Measuring Falls in Clinical Assessment
When measuring falls, the height should be measured from the standing height of the person (head height) rather than from foot height, as this better reflects the total distance and energy involved in the fall. 1
Evidence-Based Assessment of Falls
The Guidelines for Field Triage of Injured Patients clearly define falls in terms of height measurements that reflect the total distance traveled during a fall:
- For adults: >20 feet (with one story equal to 10 feet)
- For children: >10 feet or two to three times the height of the child 1
These measurements are taken from the initial position of the person (head height) to the landing surface, not from the feet to the ground. This approach captures the full distance and energy involved in the fall, which directly correlates with injury severity.
Clinical Importance of Measuring from Head Height
Measuring from head height is critical for several reasons:
Energy transfer calculation: The potential energy in a fall (and subsequent kinetic energy at impact) is directly proportional to the total distance traveled. Measuring from head height provides the most accurate assessment of this energy transfer 1, 2.
Risk stratification: Falls from greater heights correlate with increased injury severity. The Guidelines for Field Triage use specific height thresholds measured from the person's initial position to determine the need for trauma center transport 1.
Anatomical considerations: Head injuries are among the most common and serious consequences of falls. A study of fatal falls found that the head is the most vulnerable structure, with fractures of the vertex being common 2.
Fall Risk Assessment in Clinical Practice
When assessing falls in older adults, clinicians should consider:
- Location and cause of fall
- Time spent on floor or ground
- Loss of consciousness/altered mental status
- Comorbidities such as dementia, Parkinson's, stroke, diabetes, hip fracture, and depression 1
Common Pitfalls in Fall Measurement
- Underestimating fall severity: Measuring only from foot height can lead to underestimation of fall severity and potential injuries.
- Inconsistent measurement: Using different reference points for measurement can lead to inconsistent risk assessment and triage decisions.
- Age-specific considerations: Children have different thresholds for significant falls (>10 feet or 2-3 times their height) compared to adults (>20 feet) 1.
Clinical Application
When documenting falls:
- Record the total distance from the person's initial position to the landing surface
- Note the surface type (hard surfaces increase injury risk)
- Consider age-specific thresholds for significant falls
- Document any protective factors (such as breaking the fall with arms)
The U.S. Preventive Services Task Force and other guidelines emphasize comprehensive fall assessment that includes evaluation of the circumstances and height of falls as part of multifactorial risk assessment 1, 3.