Upper-Extremity Injuries in a Level 1 Trauma Center Following Border Wall Height Increase

Overview

Journal J Hand Surg Glob Online

Date 2024 Dec 20

PMID 39703575

Authors

Emma Williams

Vivian Hu

Cooper Haaland

Meera Reghunathan

Laura N Haines

Jay J Doucet

Todd W Costantini

Katharine M Hinchcliff

Affiliations

Soon will be listed here.

Abstract

Purpose: From 2018-2019, the height of over 400 miles of southern border wall was raised to 30 feet. Our aim was to evaluate the impact of the increase in border wall height on upper-extremity injuries sustained via barrier fall.

Methods: A retrospective review of patients admitted with upper-extremity injuries sustained via border wall fall between January 2015 and December 2022 at a Level 1 trauma center serving the United States-Mexico border. Patients admitted between 2015-2018 were included in the preincrease group, and those admitted between 2019-2022 were included in the postincrease group. Demographic data, injury severity metrics, fracture characteristics, operative treatments, hospital charges, and lengths of stay were compared.

Results: In total, 110 patients were identified, with 16 preincrease and 94 postincrease. Following the barrier height increase, patients had higher injury severity scores. Radial fractures were most common pre- and postincrease and accounted for nearly one-third of all fractures. Postincrease upper-extremity trauma patients required more operative events (2.15 ± 2.10 vs 1.44 ± 0.73 preincrease). The average cost for each patient's hospital stay also quadrupled after the increase in wall height ($397,632 ± $1,057,574 vs $98,978 ± $84,169 preincrease).

Conclusions: The increase in overall injury severity and costly inpatient treatment of upper-extremity injuries among patients who fell from the border following construction has placed additional stress on an already strained health care system.

Level Of Evidence: Differential Diagnosis/Symptom Prevalence Study, IV.

References

Baker R . Border Injuries: An Analysis of Prehospital Demographics, Mechanisms, and Patterns of Injuries Encountered by USBP EMS Agents in the El Paso (Texas USA) Sector. Prehosp Disaster Med. 2017; 32(4):431-436. DOI: 10.1017/S1049023X17006434. View

Tezel N, Can A . The association between injury severity and psychological morbidity, hand function, and return to work in traumatic hand injury with major nerve involvement: A one-year follow-up study. Ulus Travma Acil Cerrahi Derg. 2020; 26(6):905-910. DOI: 10.14744/tjtes.2020.39472. View

Liepert A, Berndtson A, Hill L, Weaver J, Godat L, Costantini T . Association of 30-ft US-Mexico Border Wall in San Diego With Increased Migrant Deaths, Trauma Center Admissions, and Injury Severity. JAMA Surg. 2022; 157(7):633-635. PMC: 9055512. DOI: 10.1001/jamasurg.2022.1885. View

Maddison K, Perry L, Debono D . Psychological sequelae of hand injuries: an integrative review. J Hand Surg Eur Vol. 2022; 48(1):33-40. DOI: 10.1177/17531934221117429. View

Palacio C, Cruz B, Vanier C, Cano J, Scott B . The mechanism and pattern of injuries of undocumented immigrants crossing the Texas-Mexico border along the Rio Grande Valley. Inj Epidemiol. 2021; 8(1):58. PMC: 8554975. DOI: 10.1186/s40621-021-00341-x. View

Alizo G, Sciarretta J, Gibson S, Muertos K, Romano A, Davis J . Fall from heights: does height really matter?. Eur J Trauma Emerg Surg. 2017; 44(3):411-416. DOI: 10.1007/s00068-017-0799-1. View

Karahan G, Yamak K, Demirkoparan M, Altay T, Kucuk L . An uncommon injury: Motorcycle chain injury of the hand, its socioeconomic outcome, and prevention. Orthop Traumatol Surg Res. 2020; 108(5):102800. DOI: 10.1016/j.otsr.2020.102800. View

Tenorio A, Brandel M, Produturi G, McCann C, Doucet J, Costantini T . The impact of the Mexico-San Diego border wall extension on spine injuries: a retrospective cohort review. J Travel Med. 2022; 29(7). DOI: 10.1093/jtm/taac112. View

Robinson L, Brown T, OBrien L . Cost, profile, and postoperative resource use for surgically managed acute hand and wrist injuries with emergency department presentation. J Hand Ther. 2020; 34(1):29-36. DOI: 10.1016/j.jht.2019.12.007. View

10.

Williams E, Haaland C, Haines L, Dwight K, Gonzalez A, Doucet J . Falling from new heights: Traumatic fracture burden and resource utilization after border wall height increase. Surgery. 2023; 174(2):337-342. DOI: 10.1016/j.surg.2023.04.006. View

11.

Kelada A, Hill L, Lindsay S, Slymen D, Fortlage D, Coimbra R . The U.S.-Mexico border: a time-trend analysis of border-crossing injuries. Am J Prev Med. 2010; 38(5):548-50. DOI: 10.1016/j.amepre.2010.01.028. View

12.

Psoinos C, Emhoff T, Sweeney W, Tseng J, Santry H . The dangers of being a "weekend warrior": a new call for injury prevention efforts. J Trauma Acute Care Surg. 2012; 73(2):469-73. PMC: 3586599. DOI: 10.1097/TA.0b013e318258437c. View

13.

Rosberg H, Steen Carlsson K, Cederlund R, Ramel E, Dahlin L . Costs and outcome for serious hand and arm injuries during the first year after trauma - a prospective study. BMC Public Health. 2013; 13:501. PMC: 3681586. DOI: 10.1186/1471-2458-13-501. View

14.

Fujii M, Shirakawa T, Nakamura M, Baba M, Hitosugi M . Factors influencing the injury severity score and the probability of survival in patients who fell from height. Sci Rep. 2021; 11(1):15561. PMC: 8324820. DOI: 10.1038/s41598-021-95226-w. View

15.

Robinson L, Sarkies M, Brown T, OBrien L . Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review. Injury. 2016; 47(12):2614-2626. DOI: 10.1016/j.injury.2016.09.041. View

16.

Nawijn F, Westenberg R, Langhammer C, Chen N, Eberlin K . Factors Associated with Primary and Secondary Amputation following Limb-Threatening Upper Extremity Trauma. Plast Reconstr Surg. 2020; 145(4):987-999. DOI: 10.1097/PRS.0000000000006644. View

17.

Burk D, Pah A, Ruth J . Analysis of Musculoskeletal Injuries Sustained in Falls From the United States-Mexico Border Fence. Orthopedics. 2017; 40(3):e432-e435. DOI: 10.3928/01477447-20170117-05. View

18.

Kusior M, Pejka K, Knapik M, Sajuk N, Klaptocz S, Konopka T . Analysis of the nature of injuries in victims of fall from height. Arch Med Sadowej Kryminol. 2017; 66(2):106-124. DOI: 10.5114/amsik.2016.64709. View