Risk Factors for Injurious Falls in Hospital Inpatients

Background: Patient falls are frequently reported adverse events in hospitals.  Most falls result in no injury or minor injury, but some result in significant injury or death.  Injurious falls are associated with increased hospital costs, longer length of stay, and greater likelihood of discharge to a nursing home or rehabilitation facility.  As hospitals look for ways to improve patient safety by reducing the risk of harm due to falls, information is needed regarding factors that increase risk for falls and fall injury.  While many studies have evaluated risk factors for falling in the hospital, less information is available concerning factors that increase risk for fall-related injury.

Objective: To identify demographic characteristics, comorbidities, and medications associated with moderate or major injury in patients who fell in the hospital.

Methods: We conducted a case control study comparing 156 adult inpatients who fell and sustained moderate or major injury with 468 randomly-selected control patients who fell and sustained no injury or minor injury (1:3) at three BJC hospitals from 2006-2008.  Falls that occurred outside of patient care areas and falls on the obstetrics service were excluded.  Logistic regression models were used to identify characteristics, comorbidities, and medications associated with injurious falls.

Results: Moderate/major injuries associated with falling in the hospital included lacerations (24.4%), hip fracture (15.4%), subdural hematoma (7.1%), pulling out a central line (6.4%), and fracture of the leg (5.1%), arm (4.5%), wrist (4.5%), and ankle or foot (3.8%).  One patient died as a result of their fall.  These injuries resulted in additional tests and treatments including x-rays following the fall (67.3%), CT scans (52.6%), orthopedic consults (40.4%), transfusions (38.1%), and surgery (30.1%).  Factors associated with moderate/major injury due to falls in multivariable analysis included having a bone marrow biopsy (OR, 5.3; 95% CI, 1.6 - 17.1), decubitus ulcer (OR, 3.6; 95% CI, 1.4-9.0), thrombocytopenia (OR, 3.1; 95% CI, 1.3 - 7.5), osteoporosis (OR, 2.7; 95% CI, 1.1 – 6.3), acute post hemorrhagic anemia (OR, 2.6; 95% CI, 1.1 - 6.3), eye disorders (OR, 2.4; 95% CI, 1.2 – 4.9) or an order for a cholinesterase inhibitor (OR, 3.6; 95% CI, 1.6 - 8.1).

Conclusions: This study identified independent risk factors for moderate or major injury in patients who fell in the hospital.  These risk factors may be markers for frailty and other underlying comorbidities that can increase the risk of injury.  Incorporating these risk factors into hospital fall risk assessment tools may allow for better identification of patients at risk for injury due to falling and allow for better tailoring of fall injury prevention strategies.