{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:12:56Z","timestamp":1791223976254,"version":"4.1.0"},"reference-count":21,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T00:00:00Z","timestamp":1686096000000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2023,5,12]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This study investigated the association between the number of regions with fractures in the spine, pelvis, and lower extremity (NRF) and the proportion of patients with a length of hospital stay (LOS) \u226530 days among those who attempted suicide by falling from a height.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data recorded between January 1, 2004 and May 31, 2019 in the Japan Trauma Databank of patients aged \u226518 years injured by suicidal falls from a height and with \u226572 hours of LOS (period from admission to discharge home or to another hospital) were analyzed. Patients with an Abbreviated Injury Scale score \u22655 in the head region or those who died after admission were excluded. Multivariate analyses including clinically relevant variables as covariates were performed to determine the association, expressed as risk ratio with 95% CI, between NRF and LOS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 4724 participants, the multivariate analysis revealed significant factors related to LOS \u226530 days, including NRF=1 (1.64, 95% CI 1.41 to 1.91), NRF=2 (2.00, 95% CI 1.72 to 2.33), NRF=3 (2.01, 95% CI 1.70 to 2.38), systolic blood pressure in the emergency department (ED; 0.999, 95% CI 0.998 to 0.9997), heart rate in the ED (1.002, 95% CI 1.00 to 1.004), Injury Severity Score (1.007, 95% CI 1.00 to 1.01), and intubation in the ED (1.21, 95% CI 1.10 to 1.34). However, history of psychiatric diseases was not a significant factor.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>An increase in NRF was associated with an increase in LOS of patients injured by intentional falls from a height. This finding can help both emergency physicians and psychiatrists in acute care hospitals to develop better treatment strategies with attention to time constraints. Further investigation of the association between LOS and both trauma and psychiatric treatment is required to evaluate the effect of NRF on treatment in acute care hospitals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Level III, retrospective study with up to two negative criteria.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2022-000988","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T12:36:38Z","timestamp":1686141398000},"page":"e000988","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Association between length of hospital stay and fractures in the spine, pelvis, and lower extremity among patients after intentional fall from a height: an analysis of the Japan Trauma Databank"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3002-5343","authenticated-orcid":false,"given":"Takero","family":"Terayama","sequence":"first","affiliation":[{"name":"Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Toda","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8882-4933","authenticated-orcid":false,"given":"Masanori","family":"Nagamine","sequence":"additional","affiliation":[{"name":"Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7468-8886","authenticated-orcid":false,"given":"Yoshihiro","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daizoh","family":"Saitoh","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aihide","family":"Yoshino","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,7]]},"reference":[{"key":"2025082410143096000_8.1.e000988.1","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.injury.2019.12.029","article-title":"Falls from height due to accident and suicide attempt in Greece. A comparison of the injury patterns","volume":"51","author":"Papadakis","year":"2020","journal-title":"Injury"},{"key":"2025082410143096000_8.1.e000988.2","doi-asserted-by":"crossref","first-page":"70","DOI":"10.13004\/kjnt.2014.10.2.70","article-title":"Burst fractures as a result of attempted suicide by jumping","volume":"10","author":"Kim","year":"2014","journal-title":"Korean J Neurotrauma"},{"key":"2025082410143096000_8.1.e000988.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-017-1267-5","article-title":"Possible factors influencing the duration of hospital stay in patients with psychiatric disorders attempting suicide by jumping","volume":"17","author":"Omi","year":"2017","journal-title":"BMC Psychiatry"},{"key":"2025082410143096000_8.1.e000988.4","first-page":"79","article-title":"Falls from height: Orthopaedic and psychiatric evaluation","volume":"91","author":"Faggiani","year":"2020","journal-title":"Acta Biomed"},{"key":"2025082410143096000_8.1.e000988.5","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jpsychores.2019.02.001","article-title":"Suicide attempts by jumping and length of stay in general hospital: a retrospective study of 225 patients","volume":"119","author":"Todorov","year":"2019","journal-title":"J Psychosom Res"},{"key":"2025082410143096000_8.1.e000988.6","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s00068-019-01110-8","article-title":"Suicidal fall from heights trauma: difficult management and poor results","volume":"46","author":"Piazzalunga","year":"2020","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2025082410143096000_8.1.e000988.7","article-title":"Differences in trauma injury patterns and severity between intentional and accidental falls from a height: a Japanese nationwide trauma database study","volume":"14","author":"Terayama","year":"2022","journal-title":"Cureus"},{"key":"2025082410143096000_8.1.e000988.8","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1590\/S1020-49892012000500011","article-title":"Injuries sustained after falls from bridges across the United States-Mexico border at El Paso","volume":"31","author":"McLean","year":"2012","journal-title":"Rev Panam Salud Publica"},{"key":"2025082410143096000_8.1.e000988.9","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s11751-012-0142-7","article-title":"Correlation between pattern and mechanism of injury of free fall","volume":"7","author":"Au\u00f1\u00f3n-Mart\u00edn","year":"2012","journal-title":"Strategies Trauma Limb Reconstr"},{"key":"2025082410143096000_8.1.e000988.10","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197403000-00001"},{"key":"2025082410143096000_8.1.e000988.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2020.11.010"},{"key":"2025082410143096000_8.1.e000988.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"2025082410143096000_8.1.e000988.13","unstructured":"Rubin DB . 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