Older adults, younger children and women reported more injuries, but all ages show up in emergency departments for sprains, strains, bumps and fractures.

“Stairs are a common source of injury among all ages, and the frequency and rate of stair-related injuries are increasing,” said senior author Dr. Gary Smith of Nationwide Children’s Hospital in Columbus, Ohio.

About half of homes in the United States contain stairs, according to the Census Bureau, and the direct and indirect costs of non-fatal stair injuries total about $92 billion annually, the study team notes.

“This underscores the need for increased prevention efforts, particularly those related to stair design and construction,” Smith told Reuters Health by email.

The researchers analyzed data from the National Electronic Injury Surveillance System on injuries involving stairs that were treated in emergency departments between 1990 and 2012.

They found nearly 25 million patients treated in ERs over those 23 years, representing an average rate of about 38 stair-related injuries per 10,000 U.S. residents annually, which is about 3,000 per day or one injury every 30 seconds.

Injury rates fell by about 13 percent during the early part of the study period, from 1990 to 1996, but then rose by 24 percent from 1996 to 2012, the study found. About 62 percent of patients were women and more than 60 percent of injuries happened at home.

Adults over age 85, children under 3 years old and young adults in their 20s had the highest injury rates, but over two thirds of the emergency department visitors were a mix of ages between 11 and 60 years old.

“This study was unable to identify the reasons for the higher injury rates among women,” the study authors write. “However, these are the child-bearing and parenting years . . . that could include increased exposure to stairs related to greater time in the home while caring for children and performing household chores.”

Nearly 94 percent of patients were treated and released from the hospital, but 6 percent were admitted for treatment of fractures or concussions. The most common types of injuries were sprains, strains, scrapes, bruises and broken bones. Kids under age 10 had more head injuries while older patients had more fractures, which often required hospitalization.

Overall, about 60 percent of injuries happened without a cause, according to the patients’ accounts. Twenty-three percent of patients said they slid, slipped, tripped or misstepped. A small number said they were carrying objects and couldn’t see.

Future research should look at stair design and safety, the study authors write. To help prevent accidents, new stair construction and remodels could increase the horizontal surfaces for the foot to step on, for instance. Horizontal and vertical surfaces should also be uniform to prevent missteps, they note.

An example of a common tripping hazard, the study team, points out, is a missing nosing – the part of the tread that overhangs a stair – on the top step. Stair patterns may also throw off people at the last step, causing a bottom-of-stair illusion.

“The term ‘slips, trips and falls’ is a major misstatement of the full complexity of all possible missteps,” said Jake Pauls, a building safety consultant in Toronto, Canada, and Silver Spring, Maryland, who researches stairway safety and usability but wasn’t involved in the study.

“Underlying societal factors have led (in all countries) to a double standard and lower standard for home stairways compared to those in all other settings (such as workplaces),” Pauls told Reuters Health by email.

Handrails with a “power grip,” which allows the entire hand to grab the rail rather than just the fingers, reduce more severe injuries during a fall. Slippery surfaces and loose carpeting can cause issues, too.

“Revising building codes and updating existing stairways to comply with geometric dimensions are recommended for optimal safety,” Smith said. “People can also reduce injuries by keeping stairs clear of clutter, ensuring stairways are well-lit and not multitasking while navigating the stairs.”

SOURCE: bit.ly/2yNBGax American Journal of Emergency Medicine, online September 20, 2017.

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