Predictors of serious injury among hospitalized patients evaluated for falls

Abstract

BACKGROUND:Inpatient falls are common and result in significant patient morbidity.OBJECTIVE:To identify predictors of serious injury being found on imaging studies of inpatients evaluated after a fall.DESIGN:Retrospective study.SETTING:An 1171‐bed urban academic medical center.PATIENTS:All inpatients who fell on thirteen medical and surgical units from January 1 to December 31, 2006.MEASUREMENTS:Patient characteristics, circumstances surrounding falls, fall‐related injuries, and length of stay were collected through review of incident reports and computerized medical records. Primary outcome of fall‐related injury was determined by evidence of injury on imaging studies within two weeks of the fall. Univariate and multivariate logistic regression were used to calculate adjusted odds ratios (ORs) for injury after an inpatient fall.RESULTS:A total of 513 patients had 636 falls during the study time period. Fall incidence rate was 1.97 falls per 1,000 patient days. 95 patients (19%) fell multiple times (range, 2‐6 events); 74% of the falls occurred in patients who were previously assessed as being “at risk” by the nursing staff. Multivariate analysis, adjusting for age and sex, found evidence of trauma after a fall (OR = 24.6, P < 0.001) and ambulatory status (OR = 7.3, P < 0.01) to be independent predictors of injury being found on imaging studies.CONCLUSIONS:Inpatient falls are common despite high‐risk patients being identified. After adjusting for age and sex, evidence of trauma and ambulatory status were independent predictors of an injury being found on imaging studies after an inpatient fall. Journal of Hospital Medicine 2010;5:63–68. © 2010 Society of Hospital Medicine.

Is It Possible to Identify Risks for Injurious Falls in Hospitalized Patients?

“…Of four hospital-based studies that examined the association of medication classes with fall injury, no medications were found to be statistically significant. 4,17,19,20 However, our findings of an increased risk of fall-injury reflect those found in community- and nursing home–based studies for those on SSRIs, 29–33 benzodiazepines, 29,31,34 conventional antipsychotics, 35 and opiates. 36 For a number of years, the Beers Criteria for potentially inappropriate medications (PIMs) has designated benzodiazepines, conventional antipsychotics, and opiates as PIMs because of increased risk of falls, fall injury, and delirium for older adults.…”

Effect of a Multidisciplinary Fall Risk Assessment on Falls Among Neurology Inpatients

“…9 Among hospitalized patients, rates of falls range from 1.97 to 8.40 falls per 1000 patient-days. [9][10][11][12][13] The rate of falls on our neurology inpatient unit was 5.69 falls per 1000 patient-days during 2006 and 2007. The objective of this study was to evaluate whether the addition of a physician fall risk assessment to the existing nurse fall risk assessment process was feasible and whether it would lead to a reduction in our inpatient rate of falls.…”

Era of hospitalists

“…Hospitalized patient experience falls (1.97/1000 patient days) in spite of measures used to identify high-risk hospital admissions [7]. Consequently, a trial program was introduced for a checklist-based early identification of high-risk patients.…”