Injuries Sustained With Falls From Height in Crossing the United States-Mexico Border at a Level I Trauma Center: A Prospective Cohort Study

Abstract

Introduction:The US Department of Homeland Security has reported increases in encounters and apprehensions at the US Southwest border for the past several years. The purposes of this study were to assess the demographics, patterns of injuries, and surgical interventions, associated with falls from height along the US-Mexico border.Methods:A prospective cohort study was conducted at a Level I trauma center from January 2016 through December 2021 of all patients who fell from height crossing the US-Mexico border and presented with injuries requiring admission.Results:A total of 448 patients were admitted with a median age of 30 years (interquartile range [IQR] 16, range 6 to 65). Monthly frequency of admissions increased markedly with a median of 18.5 (IQR 5.3) in 2021. Patients presented with limited health data, and comorbidities were identified in 111 patients (24.7%). Median height fallen was 5.5 m (18 ft). Patients sustaining a fall from ≥ 5.5 m were markedly more likely to have an Injury Severity Score (ISS) of > 15. Median length of stay was 9 days (IQR 11). There were a total of 1,066 injuries with 723 extremity and pelvic; 236 spine; and 107 head or neck, face, thorax, or abdominal injuries. Median ISS was 9.0 (IQR 7, range 1 to 75, 33% > 15). Tibial plafond fracture and spine injury were markedly associated with longer lengths of stay and ISS > 15. All injuries resulted in 635 separate surgical events and 930 procedures. Clinical follow-up occurred in 55 patients (12.2%), with median duration of 28 days (range 6 days to 8 months).Discussion:Injuries associated with border crossings and falls from height were serious and increased in frequency. As the US policy on border security evolves, surgeons in these regions should be prepared to handle the associated injuries and sequelae. Prevention of these serious and debilitating injuries should be undertaken to decrease the burden of disease.

What’s Important: Care of the Migrant Trauma Patient

“…Those who undergo definitive fixation often are either deported or released from U.S. CBP custody after surgery. We have documented a 1-month follow-up rate among these patients of 12.2% 4 . The rest of the patients disperse across the country as local NGOs facilitate their transportation to destinations where they have family.…”

“…At our own institution, we have identified an increase in migrant trauma since 2020. Pilon fractures represent the most frequent injury encountered (27.2%) 4 . Compared with the general population, a disproportionate number of young female patients are affected.…”

A border health crisis at the United States-Mexico border: an urgent call to action

“…Polmear and colleagues noted an increase in monthly median border fall admissions from zero in 2016 to 18·5 in 2021 in El Paso, Texas. 14 Patients falling from greater than 18 feet were more likely to have an ISS greater than 15, further highlighting the consequences of raising the border to 30-feet. The Mexican Consulate released a report in January 2023 detailing a similar trend on the other side of the border.…”

Spine Injuries Sustained After Falls While Crossing the U.S.-Mexico Border

“… 1–4 Our institution in El Paso, Texas, is the only Level I trauma center in a 280-mile radius along the U.S.-Mexico border and has observed an increase in patients sustaining falls and injuries traversing the border that require admission and operative management since 2017. 5 The purpose of this study is to report the demographics, incidence, and patterns of spine and concomitant injuries associated with border crossings resulting in fall from height.…”

“…Previous work has demonstrated that U.S. Border Patrol (USBP) apprehensions correlate with hospital admissions, suggesting that a consistent proportion of migrants sustain injuries in traversing the border. 5 , 10 …”