki. This study was approved by the Institutional Review Board of the National Defense Medical College. Informed consent was not required because this was an observational study that included only existing medical information. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [8]. Study design This was a multicenter, nationwide, and retrospective cohort study. Data source The Japanese Trauma Databank (JTDB) is a multicenter, nationwide trauma registry in Japan established in 2003 by the Japanese Association for the Surgery of Trauma and by the Japanese Association for Acute Medicine with the aim of improving the quality of trauma care in Japan. The patients who were transported to the participating hospitals and had at least one AIS score of 3 or higher were registered. Patients who refused to participate in the JTDB were excluded. As of 2021, 292 acute care hospitals that provide trauma care throughout Japan were participating in the JTDB. The data were entered by physicians and medical assistants who had attended AIS-coding lectures. The data in the JTDB includes approximately 90 items, covering prehospital care, initial treatment, diagnosis, in-hospital treatment, and clinical outcomes such as mortality and length of hospital stay. In this study, we used the JTDB, which was released in 2021, and included trauma patients treated between January 1, 2004 and May 31, 2019. Participants Patients who were aged ≥18 years and were injured by intentional and accidental fall from a height were included. We excluded patients with missing ISS data. Data collection The data related to patients and hospital information were obtained from the JTDB, including demographic information, pre-hospital, emergency department, in-hospital treatments, AIS score, ISS, and clinical outcomes. Definitions of the variables The AIS is an internationally accepted tool for ranking injury severity. The AIS is an anatomically-based, global severity scoring system that classifies each injury by body region according to its relative severity on a 6-point scale (1 = minor, 6 = lethal). In this study, AIS 98 was used [9]. The AIS scores were originally calculated separately for nine regions (head, face, neck, thorax, abdomen, spine, upper extremity, lower extremity, and others [external and thermal injuries, and other trauma]), but we re-grouped these nine regions into five for our analyses: region 1 (head, face, and neck), region 2 (thorax), region 3 (abdomen), region 4 (lower extremity and pelvis), and region 5 (upper extremity). The cervical, thoracic, and lumbar spine/spinal cord regions were classified under regions 1, 2, and 3, respectively. The region of external and thermal injuries and other trauma was excluded when re-grouping since the AIS codes in the region had no information about which part of the body is injured. The AIS provides the foundation for the ISS, a recognized tool for assessing overall injury severity. The ISS is the sum of the squares of the highest AIS code in each of the three most severely injured ISS body regions [9, 10]. Severe trauma was defined as a trauma with an ISS of 16 or higher. The cut-off score of 16 is used in Japan; for certification of trauma centers and trauma specialists, experience in treating a certain number of patients with ISS of 16 or higher is required. The included patients were divided into four groups: group I (intentional/severe), group II (accidental/severe), group III (intentional/not severe), and group IV (accidental/not severe). Weather the injury was intentional or accidental was identified by the mechanism of injury (intentional, accidental, assaulted, or unknown) in the JTDB. Fractures were identified by AIS codes registered for each patient. Outcomes The primary objective was to describe how the severity of injury in each body region contributed to overall trauma severity in the intentional and accidental groups. The overall trauma severity was defined by the ISS. We compared the median AIS scores for the ISS of each region among the groups. The secondary objective was to describe the differences in skeletal fracture patterns and to compare the characteristics of non-survivors among the groups. Statistical analysis The variables were expressed as medians (interquartile ranges [IQRs]) for continuous variables and as numbers (percentages) for categorical variables [8]. The characteristics of the four groups defined above were compared. The differences in the regional scores contributing to overall trauma severity in the intentional and accidental groups were presented using a graph that plotted the median AIS scores for the ISS of each region. Continuous variables were compared between intentional and accidental groups using the Mann–Whitney U or Kruskal–Wallis test, and categorical variables were compared using the chi-squared test. All analyses were performed using SPSS, version 28 (IBM Corp., Armonk, NY, USA). Statistical tests were two-sided, with p <0.05 indicating statistical significance. Results Selection of patients Figure 1 summarizes the process of selecting patients for this study. Among the 342,263 patients registered in the JTDB, 28,409 patients were eligible. Of these, 6,812 (24.0%) were classified under group I (intentional/severe), 11,754 (41.4%), under group II (accidental/severe), 2,384 (8.4%), under group III (intentional/not severe), and 7,459 (26.3%), under group IV (accidental/not severe). Characteristics of patients Table 1 demonstrates the characteristics of the included patients in each group. The patients in the intentional groups (group I and III) were younger than those in the accidental groups (group II and IV). The median ages in groups I, II, III, and IV were 40 years (IQR, 29–55 years), 61 years (44–71 years), 34 years (25–47 years), and 56 years (40–68 years), respectively. The intentional groups had lower proportions of males (48.7% in group I, 86.5% in group II, 38.6% in group III, and 85.3% in group IV [ p < 0.001]) and past medical history of psychiatric diseases (45.0% in group I, 5.3% in group II, 60.0% in group III, and 5.0% in group IV [ p < 0.001]) at admission. The mortality rates in the intentional groups were twice as high as those in the accidental groups. Comparisons between the intentional and accidental groups are shown in Table 2; there were statistically significant differences for all variables. Characteristics of fatal cases are shown in Additional File 1. The intentional group had higher ISS (41 [27–50] in the intentional group vs. 29 [25–41] in the accidental group, p < 0.001) and higher maximum AIS scores in region 4 (3 [2–4] vs. 0 [0–2], p < 0.001) than the accidental group. Regions contributing to trauma severity in intentional and accidental falls from a height Figure 2 shows the median AIS scores for the ISS of each region in the intentional and accidental groups. In region 1 (head, face, and neck), the median AIS score at the ISS of 75 in both groups was 6. As the ISS increased, the median AIS score in the accidental group increased earlier than that of the intentional group (Figure 2a). There were statistically significant differences between groups I and II and between groups III and IV ( p < 0.001). In region 2 (thorax), as the ISS increased, the median AIS score increased in a similar fashion in both the intentional and accidental groups. For patients with an ISS between 35 and 50, the median AIS score in the intentional group was higher than that in the accidental group (Figure 2b). In the case of patients with an ISS below 45 for region 3 (abdomen), the median AIS score was higher in the intentional group than in the accidental group, and vice versa in the case of patients with an ISS above 45, although the median AIS score in both groups was not higher than 3 (Figure 2c). For region 4 (lower extremity and pelvis), the median AIS score in the intentional group was higher than that in the accidental group, regardless of the ISS. In particular, the median AIS score in the intentional group was often higher than 4 in patients with an ISS above 30 (Figure 2d). There was a statistically significant difference in the ISS for region 5 between the groups, but the median AIS score in both groups was below 2 (Figure 2e). Skeletal trauma patterns in the four groups Table 3 summarizes the skeletal trauma patterns in the four groups, and the proportion of fractures for each bone. The severe groups (group I and II) had high proportions of skull (24.8% in group I and 26.4% in group II), rib (50.1% and 46.3%), lumbar spine (29.5% and 22.8%), and pelvis fractures (60.2% and 25.4%). Similarly, the non-severe groups (group III and IV) had high proportions of rib (9.3% in group III and 19.2% in group IV), lumbar spine (35.3% and 20.0%), and pelvis fractures (24.8% and 15.8%). There was a distinct difference in lower extremity and pelvis fractures between the intentional and accidental groups. The intentional group had higher proportions of fractures of the lower extremities and pelvis, and the difference was more pronounced in the severe group. The proportions of pelvis fractures were 60.2% in group I, 25.4% in group II, 24.8% in group III, and 15.8% in group IV ( p < 0.001). The proportions of calcaneus fractures were 11.6% in group I, 2.9% in group II, 18.7% in group III, and 6.7% in group IV ( p < 0.001). Discussion In this study, we demonstrated the differences in the trauma patterns and distribution of trauma severity in patients who experienced intentional and accidental falls from a height, using a large sample population from a nationwide trauma database. The data were classified into four groups according to injury mechanism (intentional or accidental) and trauma severity (ISS ≥ 16 or not). The most important findings of our results were as follows: First, in the intentional groups, the trauma severity increased in the lower extremities and pelvic region as the ISS increased, while in the accidental groups, the trauma severity in the head region increased. Second, both the intentional and accidental groups showed an increase in thoracic trauma severity as the ISS increased, although this pattern was observed sooner in the accidental group. Last, the intentional group had more fractures of the lower extremity and pelvis. Several studies have reported partially similar findings to our results [2, 4-7]. For example, Papadakis reported the distribution of fractures in the pelvis (42.1% in the intentional group vs 4.4%, p < 0.001), ribs (40.6% vs 25.5%, p < 0.001), lower extremities (1.1–9.4% vs 14%–59.3%), and skull (25% vs 3.8%, p < 0.001) [2]. Our studies showed that intentional group had higher proportion of skull fracture than accidental group. Faggiani also reported the distribution of foot (55.4% vs. 27.1%, p < 0.001) and thorax fractures (43.1% vs 28.6%, p < 0.001) [5] while in our study group III (intentional/ Not severe) had lower proportion of thorax fracture than group IV (accidental/ Not severe). Although no distinction was made between intentional and accidental falls, several studies that included only fatal cases reported that non-survivors had a higher proportion of head and thoracic injuries [11, 12]. Regarding the distribution of trauma severity, Piazzalunga reported the AIS scores for the head, face, thorax, abdomen, and extremities (upper and lower extremities) in intentional and accidental groups. In their study, there was not a significant difference in the AIS score for the head between intentional and accidental group (2.9 ± 1.25 vs 2.59 ± 1.42) [4]. However, our study showed that the intentional group had higher levels of the AIS scores in region 1 (head, face, and neck) than those in the accidental group (Figure 2a). Such partially concordant and discordant findings resulted from the lack of comparisons adjusted for overall trauma severity such as ISS. In addition, these studies were single-institution case series, had small sample sizes, and did not have data on the distribution of trauma severity for each body region (AIS score). Our results add to a comprehensive understanding of the differences between intentional and accidental falls from a height as our study resolved the abovementioned limitations. We used the JTDB that has more than 25,000 cases of falls from a height and summarized the distribution of trauma severity for each body region and overall trauma severity. The difference between intentional and accidental falls from a height shown in our study can be attributed to the difference in posture when landing on the ground [4]. When the patients land on their heels on the ground, the external force travels through the lower extremities and reaches the pelvis and vertebrae. In particular, unstable pelvic ring disruptions, such as vertical shear, are caused by high-energy blunt trauma including fall from a height [13, 14]. The skeletal trauma patterns in our results strongly support this finding. The difference in the ISS between the intentional and accidental groups was consistent with the difference in the AIS scores for the lower extremities and pelvis. Considering the ISS of the patients included in the previous studies, our results were consistent with the findings on skeletal trauma patterns reported in the previous studies. This study also had some limitations. First, the JTDB is not a population-based sample of all trauma patients. Patients who were not registered in the participating hospitals or who were not transferred to hospitals due to on-scene death were not included in the JTDB; therefore, selection bias cannot be ruled out. However, our study included 3,581 patients who died in the ED, which would reduce the degree of bias to a certain extent. Second, the inaccuracies of the database itself may have influenced the results. Haas et al. highlighted underreporting of some items in the national trauma databank [15]. The JTDB would also have the same limitations. However, we only used variables that required no subjective assessment, except for AIS coding. The patients were, in principle, registered on the JTDB by medical assistants who had attended lectures on AIS coding. In addition, very few data were missing in our study. Therefore, the inaccuracy within the JTDB would not have significantly influenced our results. Conclusions In this study, we demonstrated the differences in trauma patterns and trauma severity in patients who intentionally and accidentally fell from a height. Our findings are clinically relevant and can help emergency physicians to develop an initial treatment strategy for trauma patients injured by falls from a height at the ED. Further studies will be required to assess the impact of our results on the initial treatment strategy implemented at the ED. List Of Abbreviations ED Emergency department ISS Injury severity score AIS Abbreviated injury scale JTDB Japanese Trauma database IQR Interquartile range Declarations Ethics approval and consent to participate This study adhered to the principles of the Declaration of Helsinki. This study was approved by the Institutional Review Board of the National Defense Medical College. Informed consent was not required because this was an observational study conducted using existing medical information. Consent for publication Information about the study was disclosed to the patients so that they could decide whether or not to have their data included. Availability of data and materials The datasets analyzed in the current study are not publicly available for potential concerns of leakage of personally identifiable information. Competing interests None. Funding None. Authors' contributions TT conceived the study, performed all analysis, written the manuscript. DS provided the data (JTDB) and revised the manuscript. HT and YT revised the manuscript. AY made the finalized the manuscript. All authors read and approved the final manuscript. References do Kim do Y, Choi HJ, Park JY, Kim KH, Kuh SU, Chin DK, et al. Burst fractures as a result of attempted suicide by jumping. Korean J Neurotrauma. 2014;10:70–5. https://doi.org/10.13004/kjnt.2014.10.2.70 Papadakis SA, Pallis D, Galanakos S, Georgiou DF, Kateros K, Macheras G, et al. Falls from height due to accident and suicide attempt in Greece. A comparison of the injury patterns. Injury. 2020;51:230–4. https://doi.org/10.1016/j.injury.2019.12.029 Yanagawa Y, Jitsuiki K, Muramatsu KI, Ikegami S, Kushida Y, Nagasawa H, et al. Survey of trauma patients injured by falling or flying objects in Japan based on the Japan Trauma Data Bank. Eur J Trauma Emerg Surg. 2022;48:667–77. https://doi.org/10.1007/s00068-020-01519-6 Piazzalunga D, Rubertà F, Fugazzola P, Allievi N, Ceresoli M, Magnone S, et al. 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Characteristics of included patients missing cases Group I Group II Group III Group IV p -value Severe * Not Severe Intentional Accidental Intentional Accidental N 6,812 11,754 2,384 7,459 Age, years 0.3% 40 (29–55) 61 (44–71) 34 (25–47) 56 (40–68) < 0.001 Sex, male 0.02% 3,317 (48.7%) 10,169 (86.5%) 921 (38.6%) 6,358 (85.3%) < 0.001 Past medical history, Psychiatric disease 0% 3,067 (45.0%) 627 (5.3%) 1,426 (60.0%) 369 (5.0%) < 0.001 Alcohol use at admission 42.2% 386 (13.7%) 760 (10.5%) 305 (22.6%) 520 (10.3%) < 0.001 Vital signs at admission‡ Heart rate, /min 3.3% 82 (0–111) 67 (80–98) 76 (90–104) 69 (79–91) < 0.001 Systolic BP, mmHg 2.1% 76 (0–114) 100 (128–150) 104 (120–136) 120 (137–155) < 0.001 Diastolic BP, mmHg 11.9% 58 (0–77) 62 (78–92) 62 (74–86) 70 (81–93) < 0.001 Respiratory Rate, /min 7.7% 18 (0–25) 16 (20–25) 17 (20–25) 17 (20–24) < 0.001 Body Temperature, ℃ 17.5% 36 (35–37) 36 (36–37) 36 (37–37) 36 (37–37) < 0.001 GCS score 4.4% 6 (3–14) 14 (9–15) 13 (15–15) 15 (15–15) < 0.001 Admission to the general ward 0% 269 (4.0%) 1,874 (15.9%) 456 (19.1%) 2,877 (38.6%) < 0.001 ISS 0% 34 (24–45) 25 (18–33) 9 (8–13) 9 (8–13) < 0.001 TRISS Ps, % 12% 0.49 (0.02–0.94) 0.89 (0.63–0.94) 0.99 (0.98–0.99) 0.98 (0.96–0.99) < 0.001 Maximum AIS score in region 1 (head, face, and neck) † 0% 2 (0–4) 3 (0–4) 0 (0–1) 0 (0–2) < 0.001 Maximum AIS score in region 2 (thorax) 0% 4 (2–5) 3 (0–4) 0 (0–0) 0 (0–2) < 0.001 Maximum AIS score in region 3 (abdomen) 0% 0 (0–2) 0 (0–2) 0 (0–2) 0 (0–2) < 0.001 Maximum AIS score in region 4 (lower limbs) 0% 3 (2–4) 0 (0–2) 2 (0–2) 0 (0–2) < 0.001 Maximum AIS score in region 5 (upper limbs) 0% 0 (0–2) 0 (0–2) 0 (0–0) 0 (0–1) < 0.001 In-hospital mortality 3266 (47.9%) 2408 (20.5%) 132 (5.5%) 149 (2.0%) < 0.001 BP, blood pressure; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; TRISS, Trauma and Injury Severity Score; Ps, Probability of survival; AIS, Abbreviated Injury Scale * ISS ≥16 is defined as “severe”. ‡ Patients with cardiopulmonary arrest before arrival at the emergency department were included. † AIS score in each region was recalculated for this study from the data registered in the Japanese Trauma Databank. Table 2. Comparison of characteristics of patients in the intentional and accidental group Intentional Accidental p -value N 9,196 19,213 Age, years 39 (28–53) 59 (42–70) < 0.001 Sex, male 4,238 (46.1%) 16,527 (86.0%) < 0.001 Past medical history, Psychiatric disease 4,493 (48.9%) 996 (5.2%) < 0.001 Alcohol use at admission 691 (16.6%) 1,280 (10.4%) < 0.001 Vital signs at admission * Heart rate, /min 86 (0–109) 80 (68–95) < 0.001 Systolic BP, mmHg 97 (0–123) 132 (110–152) < 0.001 Diastolic BP, mmHg 64 (40–80) 80 (66–92) < 0.001 Respiratory rate, /min 19 (0–25) 20 (16–24) < 0.001 Body temperature, ℃ 36.2 (35.4–36.8) 36.4 (35.9–36.8) < 0.001 GCS score 12 (3–15) 15 (13–15) < 0.001 ISS 26 (14–41) 17 (10–26) < 0.001 TRISS Ps, % 0.88 (0.054–0.98) 0.95 (0.85–0.98) < 0.001 Maximum AIS score in region 1 (head, face, and neck) † 1 (0–3) 2 (0–4) < 0.001 Maximum AIS score in region 2 (thorax) 3 (0–4) 2 (0–3) < 0.001 Maximum AIS score in region 3 (abdomen) 0 (0–2) 0 (0–2) < 0.001 Maximum AIS score in region 4 (lower extremity and pelvis) 2 (0–3) 0 (0–2) < 0.001 Maximum AIS score in region 5 (upper extremity) 0 (0–2) 0 (0–2) 0.003 Death at emergency department 2,515 (27.3%) 1,066 (5.5%) < 0.001 BP, blood pressure; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; TRISS, Trauma and Injury Severity Score; Ps, Probability of survival; AIS, Abbreviated injury scale. * Patients with cardiopulmonary arrest before arrival at emergency department were included. † The maximum AIS score in each region is obtained from the data registered in the Japanese Trauma Databank. Table 3. Skeletal trauma patterns in the groups Group I Group II Group III Group IV p - value Severe * Not Severe Intentional Accidental Intentional Accidental N 6,812 11,754 2,384 7,459 Skull 1,688 (24.8%) 3,104 (26.4%) 90 (3.8%) 426 (5.7%) < 0.001 Facial bone 1,144 (16.8%) 1,199 (10.2%) 198 (8.3%) 427 (5.7%) < 0.001 Cervical spine 789 (11.6%) 1,199 (10.2%) 70 (2.9%) 470 (6.3%) < 0.001 Rib 3,415 (50.1%) 5,447 (46.3%) 221 (9.3%) 1,429 (19.2%) < 0.001 Sternal 261 (3.8%) 340 (2.9%) 21 (0.9%) 105 (1.4%) < 0.001 Thoracic spine 1,096 (16.1%) 1,847 (15.7%) 236 (9.9%) 844 (11.3%) < 0.001 Lumbar spine 2,007 (29.5%) 2,677 (22.8%) 842 (35.3%) 1,493 (20.0%) < 0.001 Scapula 463 (6.8%) 961 (8.2%) 24 (1.0%) 239 (3.2%) < 0.001 Humerus 869 (12.8%) 454 (3.9%) 127 (5.3%) 253 (3.4%) < 0.001 Radius or ulna 869 (12.8%) 454 (3.9%) 127 (5.3%) 253 (3.4%) < 0.001 Hand 119 (1.8%) 251 (2.1%) 48 (2.0%) 198 (2.7%) 0.002 Pelvis 4,101 (60.2%) 2,987 (25.4%) 591 (24.8%) 1,179 (15.8%) < 0.001 Femur 1,775 (26.1%) 1,105 (9.4%) 290 (12.2%) 811 (10.9%) < 0.001 Patella 190 (2.8%) 180 (1.5%) 79 (3.3%) 140 (1.9%) < 0.001 Tibia 879 (12.9%) 472 (4.0%) 272 (11.4%) 534 (7.2%) < 0.001 Fibula 538 (7.9%) 297 (2.5%) 154 (6.5%) 382 (5.1%) < 0.001 Foot 287 (4.2%) 143 (1.2%) 186 (7.8%) 129 (1.7%) < 0.001 Calcaneus 788 (11.6%) 342 (2.9%) 445 (18.7%) 498 (6.7%) < 0.001 Talus 128 (1.9%) 59 (0.5%) 55 (2.3%) 58 (0.8%) < 0.001 * Injury Severity Score ≥16 was defined as “severe”. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1705393","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":110613709,"identity":"1a19304f-ac99-43d0-a6c8-46c1b0651296","order_by":0,"name":"Takero Terayama","email":"data:image/png;base64,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","orcid":"","institution":"Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Saitama","correspondingAuthor":true,"prefix":"","firstName":"Takero","middleName":"","lastName":"Terayama","suffix":""},{"id":110613710,"identity":"46ee195d-19fa-42a6-874a-7600e25d71ef","order_by":1,"name":"Hiroyuki Toda","email":"","orcid":"","institution":"Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Saitama","correspondingAuthor":false,"prefix":"","firstName":"Hiroyuki","middleName":"","lastName":"Toda","suffix":""},{"id":110613711,"identity":"d27417f0-b7c6-4f2f-97de-c5dc812dd995","order_by":2,"name":"Daizo Saito","email":"","orcid":"","institution":"Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Division of Traumatology, Research Institute, National Defense Medical College, Saitama","correspondingAuthor":false,"prefix":"","firstName":"Daizo","middleName":"","lastName":"Saito","suffix":""},{"id":110613712,"identity":"f3ea834b-5bf3-41d0-90ee-869f97dc0f8b","order_by":3,"name":"Yoshihiro Tanaka","email":"","orcid":"","institution":"Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Division of Traumatology, Research Institute, National Defense Medical College, Saitama","correspondingAuthor":false,"prefix":"","firstName":"Yoshihiro","middleName":"","lastName":"Tanaka","suffix":""},{"id":110613713,"identity":"69c166d0-8cdc-4015-a57c-33b7fd67e34f","order_by":4,"name":"Aihide Yoshino","email":"","orcid":"","institution":"Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Saitama","correspondingAuthor":false,"prefix":"","firstName":"Aihide","middleName":"","lastName":"Yoshino","suffix":""}],"badges":[],"createdAt":"2022-05-29 17:44:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1705393/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1705393/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":22463365,"identity":"598d6f9a-2bc1-4cfe-b459-e7b74804c1e8","added_by":"auto","created_at":"2022-06-09 15:39:39","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":112458,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePatient flow\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eJTDB, Japanese Trauma Data Bank; ISS, Injury Severity Score.\u0026nbsp;\u003c/p\u003e\u003cp\u003e* ISS ≥ 16 is defined as “severe”.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-1705393/v1/7c6932bfc7cce75f113fdcc4.jpeg"},{"id":22463364,"identity":"15b140b9-15ce-471f-8f8d-07169d5c3e94","added_by":"auto","created_at":"2022-06-09 15:39:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":443616,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of the median AIS score for the ISS of each region in the intentional and accidental groups\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eAIS, Abbreviated Injury Scale; ISS, Injury Severity Score\u003c/p\u003e\u003cp\u003eThe median AIS score in each region: a) region 1 (head, face, and neck), b) region 2 (thorax), c) region 3 (abdomen), d) region 4 (lower extremities and pelvis), and e) region 5 (upper extremities)\u003c/p\u003e\u003cp\u003eComparison between group III (intentional and not severe) and group IV (accidental and not severe).\u003c/p\u003e\u003cp\u003e† Comparison between group I (intentional and severe) and group II (accidental and severe).\u003c/p\u003e","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-1705393/v1/f029dabb216d79f62f1eec59.png"},{"id":22463370,"identity":"bbd2755a-1c85-43dc-8e8f-c3650b1692d6","added_by":"auto","created_at":"2022-06-09 15:39:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":515344,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1705393/v1/3bc7bc40-824a-4135-a09d-8f2a3ccf7c39.pdf"},{"id":22463369,"identity":"1555f2c2-8cc6-4581-8f73-d2ad5cbace57","added_by":"auto","created_at":"2022-06-09 15:39:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":515344,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1705393/v1/c7b1cac9-7b20-4f1a-a8c6-ab58a1ef2028.pdf"},{"id":22463366,"identity":"605d3141-2904-4d36-9c68-2a98c8872333","added_by":"auto","created_at":"2022-06-09 15:39:39","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":19159,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-1705393/v1/d8915a1f8aacf9ea85b03076.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Differences in trauma injury patterns and severity between intentional and accidental fall from a height: A Japanese nationwide trauma database study","fulltext":[{"header":"Background","content":"\u003cp\u003eFall from a height is one of the most common severe traumas observed at emergency departments (EDs), and it is associated with high rates of death and significant disability due to the characteristic distribution of bodily injuries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAt the ED, patients who fall from a height often require collaborative treatment, involving the expertise of physicians from various departments, such as neurosurgeons, orthopedic surgeons, and thoracic surgeons. Thus, predicting injury patterns as soon as possible at the ED helps trauma team leaders develop an appropriate initial treatment strategy. For this purpose, epidemiological data on the distribution of fractures would be useful. Skeletal injury patterns due to fall from a height have been investigated, focusing on the mechanism of injury (intentional or accidental) [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Previous studies have reported that intentional falls caused more fractures in lower extremities than unintentional falls [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, these findings should be interpreted with caution owing to the heterogeneity of trauma severity in the intentional and the accidental groups in the previous studies, and to our knowledge, no study had reported the differences in both trauma patterns and overall severity using the Abbreviated Injury Scale (AIS) score and Injury Severity Score (ISS). Small sample sizes and single-center case series design are also some of the limitations of previous studies.\u003c/p\u003e \u003cp\u003eTherefore, we aimed to investigate the differences in both skeletal trauma patterns and trauma severity between intentional and accidental falls from a height using a large sample population from a nationwide trauma database.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adhered to the principles of the Declaration of Helsinki. This study was approved by the Institutional Review Board of the National Defense Medical College. Informed consent was not required because this was an observational study that included only existing medical information. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [8].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a multicenter, nationwide, and retrospective cohort study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Japanese Trauma Databank (JTDB) is a multicenter, nationwide trauma registry in Japan established in 2003 by the Japanese Association for the Surgery of Trauma and by the Japanese Association for Acute Medicine with the aim of improving the quality of trauma care in Japan. The patients who were transported to the participating hospitals and had at least one AIS score of 3 or higher were registered. Patients who refused to participate in the JTDB were excluded. As of 2021, 292 acute care hospitals that provide trauma care throughout Japan were participating in the JTDB. The data were entered by physicians and medical assistants who had attended AIS-coding lectures. The data in the JTDB includes approximately 90 items, covering prehospital care, initial treatment, diagnosis, in-hospital treatment, and clinical outcomes such as mortality and length of hospital stay. In this study, we used the JTDB, which was released in 2021, and included trauma patients treated between January 1, 2004 and May 31, 2019.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients who were aged \u0026ge;18 years and were injured by intentional and accidental fall from a height were included. We excluded patients with missing ISS data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data related to patients and hospital information were obtained from the JTDB, including demographic information, pre-hospital, emergency department, in-hospital treatments, AIS score, ISS, and clinical outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitions of the variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe AIS is an internationally accepted tool for ranking injury severity. The AIS is an anatomically-based, global severity scoring system that classifies each injury by body region according to its relative severity on a 6-point scale (1 = minor, 6 = lethal). In this study, AIS 98 was used [9]. The AIS scores were originally calculated separately for nine regions (head, face, neck, thorax, abdomen, spine, upper extremity, lower extremity, and others [external and thermal injuries, and other trauma]), but we re-grouped these nine regions into five for our analyses: region 1 (head, face, and neck), region 2 (thorax), region 3 (abdomen), region 4 (lower extremity and pelvis), and region 5 (upper extremity). The cervical, thoracic, and lumbar spine/spinal cord regions were classified under regions 1, 2, and 3, respectively. The region of external and thermal injuries and other trauma was excluded when re-grouping since the AIS codes in the region had no information about which part of the body is injured. The AIS provides the foundation for the ISS, a recognized tool for assessing overall injury severity. The ISS is the sum of the squares of the highest AIS code in each of the three most severely injured ISS body regions [9, 10]. Severe trauma was defined as a trauma with an ISS of 16 or higher. The cut-off score of 16 is used in Japan; for certification of trauma centers and trauma specialists, experience in treating a certain number of patients with ISS of 16 or higher is required.\u003c/p\u003e\n\u003cp\u003eThe included patients were divided into four groups: group I (intentional/severe), group II (accidental/severe), group III (intentional/not severe), and group IV (accidental/not severe). Weather the injury was intentional or accidental was identified by the mechanism of injury (intentional, accidental, assaulted, or unknown) in the JTDB. Fractures were identified by AIS codes registered for each patient.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary objective was to describe how the severity of injury in each body region contributed to overall trauma severity in the intentional and accidental groups. The overall trauma severity was defined by the ISS. We compared the median AIS scores for the ISS of each region among the groups. The secondary objective was to describe the differences in skeletal fracture patterns and to compare the characteristics of non-survivors among the groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe variables were expressed as medians (interquartile ranges [IQRs]) for continuous variables and as numbers (percentages) for categorical variables [8]. The characteristics of the four groups defined above were compared. The differences in the regional scores contributing to overall trauma severity in the intentional and accidental groups were presented using a graph that plotted the median AIS scores for the ISS of each region. Continuous variables were compared between intentional and accidental groups using the Mann\u0026ndash;Whitney U or Kruskal\u0026ndash;Wallis test, and categorical variables were compared using the chi-squared test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll analyses were performed using SPSS, version 28 (IBM Corp., Armonk, NY, USA). Statistical tests were two-sided, with \u003cem\u003ep\u003c/em\u003e \u0026lt;0.05 indicating statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSelection of patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 1 summarizes the process of selecting patients for this study. Among the 342,263 patients registered in the JTDB, 28,409 patients were eligible. Of these, 6,812 (24.0%) were classified under group I (intentional/severe), 11,754 (41.4%), under group II (accidental/severe), 2,384 (8.4%), under group III (intentional/not severe), and 7,459 (26.3%), under group IV (accidental/not severe).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics of patients\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 demonstrates the characteristics of the included patients in each group. The patients in the intentional groups (group I and III) were younger than those in the accidental groups (group II and IV). The median ages in groups I, II, III, and IV were 40 years (IQR, 29–55 years), 61 years (44–71 years), 34 years (25–47 years), and 56 years (40–68 years), respectively. The intentional groups had lower proportions of males (48.7% in group I, 86.5% in group II, 38.6% in group III, and 85.3% in group IV [\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001]) and past medical history of psychiatric diseases (45.0% in group I, 5.3% in group II, 60.0% in group III, and 5.0% in group IV [\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001]) at admission. The mortality rates in the intentional groups were twice as high as those in the accidental groups. Comparisons between the intentional and accidental groups are shown in Table 2; there were statistically significant differences for all variables.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCharacteristics of fatal cases are shown in Additional File 1. The intentional group had higher ISS (41 [27–50] in the intentional group vs. 29 [25–41] in the accidental group, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and higher maximum AIS scores in region 4 (3 [2–4] vs. 0 [0–2], \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) than the accidental group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegions contributing to trauma severity in intentional and accidental falls from a height\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2 shows the median AIS scores for the ISS of each region in the intentional and accidental groups. In region 1 (head, face, and neck), the median AIS score at the ISS of 75 in both groups was 6. As the ISS increased, the median AIS score in the accidental group increased earlier than that of the intentional group (Figure 2a). There were statistically significant differences between groups I and II and between groups III and IV (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). In region 2 (thorax), as the ISS increased, the median AIS score increased in a similar fashion in both the intentional and accidental groups. For patients with an ISS between 35 and 50, the median AIS score in the intentional group was higher than that in the accidental group (Figure 2b). In the case of patients with an ISS below 45 for region 3 (abdomen), the median AIS score was higher in the intentional group than in the accidental group, and vice versa in the case of patients with an ISS above 45, although the median AIS score in both groups was not higher than 3 (Figure 2c). For region 4 (lower extremity and pelvis), the median AIS score in the intentional group was higher than that in the accidental group, regardless of the ISS. In particular, the median AIS score in the intentional group was often higher than 4 in patients with an ISS above 30 (Figure 2d). There was a statistically significant difference in the ISS for region 5 between the groups, but the median AIS score in both groups was below 2 (Figure 2e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSkeletal trauma patterns in the four groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 summarizes the skeletal trauma patterns in the four groups, and the proportion of fractures for each bone. The severe groups (group I and II) had high proportions of skull (24.8% in group I and 26.4% in group II), rib (50.1% and 46.3%), lumbar spine (29.5% and 22.8%), and pelvis fractures (60.2% and 25.4%). Similarly, the non-severe groups (group III and IV) had high proportions of rib (9.3% in group III and 19.2% in group IV), lumbar spine (35.3% and 20.0%), and pelvis fractures (24.8% and 15.8%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere was a distinct difference in lower extremity and pelvis fractures between the intentional and accidental groups. The intentional group had higher proportions of fractures of the lower extremities and pelvis, and the difference was more pronounced in the severe group. The proportions of pelvis fractures were 60.2% in group I, 25.4% in group II, 24.8% in group III, and 15.8% in group IV (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). The proportions of calcaneus fractures were 11.6% in group I, 2.9% in group II, 18.7% in group III, and 6.7% in group IV (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we demonstrated the differences in the trauma patterns and distribution of trauma severity in patients who experienced intentional and accidental falls from a height, using a large sample population from a nationwide trauma database. The data were classified into four groups according to injury mechanism (intentional or accidental) and trauma severity (ISS \u0026ge; 16 or not). The most important findings of our results were as follows: First, in the intentional groups, the trauma severity increased in the lower extremities and pelvic region as the ISS increased, while in the accidental groups, the trauma severity in the head region increased. Second, both the intentional and accidental groups showed an increase in thoracic trauma severity as the ISS increased, although this pattern was observed sooner in the accidental group. Last, the intentional group had more fractures of the lower extremity and pelvis.\u003c/p\u003e\n\u003cp\u003eSeveral studies have reported partially similar findings to our results [2, 4-7]. For example, Papadakis reported the distribution of fractures in the pelvis (42.1% in the intentional group vs 4.4%, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), ribs (40.6% vs 25.5%, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), lower extremities (1.1\u0026ndash;9.4% vs 14%\u0026ndash;59.3%), and skull (25% vs 3.8%, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) [2]. Our studies showed that intentional group had higher proportion of skull fracture than accidental group. Faggiani also reported the distribution of foot (55.4% vs. 27.1%, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and thorax fractures (43.1% vs 28.6%, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) [5] while in our study group III (intentional/ Not severe) had lower proportion of thorax fracture than group IV (accidental/ Not severe). Although no distinction was made between intentional and accidental falls, several studies that included only fatal cases reported that non-survivors had a higher proportion of head and thoracic injuries [11, 12]. Regarding the distribution of trauma severity, Piazzalunga reported the AIS scores for the head, face, thorax, abdomen, and extremities (upper and lower extremities) in intentional and accidental groups. In their study, there was not a significant difference in the AIS score for the head between intentional and accidental group (2.9 \u0026plusmn; 1.25 vs 2.59 \u0026plusmn; 1.42) [4]. However, our study showed that the intentional group had higher levels of the AIS scores in region 1 (head, face, and neck) than those in the accidental group (Figure 2a). Such partially concordant and discordant findings resulted from the lack of comparisons adjusted for overall trauma severity such as ISS. In addition, these studies were single-institution case series, had small sample sizes, and did not have data on the distribution of trauma severity for each body region (AIS score).\u003c/p\u003e\n\u003cp\u003eOur results add to a comprehensive understanding of the differences between intentional and accidental falls from a height as our study resolved the abovementioned limitations. We used the JTDB that has more than 25,000 cases of falls from a height and summarized the distribution of trauma severity for each body region and overall trauma severity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe difference between intentional and accidental falls from a height shown in our study can be attributed to the difference in posture when landing on the ground [4]. When the patients land on their heels on the ground, the external force travels through the lower extremities and reaches the pelvis and vertebrae. In particular, unstable pelvic ring disruptions, such as vertical shear, are caused by high-energy blunt trauma including fall from a height [13, 14]. The skeletal trauma patterns in our results strongly support this finding. The difference in the ISS between the intentional and accidental groups was consistent with the difference in the AIS scores for the lower extremities and pelvis. Considering the ISS of the patients included in the previous studies, our results were consistent with the findings on skeletal trauma patterns reported in the previous studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study also had some limitations. First, the JTDB is not a population-based sample of all trauma patients. Patients who were not registered in the participating hospitals or who were not transferred to hospitals due to on-scene death were not included in the JTDB; therefore, selection bias cannot be ruled out. However, our study included 3,581 patients who died in the ED, which would reduce the degree of bias to a certain extent. Second, the inaccuracies of the database itself may have influenced the results. Haas et al. highlighted underreporting of some items in the national trauma databank [15]. The JTDB would also have the same limitations. However, we only used variables that required no subjective assessment, except for AIS coding. The patients were, in principle, registered on the JTDB by medical assistants who had attended lectures on AIS coding. In addition, very few data were missing in our study. Therefore, the inaccuracy within the JTDB would not have significantly influenced our results. \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, we demonstrated the differences in trauma patterns and trauma severity in patients who intentionally and accidentally fell from a height. Our findings are clinically relevant and can help emergency physicians to develop an initial treatment strategy for trauma patients injured by falls from a height at the ED. Further studies will be required to assess the impact of our results on the initial treatment strategy implemented at the ED.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eED\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency department\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eISS\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInjury severity score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eAIS\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAbbreviated injury scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eJTDB\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJapanese Trauma database\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eIQR\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adhered to the principles of the Declaration of Helsinki. This study was approved by the Institutional Review Board of the National Defense Medical College. Informed consent was not required because this was an observational study conducted using existing medical information.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformation about the study was disclosed to the patients so that they could decide whether or not to have their data included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed in the current study are not publicly available for potential concerns of leakage of personally identifiable information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTT conceived the study, performed all analysis, written the manuscript. DS provided the data (JTDB) and revised the manuscript. HT and YT revised the manuscript. AY made the finalized the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003edo Kim do Y, Choi HJ, Park JY, Kim KH, Kuh SU, Chin DK, et al. Burst fractures as a result of attempted suicide by jumping. Korean J Neurotrauma. 2014;10:70\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.13004/kjnt.2014.10.2.70\u003c/span\u003e\u003cspan address=\"10.13004/kjnt.2014.10.2.70\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapadakis SA, Pallis D, Galanakos S, Georgiou DF, Kateros K, Macheras G, et al. Falls from height due to accident and suicide attempt in Greece. A comparison of the injury patterns. 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Rev Panam Salud Publica. 2012;31:427\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1590/s1020-49892012000500011\u003c/span\u003e\u003cspan address=\"10.1590/s1020-49892012000500011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAu\u0026ntilde;\u0026oacute;n-Mart\u0026iacute;n I, Doussoux PC, Baltasar JL, Polentinos-Castro E, Mazzini JP, Erasun CR. Correlation between pattern and mechanism of injury of free fall. 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J Clin Epidemiol. 2008;61:344\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jclinepi.2007.11.008\u003c/span\u003e\u003cspan address=\"10.1016/j.jclinepi.2007.11.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDes Plaines I. The abbreviated injury Scale-1990 revision. Update. 1998. \u003cem\u003eAssociation for the Advancement of Automotive Medicine (AAAM)\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaker SP, O\u0026rsquo;Neill B, Haddon W, Jr., Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00005373-197403000-00001\u003c/span\u003e\u003cspan address=\"10.1097/00005373-197403000-00001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkatesh VT, Kumar MV, Jagannatha SR, Radhika RH, Pushpalatha K. Pattern of skeletal injuries in cases of falls from a height. Med Sci Law. 2007;47:330\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1258/rsmmsl.47.4.330\u003c/span\u003e\u003cspan address=\"10.1258/rsmmsl.47.4.330\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRowbotham SK, Blau S, Hislop-Jambrich J, Francis V. An Assessment of the Skeletal Fracture Patterns Resulting from Fatal High (˃3 m) Free Falls. J Forensic Sci. 2019;64:58\u0026ndash;68. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/1556-4029.13803\u003c/span\u003e\u003cspan address=\"10.1111/1556-4029.13803\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelhem E, Riouallon G, Habboubi K, Gabbas M, Jouffroy P. Epidemiology of pelvic and acetabular fractures in France. Orthop Traumatol Surg Res. 2020;106:831\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.otsr.2019.11.019\u003c/span\u003e\u003cspan address=\"10.1016/j.otsr.2019.11.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS, Jr., Poka A, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;30:848\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00005373-199007000-00015\u003c/span\u003e\u003cspan address=\"10.1097/00005373-199007000-00015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaas B, Gomez D, Hemmila MR, Nathens AB. Prevention of complications and successful rescue of patients with serious complications: characteristics of high-performing trauma centers. J Trauma. 2011;70:575\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/TA.0b013e31820e75a9\u003c/span\u003e\u003cspan address=\"10.1097/TA.0b013e31820e75a9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Characteristics of included patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.834710743801654%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e\u003cstrong\u003emissing cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup I\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup II\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup III\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup IV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.31645569620253%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"37.34177215189873%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere\u003c/strong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"37.34177215189873%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot Severe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.31645569620253%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.9873417721519%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntentional\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.354430379746834%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccidental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.9873417721519%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntentional\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.354430379746834%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccidental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e6,812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e11,754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e2,384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e7,459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e0.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e40 (29\u0026ndash;55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e61 (44\u0026ndash;71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e34 (25\u0026ndash;47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e56 (40\u0026ndash;68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eSex, male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e0.02%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e3,317 (48.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e10,169 (86.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e921\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(38.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e6,358\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(85.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003ePast medical history,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePsychiatric disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e3,067 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e627\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e1,426\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e369\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eAlcohol use at admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e42.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e386 (13.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e760 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e305 (22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e520 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" width=\"45.52980132450331%\"\u003e\n \u003cp\u003eVital signs at admission\u0026Dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.403973509933774%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.900662251655628%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.403973509933774%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.76158940397351%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eHeart rate, /min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e3.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e82 (0\u0026ndash;111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e67 (80\u0026ndash;98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e76 (90\u0026ndash;104)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e69 (79\u0026ndash;91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eSystolic BP, mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e2.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e76 (0\u0026ndash;114)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e100 (128\u0026ndash;150)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e104 (120\u0026ndash;136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e120 (137\u0026ndash;155)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eDiastolic BP, mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e11.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e58 (0\u0026ndash;77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e62 (78\u0026ndash;92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e62 (74\u0026ndash;86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e70 (81\u0026ndash;93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eRespiratory Rate, /min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e7.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e18 (0\u0026ndash;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e16 (20\u0026ndash;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e17 (20\u0026ndash;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e17 (20\u0026ndash;24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eBody Temperature, ℃\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e17.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e36 (35\u0026ndash;37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e36 (36\u0026ndash;37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e36 (37\u0026ndash;37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e36 (37\u0026ndash;37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eGCS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e4.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e6 (3\u0026ndash;14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e14 (9\u0026ndash;15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e13 (15\u0026ndash;15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e15 (15\u0026ndash;15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eAdmission to the general ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e 0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e269 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e1,874 (15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e456 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e2,877 (38.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eISS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e34 (24\u0026ndash;45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e25 (18\u0026ndash;33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e9 (8\u0026ndash;13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e9 (8\u0026ndash;13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eTRISS Ps, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e0.49 (0.02\u0026ndash;0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e0.89 (0.63\u0026ndash;0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e0.99 (0.98\u0026ndash;0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e0.98 (0.96\u0026ndash;0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eMaximum AIS score in region 1 (head, face, and neck)\u0026nbsp;\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e2 (0\u0026ndash;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e3 (0\u0026ndash;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eMaximum AIS score in region 2 (thorax)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e3 (0\u0026ndash;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eMaximum AIS score in region 3 (abdomen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eMaximum AIS score in region 4 (lower limbs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e2 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eMaximum AIS score in region 5 (upper limbs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.87603305785124%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.380165289256198%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.834710743801654%\"\u003e\n \u003cp\u003eIn-hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.87603305785124%\"\u003e\n \u003cp\u003e3266 (47.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.380165289256198%\"\u003e\n \u003cp\u003e2408 (20.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.87603305785124%\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.380165289256198%\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBP, blood pressure; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; TRISS, Trauma and Injury Severity Score; Ps, Probability of survival; AIS, Abbreviated Injury Scale\u003c/p\u003e\n\u003cp\u003e* ISS \u0026ge;16 is defined as \u0026ldquo;severe\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u0026Dagger; Patients with cardiopulmonary arrest before arrival at the emergency department were included.\u003c/p\u003e\n\u003cp\u003e\u0026dagger; AIS score in each region was recalculated for this study from the data registered in the Japanese Trauma Databank.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Comparison of characteristics of patients in the intentional and accidental group\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"35.72778827977316%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.95274102079395%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntentional\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.95274102079395%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccidental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e9,196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e19,213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e39 (28\u0026ndash;53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e59 (42\u0026ndash;70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eSex, male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.95274102079395%\"\u003e\n \u003cp\u003e4,238 (46.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.95274102079395%\"\u003e\n \u003cp\u003e16,527 (86.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003ePast medical history,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePsychiatric disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.95274102079395%\"\u003e\n \u003cp\u003e4,493 (48.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.95274102079395%\"\u003e\n \u003cp\u003e996 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eAlcohol use at admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.95274102079395%\"\u003e\n \u003cp\u003e691 (16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.95274102079395%\"\u003e\n \u003cp\u003e1,280 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eVital signs at admission\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eHeart rate, /min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e86 (0\u0026ndash;109)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e80 (68\u0026ndash;95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eSystolic BP, mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e97 (0\u0026ndash;123)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e132 (110\u0026ndash;152)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eDiastolic BP, mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e64 (40\u0026ndash;80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e80 (66\u0026ndash;92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eRespiratory rate, /min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e19 (0\u0026ndash;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e20 (16\u0026ndash;24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eBody temperature, ℃\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e36.2 (35.4\u0026ndash;36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e36.4 (35.9\u0026ndash;36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eGCS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e12 (3\u0026ndash;15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e15 (13\u0026ndash;15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eISS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e26 (14\u0026ndash;41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e17 (10\u0026ndash;26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eTRISS Ps, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e0.88 (0.054\u0026ndash;0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e0.95 (0.85\u0026ndash;0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eMaximum AIS score in region 1 (head, face, and neck)\u0026nbsp;\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e1 (0\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e2 (0\u0026ndash;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eMaximum AIS score in region 2 (thorax)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e3 (0\u0026ndash;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e2 (0\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eMaximum AIS score in region 3 (abdomen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eMaximum AIS score in region 4 (lower extremity and pelvis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e2 (0\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eMaximum AIS score in region 5 (upper extremity)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.72778827977316%\"\u003e\n \u003cp\u003eDeath at emergency department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e2,515 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.95274102079395%\"\u003e\n \u003cp\u003e1,066 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.366729678638942%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBP, blood pressure; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; TRISS, Trauma and Injury Severity Score; Ps, Probability of survival; AIS, Abbreviated injury scale.\u003c/p\u003e\n\u003cp\u003e* Patients with cardiopulmonary arrest before arrival at emergency department were included.\u003c/p\u003e\n\u003cp\u003e\u0026dagger; The maximum AIS score in each region is obtained from the data registered in the Japanese Trauma Databank.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Skeletal trauma patterns in the groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup I\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup II\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup III\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup IV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e- value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"35.44973544973545%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"35.44973544973545%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot Severe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntentional\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccidental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntentional\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccidental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e6,812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e11,754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e2,384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e7,459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eSkull\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e1,688 (24.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e3,104 (26.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e90 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e426 (5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eFacial bone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e1,144 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e1,199 (10.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e198 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e427 (5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eCervical spine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e789 (11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e1,199 (10.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e70 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e470 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eRib\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e3,415 (50.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e5,447 (46.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e221 (9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e1,429 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eSternal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e261 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e340 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e21 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e105 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eThoracic spine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e1,096 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e1,847 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e236 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e844 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eLumbar spine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e2,007 (29.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e2,677 (22.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e842 (35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e1,493 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eScapula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e463 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e961 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e24 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e239 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eHumerus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e869 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e454 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e127 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e253 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eRadius or ulna\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e869 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e454 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e127 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e253 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eHand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e119 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e251 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e48 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e198 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003ePelvis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e4,101 (60.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e2,987 (25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e591 (24.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e1,179 (15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 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0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eFoot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e287 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e143 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e186 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e129 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eCalcaneus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e788 (11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e342 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e445 (18.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e498 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.10758377425044%\"\u003e\n \u003cp\u003eTalus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e128 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e59 (0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.81305114638448%\"\u003e\n \u003cp\u003e55 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.63668430335097%\"\u003e\n \u003cp\u003e58 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.99294532627866%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Injury Severity Score \u0026ge;16 was defined as \u0026ldquo;severe\u0026rdquo;.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Fall from a height, suicide, jumping, trauma database, injury patterns","lastPublishedDoi":"10.21203/rs.3.rs-1705393/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1705393/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFall from a height is a common cause of trauma requiring emergency care; in many cases, the trauma team needs to urgently develop the initial treatment strategy. The mechanism of injury (intentional or accidental) is an important factor in predicting trauma patterns and severity. We aimed to describe how the severity of injuries in each body region contributes to overall trauma severity and skeletal trauma patterns in intentional and accidental falls.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eData were obtained from a nationwide trauma database between January 1, 2004 and May 31, 2019. Patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years and injured by fall from a height were included. The median Abbreviated Injury Scale (AIS) score for the Injury Severity Score (ISS) for each body region (region 1 [head, face, and neck], region 2 [thorax], region 3 [abdomen], region 4 [lower extremity and pelvis], and region 5 [upper extremity]) was investigated. Skeletal injury patterns were classified into four groups: group I (intentional/severe), group II (accidental/severe), group III (intentional/not severe), and group IV (accidental/not severe). Severe trauma was defined as a trauma with an ISS of 16 or more. The comparison between groups was assessed using the chi-square test and Mann\u0026ndash;Whitney U test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 342,263 patients enrolled in the database, 28,409 met the inclusion criteria: 6,812 in group I, 11,754 in group II, 2,384 in group III, and 7,459 in group IV. The intentional group showed an increase in the AIS score for the lower region (region 4) as the ISS increased, whereas the accidental group showed an increase in the AIS score for the upper region (region 1). Both groups showed an increase in the AIS score for region 2 as the ISS increased. The intentional fall group had a higher proportion of fractures in the lower extremities and pelvis.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThere were differences in trauma patterns and trauma severity levels between patients who experienced intentional and accidental falls from a height. Our findings provide a comprehensive understanding of this topic. Further studies are required to assess the usefulness of our findings for the development of initial treatment strategies at the ED.\u003c/p\u003e","manuscriptTitle":"Differences in trauma injury patterns and severity between intentional and accidental fall from a height: A Japanese nationwide trauma database study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-06-09 15:39:37","doi":"10.21203/rs.3.rs-1705393/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a9203ce1-5718-4db8-8daf-eff65cc627f1","owner":[],"postedDate":"June 9th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-06-09T15:39:39+00:00","versionOfRecord":[],"versionCreatedAt":"2022-06-09 15:39:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1705393","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1705393","identity":"rs-1705393","version":["v1"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}