1018 - Overhead Danger: a Case Series of Traumatic Brain Injuries due to Tree Limb Failure

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

ZW

Zachary Ward, DO

Resident Physician
Indiana University
Indianapolis, Indiana, United States

Co-Author(s)

SK

Sheryl Katta-Charles, MD

Assistant Clinical Professor
Indiana University School of Medicine
INDIANAPOLIS, Indiana, United States
NL

Nicole LaRue, MS, BS

OMS-III
Marian University Wood College of Osteopathic Medicine
Indianapolis, Indiana, United States
JV

Joshua Vail, BS

MS2
Indiana University School of Medicine
Indianapolis, Indiana, United States

Submitter(s)

ZW

Zachary Ward, DO

Resident Physician
Indiana University
Indianapolis, Indiana, United States

Case Diagnosis: A three case series of patients with intracranial hemorrhage and multiple skull fractures as a result of tree limb failures. In each case, the patients were found to have severe traumatic brain injuries (TBI) requiring admission to an acute inpatient rehab facility, and ongoing out-patient medical care.

Case Description: The patients were functionally independent at baseline. They were injured by higher limbs failing while trimming lower tree branches. Each patient was severely incapacitated, requiring advanced airway management in the field, ICU admission, prolonged hospitalization, and admission to acute inpatient rehab for ongoing functional deficits. None of the patients returned to their pre-injury baseline and one of the three was able to return to living independently.

Discussions: TBI as a result of tree limb failure is a potentially underrecognized mechanism of injury with an evolving risk profile. Although population-level data on injuries specifically caused by tree limb failure is lacking, environmental conditions contributing to tree limb instability appear to be increasing. Changes linked to climate change, such as higher wind speeds and extended growing seasons resulting in less dense wood, may be contributing to the frequency and severity of such incidents. These findings suggest a need for further investigation into environmental risk factors and support the development of updated safety recommendations for individuals engaging in activities at risk of injury due to tree limb failure.

Conclusions: Tree limb failure is an uncommon but unmonitored cause of TBI. Due to increasing wind speeds and prolonged growing seasons, activities at risk of injury due to tree limb failure are becoming increasingly hazardous. In the interest of public health, additional data collection on injury due to tree limb failure should be collected and health safety recommendations should consider the evolving risk profile associated with tree limb failure.