Copyright c  Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. J Head Trauma Rehabil Copyright c  2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Acute Assessment of Brain Injuries in Ground-Level Falls Tiina P ¨ oyry, BM; Teemu M. Luoto, MD; Anneli Kataja, MD; Antti Brander, PhD, MD; Olli Tenovuo, PhD, MD; Grant L. Iverson, PhD; Juha ¨ Ohman, PhD, MD Objective: The purpose of this study was to characterize traumatic brain injuries (TBI) sustained in ground-level falls (GLFs). The focus was on factors associated with acute computed tomographic (CT) findings. Methods: The sample included 575 subjects examined and treated at the Tampere University Hospital emergency department (ED). Retrospective data collection consisted of subject- and injury-related data and clinical information from the emergency department. All CT scans were analyzed and systematically coded. Results: Ground-level falls were the mechanism of injury in 48.3% (n = 278) of the subjects. In the GLF group, independent risk factors for acute traumatic CT findings were long-term alcohol abuse, older age, being found on the ground, and left temporoparietal and occipital location of direct head impact. There were no significant differences in the incidence of any intracranial traumatic lesion type between those with GLFs and other causes of TBI. None of the classic clinical TBI severity markers studied were associated with acute traumatic CT findings in patients with GLFs. Conclusions: Older age and long-term alcohol abuse increase the likelihood of acute intracranial CT abnormalities. The pattern of intracranial traumatic CT findings does not differ from other causes of TBI. Clinical signs and indices of TBI severity did not predict traumatic CT findings. Key words: computed tomograhpy, risk factors, traumatic brain injuries A GROUND-LEVEL FALL (GLF) is a common cause of traumatic brain injury (TBI), especially among the older adults. 1 Patients injured in GLFs are often not seen by trauma services unless other injuries than an isolated head injury are discovered. Similarly, falls from up to 20 feet are sometimes considered mild injuries unless obvious orthopedic or neurological in- juries occur. 1 However, it has been shown that even a low-energy trauma may cause significant injuries, espe- cially intracranially. 1–5 According to a literature review, an intracranial lesion visible on head computed tomo- graphic (CT) scan could be expected in 13.2% of patients who present to the emergency department (ED) with a TBI due to any cause. 6,7 In a recent large study, the in- cidence of traumatic lesions in acute head CT scan was Author Affiliations: Department of Neurosciences and Rehabilitation (Ms P ¨ oyry and Drs Luoto and ¨ Ohman) and Medical Imaging Centre, Department of Radiology (Drs Kataja and Brander), Tampere University Hospital, Tampere, Finland; Department of Neurology, University of Turku and Turku University Central Hospital, Turku, Finland (Dr Tenovuo); and Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada (Dr Iverson). The authors thank research assistant Anne Simi for her contribution in data collection and biostatistician M. A. Mika Helminen for his assistance in statistical analysis. The authors declare no conflicts of interest. Corresponding Author: Teemu Luoto, MD, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland (teemu.luoto@pshp.fi) DOI: 10.1097/HTR.0b013e318250eadd 20% after a fall from the standing position (ie, a GLF). 2 The risk of falling among the older adults increases with older age, poor nutritional status, presence of chronic diseases, and use of certain medications. 8–10 Fall-related TBI deaths among the older adults (≥65 years) accounted for 50.3% of all unintentional fall- related deaths in the United States in 2005. 3 Falls and fall-related injuries are common among the older adults according to several studies. 11–14 In developed countries, the improvement in motor vehicle safety has been associated with a reduced inci- dence of TBIs in traffic accidents—highlighting the num- ber of TBIs accounted for by other types of accidents, including GLFs. 15 However, factors affecting the risk of brain injury due to falling are not definitive and studies have examined GLFs from different perspectives. In ad- dition, various combinations of sociodemographic fac- tors, injury factors, and preexisting medical conditions have been associated with the risk of TBI in different mechanisms of injury. At present, there are very few published studies focusing on factors associated with TBI due to GLFs. 2,4 An important management issue following head trauma is determining the need for an emergency head CT scan. The indications for acute head CT scan are widely studied and published, and several guidelines have been established, such as the Canadian CT Head Rule, 16 the National Institute for Health and Clinical Excellence criteria, 17 and New Orleans Criteria. 18 In the Canadian CT Head Rule, the investigators concluded 1