Falling from new heights: Traumatic fracture burden and resource utilization after border wall height increase

Area of Science:

• Trauma surgery
• Public health policy
• Orthopedic injury

Background:

• San Diego hospitals treat many patients injured in falls from the US-Mexico border wall.
• A significant increase in border wall fall injuries was noted after barrier height expansion.
• This study investigates the impact of the border wall height increase on fracture burden and resource utilization.

Purpose of the Study:

• To evaluate the effect of increased border wall height on traumatic lower extremity and pelvic fractures.
• To assess the associated increase in hospital resource utilization and patient outcomes.

Main Methods:

• Retrospective review of patients admitted to a level 1 trauma center from 2016-2021.
• Categorization into pre-wall (2016-2018) and post-wall (2019-2021) groups based on barrier height increase.
• Analysis of demographic data, treatment, hospital charges, weight-bearing status, and follow-up.

Main Results:

• A substantial rise in patients (45 to 275) and fractures (101 to 850) admitted post-wall height increase.
• Significant increases in hospital resource use: 537% more hospital days, 776% more ICU days, 468% more operative procedures.
• Most patients (86%) discharged with weight-bearing limitations; high loss to follow-up rate (82%).

Conclusions:

• Traumatic fractures from border wall falls increased dramatically after the wall height increase.
• There was a marked escalation in hospital resource consumption and patient morbidity.
• Policy implications include addressing the financial burden of care and improving access to follow-up for these patients.