Into the Wild and On to the Table: A Western Trauma Association Multicenter Analysis and Comparison of Wilderness Falls in Rock Climbers and Non-Climbers.

BACKGROUND: Wilderness activities expose outdoor enthusiasts to austere environments with injury potential, including falls from height. The majority of published data on falls while climbing or hiking are from emergency departments. We sought to more accurately describe the injury pattern of wilderness falls that lead to serious injury requiring trauma center evaluation, and to further distinguish climbing as a unique pattern of injury. METHODS: Data were collected from 17 centers in 11 states on all wilderness falls (fall from cliff: ICD-9 e884.1, ICD-10 w15.xx) from 2006-2018 as a Western Trauma Association multicenter investigation. Demographics, injury characteristics, and care delivery were analyzed. Comparative analyses were performed for climbing vs non-climbing mechanisms. RESULTS: Over the 13 year study period, 1176 wilderness fall victims were analyzed (301 climbers, 875 non-climbers). Fall victims were male (76%), young (33 years) and moderately injured (Injury Severity Score 12.8). Average fall height was 48 feet and average rescue/transport time was over 4 hours. 19% were intoxicated. The most common injury regions were soft tissue (57%), lower extremity (47%), head (40%) and spine (36%). Non-climbers had a higher incidence of severe head and facial injuries despite having equivalent overall ISS. On multivariate analysis, climbing remained independently associated with increased need for surgery but lower odds of composite ICU admission/death. Contrary to studies of urban falls, height of fall in wilderness falls was not independently associated with mortality or ISS. CONCLUSION: Wilderness falls represent a unique population with distinct patterns of predominantly soft tissue, head, and lower extremity injury. Climbers are younger, usually male, more often discharged home, and require more surgery but less critical care. LEVEL OF EVIDENCE: Level 3, retrospective case control.