C. D. Minifee1,2, C. E. Wade1,2,3, J. Holcomb1,2,3, S. D. Adams1,2,3 1Center For Translational Injury Research,Houston, TEXAS, USA 2University Of Texas Health Science Center At Houston,Houston, TX, USA 3Memorial Hermann Hospital,Trauma Surgery,Houston, TX, USA
Introduction: Approximately 33% of elderly people (aged ≥ 65 years) experience a fall each year. With the rapidly aging population, the incidence of injury from ground level falls has surpassed that for motor vehicle crashes. Although most falls cause minor injuries, 20-30% are severe resulting in significant physical impairment, and elderly hospitalized for severe fall-related injuries have a 50% mortality rate. Many health and environmental factors contribute to fall risk in the elderly, however the most predictive risk factor is a prior fall. The CDC has emphasized the importance of injury prevention through identification of risk and intervention. In patients with severe injuries due to a fall, we determined the incidence of fall assessment and prevention during previous hospital encounters.
Methods: We performed a retrospective review of adult (≥65 years of age) trauma patients with severe injury (any AIS ≥ 3) admitted to our Level I center after a ground-level fall in 2014. We reviewed inpatient and clinic records to identify patients with previous admissions to our hospital, and recorded fall risk assessments and prevention efforts.
Results: Of 5448 admissions, 214 patients met the inclusion criteria. The median age was 79 (65-98), and 47% were male with an average ISS of 21 (16-42) and mortality 22%. After chart review, previous admissions were found in 39 (18%), most within 10 years. All 2014 admissions were for severe head injury (AIS > 3) and had a median length of stay of 6 days. Median age was 80 (65-98), 54% were male, and the average ISS was 22 with mortality of 10%. The 39 patients had a total of 66 prior encounters, an average of 1.7 per patient. Prior admissions were for injuries (fall, MVC, stroke) and medical illness (cardiac, cancer, infection). Fall education or intervention was not documented in 68% of the patient encounters and in 4 of the 12 patients with a known history of falls.
Conclusion: As people age, physiological changes and illness affect gate and balance, increasing the risk for falls. Patients with falls are known to be at highest risk for subsequent falls, and potentially fatal injury. We have demonstrated that our institution only documented appropriate risk identification and intervention in 46% of high risk patients. Many elderly patients presenting with a major fall-related injury had not received appropriate intervention during previous encounters, which demonstrates a missed opportunity for injury prevention.