Brain Injury More Severe From Falls at U.S.-Mexico Border Wall

Hospitalized patients who presented with traumatic brain injury (TBI) after falls at the U.S.-Mexico border wall had more severe injuries and were less likely to receive follow-up care than other patients with TBI from high falls, a single-center study showed.

Compared with other falls from 15 ft or higher, border wall falls were associated with a greater proportion of diffuse axonal injury (37% vs 8%, P=0.003), progression of TBI pathology on repeat imaging (69% vs 44%, P=0.048), and neurological deficits at discharge (21% vs 3%, P=0.04), reported Alexander Tenorio, MD, of the University of California San Diego, and co-authors. Diffuse axonal injury is a severe form of TBI and a major cause of coma.

Patients with border wall falls also had significantly longer times from injury to admission (245 vs 51 minutes, P=0.001), Tenorio and colleagues wrote in a JAMA Surgery research letter.

“The nearly 5-fold increase in time from injury to admission likely played a role in greater neurological deficits given the increased morbidity and mortality associated with TBI treatment delay,” the researchers observed.

“Despite worse clinical outcomes, fewer patients with border-wall falls vs general falls were discharged to health facilities or had any follow-up visits, highlighting the disparities in post-discharge health care,” they added.

Over 400 miles of the southern U.S. border wall were replaced during the Trump administration, mainly with bollard fencing that varied in height from 18 to 30 ft.

In areas like San Diego, raising the wall height led to increases in fall-related deaths, severe injuries, and hospitalizations. In 2022, researchers reported the grim toll of migrant mortality and trauma center admissions.

Another study of falls or jumps from the U.S.-Mexico border in Texas predated the 30-ft height extension. To reflect injuries incurred by higher walls, Tenorio and colleagues aimed to characterize TBI associated with recent falls at the San Diego border.

Their retrospective study examined patients admitted between 2018 and 2022 who presented with TBI (based on suspected head trauma and intracranial imaging abnormalities) from 15-ft or greater falls. Falls were classified as either border wall falls or general free falls.

A total of 69 patients with TBI were included in the study: 39 with general falls and 30 with border wall falls. Mean age was 38, and 86% of patients were men.

Patients with TBIs after border wall falls were younger (32 vs 43 years, P=0.003) and fell from greater heights (30 vs 20 ft, P=0.005). They needed more neurosurgical operations (6 vs 1, P=0.04), and a smaller proportion were discharged to health facilities (10% vs 44%, post hoc P=0.02). They were less likely to receive follow-up care (23% vs 51%, P=0.02).

“Clinicians caring for migrants at the U.S.-Mexico border should be aware of their TBI severity, poor health outcomes, and insufficient after-hospital care,” Tenorio and co-authors wrote.

The study was conducted at a single center and does not include information about people with TBIs after border wall falls treated at other facilities.

“Data included only patients with documented height falls and excluded on-scene deaths and individuals who were never found,” the researchers acknowledged. “This situation likely led to underreported mortality and resource burden.”

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