梯子・脚立からの転落による頭部外傷の検討

Head Injuries due to Ladder-related Falls

Ⅰ．はじめに

　梯子や脚立などは，建築工事などの労務以外に家事でも使用される身近な道具であるが⁷⁾，近年これら梯子・脚立からの転落外傷（ladder-related fall injury：LRFI）が問題視されている．2016年に消費者庁が発表した437件のLRFI関連の事故情報によると，多くは自宅周囲の軽作業中の発生であったものの，8件の死亡事故を含んでいた¹⁹⁾．国内の労務現場においても「はしご等からの墜落・転落災害」により毎年30人弱の労働者が亡くなっている¹⁰⁾．

　LRFIは頭部外傷を伴うことにより重篤化することが知られており，われわれ脳神経外科医が治療の中心を担うことも多い^2,5)．しかしLRFIに関する研究は海外からの報告が多く，わが国の，特に脳神経外科救急施設からの情報は少ない^15,18)．そこで，今回われわれは，自験例を対象にLRFIの臨床的特徴や予後，特に頭部外傷が与える影響について検討した．

　We examined the clinical characteristics and outcomes of patients who had fallen from ladders and statistically analyzed the prognostic factors, highlighting the impact of the coexistence of head injuries on their prognoses. The clinical records of patients who had experienced ladder-related falls who were admitted to the Advanced Emergency Medical Service Center at Kurume University Hospital between April 2013 and August 2015 were retrospectively reviewed. A total of 86 patients were enrolled. The mean patient age was 69.2 years, and 82 patients were male. The median fall height was 2.55 m. Sixty patients fell during non-professional use of the ladder. Forty-four patients experienced some type of head injury. Although the older patients had more frequent complications with head injuries, the height of the fall was not related statistically. The group of patients with head injuries exhibited trends of older age, lower Glasgow Coma Scale scores, higher Injury Severity Score, and poorer outcomes than those of the group of patients without head injuries. Multivariate analysis showed that head injury and non-professional use were independent risk factors for poor outcomes. Our results revealed that ladder-related falls with head injury can occur when older people are working at home, even if they have fallen from a low height. Especially when older men work with the ladder at home, local community-based education and guidance for the prevention of ladder-related fall injuries are needed.