Incidence of falls in a cohort of critical adults: a cause for concerns?

Abstract

Objective: To describe the incidence and to report the cases of falls in a cohort of critical adults. Method: A prospective cohort study, conducted in 2018 at an adult Intensive Care Unit (ICU) in the south of Brazil. The patients were followed up from admission to discharge; observations were made in the morning and afternoon. The clinical and care variables were evaluated. The descriptive analysis was performed followed by the reporting of the cases. Results: 551 patients were monitored during 6 [3-12.7] days of hospitalization, generating 7,839 observations. There were four cases of falls, with an incidence rate of 5.1/10.000 observations/day - confidence interval of 99% [0.9 to 16] and density of incidence of 7/10.000 observations/day - confidence interval of 99% [1.2 to 22]. No serious harms were observed. Conclusion: Falls occur less in the ICU, which can be explained by the use of safe care practices.

What is new in critical illness and injury science? Patient falls in the intensive care unit

“…[ 2 ] The incidence of falls may vary according to the patient-specific variables, circumstances of hospitalization, and institutional and inpatient unit characteristics. [ 3 ]…”

“…One way of categorizing may include (1) Extrinsic (e.g., slipping or tripping, equipment failure, no bed railing, poor lighting, obstacle, wet, or freshly waxed floor), (2) Anticipated physiological (e.g., considered at risk for fall due to cause: limitation of walking, unaccompanied, sedative use, decreased strength, dizziness, confusion, syncope, and seizure), and (3) Unanticipated physiological (falls attributed to physiological factors that cannot be predicted before the first fall). [ 3 4 ] Anticipated physiological falls account for 78% of the total hospital falls, and thus have been a primary focus of many investigations assessing fall risk. [ 3 4 ]…”

“…[ 3 4 ] Anticipated physiological falls account for 78% of the total hospital falls, and thus have been a primary focus of many investigations assessing fall risk. [ 3 4 ]…”

“…Although less common in the intensive care unit (ICU) relative to other inpatient settings, inpatient falls may result in significant physical and psychological morbidity and mortality. [ 3 4 5 6 7 ] About 30%–50% of falls result in some form of patient harm. [ 8 9 ] Nonfatal consequences include soft tissue and orthopedic trauma (sprain, fracture, and dislocation), intracranial hemorrhage, increased disability, fear of falling, anxiety, depression, increased hospital length of stay (LOS), increased cost of hospitalization, and increased chance of discharge to a residential or nursing care facility.…”

“…Apart from a scarcity of studies focused on ICU populations, existing studies are restricted to few observations, and at times suboptimal designs or statistical analysis. [ 3 ] Moreover, further studies in ICU populations are needed to assess the efficacy and risks associated with commonly used fall interventions such as bed alarms and early mobility.…”