Are injuries only skin deep? The quandary of the ‘Found Down’ patient

The ‘found down’ patient presents a unique circumstance for the clinician in that the patients are often unable to provide history of the events preceding their presentation to the emergency department. Studies on this population are limited. The trauma and emergency department registries from January 2013 through December 2014 at an urban level one trauma center were queried for patients described as ‘found down’ and related descriptions. Basic demographic data included patient disposition, Glasgow coma score and injury severity score (ISS), patient requiring intubation, imaging performed, and injuries sustained. Patients were stratified into those managed by the trauma service versus the emergency department. A total of 298 patients met criteria to be included in this study, nine of whom died; the average age was 50 years old and 9% of this population was found to have an intracranial hematoma. The subset of patients who had a rapid return to Glasgow coma score 15 had a 6% incidence of having an intracranial hematoma. Four cervical fractures were identified. There was only one intra-abdominal injury. Computerized tomography scans of the brain and cervical spine should be performed for all patients who are found down. Intra-abdominal injuries are exceedingly rare and selective use of computerized tomography should be made. Superficial injury does not indicate more significant injury in this population; however, lack of superficial injury does not preclude more significant injuries