A total of 185 patients were included in the study between January 2016 and August 2019, in a 44-month period, following the exclusion criteria.
Among 184 individuals included in the study, 99.5% (n = 184) were male and 0.5% (n = 1) were female. The mean age of the patients was 26.7 ± 6.2 years (youngest: 19, oldest: 51). When analyzed as age groups, 48.8% were 19–23 years old, 31.4% were 24–29 years old and 24.9% were 30 years old and older. Patients who applied to the emergency department in years 2016 (7%), 2017 (39.5), 2018 (24.3) and 2019 (29.2%) were evaluated. Distribution of patients who came to our emergency clinic with the complaint of injury due to parachute jumps by years were; 13 people in 2016, 73 people in 2017, 45 people in 2018 and 54 people in 2019 (in the first 8 months) (Table 1).
Table 1. Distribution of patients by age groups, gender and years of application
|
|
Age Mean ± SS
|
26,7 ± 6,2
|
Age n (%)
|
|
between ages 19-23
|
81 (43,8)
|
between ages 24-29 yaş
|
58 (31,4)
|
30 years and over
|
46 (24,9)
|
Gender n (%)
|
|
Male
|
184 (99,5)
|
Female
|
1 (0,5)
|
Application by years
|
|
2016
|
13 (7)
|
2017
|
73 (39,5)
|
2018
|
45 (24,3)
|
2019
|
54 (29,2)
|
Descriptive statistics are given as number (%) for categorical variables and mean ± standard deviation for numerical variables.
When we evaluate patients in terms of injury site, the most common were foot 33.5% (n = 62), ankle 29.1% (n = 54), spine 18.3% (n = 34) and head 12.4% (n = 23), respectively. When the trauma sites exposed according to ISS are examined; pelvis (75.7%), extremity (67.6), head and neck (13.5) and chest (13.5%) injuries were observed to be the majority. Similarly, when the injury sites are examined, generally foot (33.5%), ankle (29.2%), spine (18.4%), pelvis (14.1%), head (13.5%), leg (13%), knee (7.6%), thigh (6.5%) and shoulder (5.9%) injuries were determined to be intensive. Diagnoses made to the patients applied to the emergency department were most commonly soft tissue trauma (strain and stretching) (64.3%). This diagnosis was followed by lower limb fracture-dislocation (15.1%), head trauma (10.3%) and spinal injury (5.4%), respectively. Considering the treatment methods applied, 51.4% (n = 95) medication cold application, 42.7% (n = 79) splint plaster, and 5.9% (n = 11) surgery (Table 2, Fig. 1–3).
Table 2
Distribution of trauma site, injury site, diagnosis and treatment method applied according to ISS
| n (%) |
ISS exposed trauma site | |
Pelvic, yes | 140 (75,7) |
Extremities, yes | 125 (67,6) |
Head neck, yes | 25 (13,5) |
Chest, yes | 25 (13,5) |
Subcutaneous superficial, yes | 8 (4,3) |
Face, yes | 4 (2,2) |
West, yes | 3 (1,6) |
Injury Site | |
Foot, yes | 62 (33,5) |
Ankle, yes | 54 (29,2) |
Spine, yes | 34 (18,4) |
Pelvis, yes | 26 (14,1) |
Head yes | 25 (13,5) |
Leg, yes | 24 (13) |
Knee, yes | 14 (7,6) |
Thigh, yes | 12 (6,5) |
Shoulder, yes | 11 (5,9) |
Thorax, yes | 6 (3,2) |
Cervical, yes | 5 (2,7) |
Wrist, yes | 4 (2,2) |
Abdomen, yes | 3 (1,6) |
Hand, yes | 3 (1,6) |
Elbow, yes | 2 (1,1) |
Arm, yes | 2 (1,1) |
Forearm, yes | 1 (0,5) |
Diagnosis | |
STT, yes | 119 (64,3) |
Lower limb fracture, dislocation, yes | 28 (15,1) |
Head injury, yes | 19 (10,3) |
Spinal injury, yes | 10 (5,4) |
Upper limb fracture, dislocation, yes | 4 (2,2) |
Cervical injury, yes | 4 (2,2) |
Facial trauma, yes | 4 (2,2) |
Abdominal injury, yes | 2 (1,1) |
Thoracic injury, yes | 3 (1,6) |
Pelvis fracture, yes | 1 (0,5) |
Treatment method applied | |
Medication cold application | 95 (51,4) |
Splint plaster | 79 (42,7) |
Surgery | 11 (5,9) |
Descriptive statistics are given as numbers (%). |
The patients' Glaskow Coma Scores (GKS) were ≥ 13. The mean ISS of the patients was 5.16 ± 3.92 (minimum: 1, maximum: 25). The exposed ISS trauma region was most frequently extremity and the pelvis was 67.6% (n = 125). This was followed by head and neck 8.6% (n = 16) and chest 7.0% (n = 13), respectively. The least injury was observed in the abdomen (n = 3) with 1.6%. According to the ISS classification, the most common shoulder injury (50%) (n = 9) was observed in the upper extremity group. This was followed by whole upper extremity, arm, elbow, hand and wrist injuries, respectively (n = 18). In the lower extremity group, the most common was foot injury (24.1%) (n = 32). This was followed by ankle (13.5%) (n = 18), leg (7.5%) (n = 10), knee (5.3%) (n = 7), thigh (3.8%) (n = 5), whole lower extremity (31.6%) (n = 42) and pelvis (14.3%) (n = 19) injuries, respectively. Similarly, according to ISS, in the head and neck spinal group, the most common injuries were found to be spine (18.4%) (n = 34), head (13.5%) and cervical (1.1%). Again, according to ISS, the most common injuries in the body group were thoracic (66.7%) (n = 6) injuries. This was followed by abdomen (33.3%) (n = 3) and cutaneous-subcutaneous superficial (11.1%) (n = 1) injuries, respectively (Table 3).
Table 3
Injury rates of upper-lower extremity, head and neck spinal and body group according to ISS
| n (%) |
ISS Upper Extremity group | |
Hand | 1 (5,6) |
Wrist | 1 (5,6) |
Elbow | 2 (11,1) |
Arm | 2 (11,1) |
Whole upper extremity | 3 (16,7) |
Shoulder | 9 (50) |
ISS Lower Extremity group | |
Foot | 32 (24,1) |
Ankle | 18 (13,5) |
Leg | 10 (7,5) |
Knee | 7 (5,3) |
Thigh | 5 (3,8) |
Whole lower extremity | 42 (31,6) |
Pelvis | 19 (14,3) |
ISS head and neck spinal group | |
Head yes | 25 (13,5) |
Cervical, yes | 2 (1,1) |
Spine, yes | 34 (18,4) |
ISS Body group | |
Thorax, yes | 6 (66,7) |
Abdomen, yes | 3 (33,3) |
Skin, subcutaneous superficial, yes | 1 (11,1) |
Descriptive statistics are given as numbers (%). |
While 22.2% (n = 41) of the patients were observed as mild, 62.2% (n = 115) as moderate, 15.1% (n = 28) as severe, 0.5% (n = 1) as critical, the fatal AIS score was not observed in any patient. The median of the ISS score was 4. The mean ISS of the patients was 5.16 ± 3.92 (minimum: 1, maximum: 25) (Table 4).
Table 4
AIS score level rates and ISS score
AIS score n (%) | |
Mild | 41 (22,2) |
Moderate | 115 (62,2) |
Severe | 28 (15,1) |
Critical | 1 (0,5) |
ISS score Median [IQR] Min.-Max | 4 [4–8] 1–25 |
Descriptive statistics were given as number (%) for categorical variables and mean ± standard deviation and minimum - maximum for numerical variables. |
When the average of ISS scores by age groups (Minimum ISS score = 1, maximum ISS score = 25) examined, although the ISS score increased with age, there was no statistically significant difference (One-way ANOVA). There was no statistically significant relationship between patients' age values and ISS values (Spearman Correlation, p = 0.108) (Table 5).
Injury sites rates were compared according to the age groups of the patients admitted to the emergency department. Accordingly, the rate of leg injury in patients 30 years and older was found to be statistically more significantly than patients between the ages of 24–29 (p = 0.043). In addition, in patients between the ages of 19–23, the knee injury rate was statistically more significant than those between the ages of 24–29 and those over 30 years old (p = 0.006). In other comparisons, there was no statistical difference between foot, ankle, thigh, pelvis, spine, abdomen, thorax, shoulder, hand, ankle, forearm, elbow, arm, cervical and head injury rates by age groups (for each p > 0.05) (Table 6).
Table 5. Average ISS score by Age Group |
Tukey HSDa,b |
Age groups | N | Subset for alpha = 0.05(ISS mean score) |
1 |
Between 19–23 years old | 81 | 4,6667 |
Between24-29 years old | 58 | 5,0862 |
30 years old and above | 46 | 6,1304 |
Sig. | | ,108 |
Means for groups in homogeneous subsets are displayed. |
a. Uses Harmonic Mean Sample Size = 58,450. |
b. The group sizes are unequal. The harmonic mean of the group sizes is used. Type I error levels are not guaranteed. |
Table 6
Comparison of injury sites in terms of age groups of patients
| Between ages 19–23 | Between ages 24–29 | 30 and older | p |
Injurt Site | | | | |
Foot, yes | 31 (38,3) | 21 (36,2) | 10 (21,7) | 0,144* |
Ankle, yes | 27 (33,3) | 19 (32,8) | 8 (17,4) | 0,127* |
Leg, yes | 11 (13,6)a,b | 3 (5,2)b | 10 (21,7)a | 0,043* |
Knee, yes | 12 (14,8)a | 1 (1,7)b | 1 (2,2)b | 0,006** |
Thigh, yes | 7 (8,6) | 2 (3,4) | 3 (6,5) | 0,504** |
Pelvis, yes | 8 (9,9) | 11 (19) | 7 (15,2) | 0,304* |
Spine, yes | 13 (16) | 14 (24,1) | 7 (15,2) | 0,390* |
Abdomen, yes | 2 (2,5) | 1 (1,7) | 0 (0) | 0,789** |
Thorax, yes | 4 (4,9) | 2 (3,4) | 0 (0) | 0,428** |
Shoulder, yes | 3 (3,7) | 6 (10,3) | 2 (4,3) | 0,266** |
Hand, yes | 1 (1,2) | 1 (1,7) | 1 (2,2) | 0,999** |
Wrist, yes | 1 (1,2) | 1 (1,7) | 2 (4,3) | 0,463** |
Forearm, yes | 1 (1,2) | 0 (0) | 0 (0) | 0,999** |
Elbow, yes | 2 (2,5) | 0 (0) | 0 (0) | 0,500** |
Arm, yes | 0 (0) | 1 (1,7) | 1 (2,2) | 0,318** |
Cervical, yes | 4 (4,9) | 1 (1,7) | 0 (0) | 0,316** |
Head, yes | 8 (9,9) | 6 (10,3) | 11 (23,9) | 0,059* |
Descriptive statistics were given as numbers (%). |
*. Pearson Chi-Square test was used. |
**. Fisher Freeman Halton test was used. |
There was a statistically significant difference in hospital admission rates according to AIS score levels in patients admitted to the emergency department (p < 0.001). The hospitalization rate of patients with a critical AIS score was significantly higher than those with a severe AIS score. Similarly, the difference between the median scores of ISS was statistically significant according to their hospitalization status (p < 0.001). Accordingly, the median ISS score of the hospitalized patients was significantly higher than those who were not hospitalized (Table 7).
Table 7
Comparison of hospitalization rates according to AIS score levels and ISS score medians in terms of hospitalization.
| Hospitalization Status | p |
Yes | No |
AIS score | Mild | 0 (0) | 41 (100) | < 0,001* |
Moderate | 0 (0) | 115 (100) |
Severe | 10 (35,7) | 18 (64,3) |
Critical | 1 (100) | 0 (0) |
ISS score | | 9 [9–18] | 4 [4–6] | < 0,001** |
*. Fisher Freeman Halton test was used. Descriptive statistics are given as numbers (%). |
**. Mann-Whitney U test was used. Descriptive statistics are given as median [IQR]. |
While 5.9% (n = 11) of the patients received inpatient treatment, 94.1% (n = 174) were discharged with outpatient treatment. The average length of hospitalization of inpatients was found to be 3.45 ± 2.20 (minimum: 1, maximum: 7). Also, in Table 7.1, the median day of hospitalization of patients with a severe AIS score level was 3 days, while the median day of hospitalization of critical patients was 6 days.
Table 7.1
Hospitalization duration according to AIS score *
| Hospitalization days |
AIS score | Mild | - |
Moderate | - |
Severe | 3 [1–4] |
Critical | 6 [6–6] |
* Duration was taken in days. |