Table e-1.

Patient / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8
Age / 19 / 15 / 14 / 20 / 15 / 17 / 16 / 14
Ambulatory / NO / YES / NO / NO / NO / NO / NO / NO
Steroids / prednisone 13 yrs / deflazacort 9 yrs / prednisone 5 yrs / none / prednisone 10 yrs / prednisone / deflazacort / prednisone
Metabolic Bone disease and fracture history / Osteoporosis, History of fragility fractures / Osteoporosis vertebral compression and femur fractures / Osteoporosis, History of fragility fractures / Osteopenia / Osteoporosis R ight distal femur Fracture 6 months prior / Osteoporosis vertebral Compression ractures T8,T12,L1,L5 / NA / Osteopenia
Bone health medications / None / risedronate, calcium, vitamin D / calcium / none / alendronate, vitamin D / alendronate / vitamin D / calcium and vitamin D
Mechanism of Injury / Fall from wheelchair / Ground level fall / Fall from wheelchair / Fall from shower chair / Fall from wheelchair / Ground level fall / Fall from wheelchair / Fall from wheelchair
Fracture type / Bilateral distal femur / Non-displaced bilateral distal femur-Salter II / Comminuted distal femur – Salter II / Right distal femur / Non-displaced distal femur-Salter II / Bilateral non-displaced distal femur / NA / Minimally displaced distal femur
ED/ICU course / Intubated, fever unknown origin, leukocytosis, / Intubated / BIPAP / BIPAP / BIPAP 24 hrs, intubated, shock, ATN, dialysis, CPRx2 / Intubated / NA / Intubated, CPR/ Vfib arrest
Presenting clinical features / Agitation, visual changes, knee pain, loss of consciousness, respiratory failure, petechiae, retinal emboli / Agitation visual changes tachycardia, respiratory failure, leukocytosis, Petechiae / Agitation, respiratory distress, knee pain followed by lethargy / Agitation, confusion, respiratory distress / Agitation, confusion,Leg pain, progressive respiratory distress / NA / Decreased responsivness, respiratory distress, CPR administered / Hemiparesis, unresponsive, respiratory failure
Additional clinical features / Initial suspicion of seizure, PNA, or sedation from benzodiazepines.
MRI-diffuse punctate emboli / Initial concern for PE or stroke. MRI-diffuse punctate emboli. Fractures found later. / Initially thought to have PNA, or sleep apnea,
deterioration attributed to opiates. / Initially treated for PNA Mental status attributed to medications
Fractures found later / Confusion, agitation initially attributed to medications and delerium / NA / NA
life-flighted to ED / Initial evaluation focused on seizure, PNA, and, spinal cord injury
Outcome / Persistent vegetative state / Full recovery in 5 days / Full recovery in 11 days / Full recovery in 5 days / Full recovery in 12 days / Death 6 hrs after fall / Death 8 hrs after fall / Death 8 hrs after fall

Table e-1: patients 1-5 were followed in the Neuromuscular Clinic for their DMD and treated at Strong Memorial Hospital for their FES, University of Rochester, NY; patients 6-8 were followed at the Neuromuscular Clinic at Ohio State University Medical Center for their DMD and treated in local Emergency Departments for their FES. Abbreviations: fracture (Fx), wheelchair (WC), right/left (R/L), bilateral (B) pneumonia (PNA)