A. S. Chiu1, R. A. Jean1, M. Flemming1, B. Resio1, K. Y. Pei1 1Yale University School Of Medicine,Surgery,New Haven, CT, USA
Introduction:
Traumatic falls are the leading source of injury and trauma related hospital admission for adults over 65 in the United States. A strong predictor of future falls is a history of previous falls, making patients hospitalized for a fall a high-risk population. It is unknown exactly how frequently this group is hospitalized for a repeat fall. Additionally, there remains debate whether to resume anticoagulation in elderly patients who fall due to fears of bleeding complications with repeat falls. We evaluated the rates of readmission after a fall and frequency of bleeding complications.
Methods:
The National Readmission Database is a nationally representative, all-payer database that tracks patient readmissions. All patients over 65 and admitted in the first 6 months of 2013 and 2014 for a traumatic fall were included for analysis. Those who died during their index hospitalization were excluded.
Primary outcome measured was 6-month readmission rate for a subsequent traumatic fall. Secondary outcomes included the frequency of death and bleeding complications (intracranial hemorrhage, solid organ bleed, and hemothorax) during readmission. Further analysis was conducted stratifying by anticoagulation use.
Results:
In the first 6 months of 2013 and 2014, there were 342,731 admissions for a fall. The cohort had a mean age of 80.2 and 9.3% were on anticoagulation. The rate of 6-month readmission for a repeat fall was 4.7%. Of those who were readmitted for a fall, 3.9% died during the subsequent admission and 12.6% had a bleeding complication. The mortality rate among those with a bleeding complication was 8.5%. The most common bleeding complication on readmission was intracranial bleed (90.8%), followed by hemothorax (5.8%) and solid organ bleed (3.5%).
The rate of readmissions for falls among patients on anticoagulation (4.4%) was not significantly different from those not on anticoagulation (4.7%, p=0.0933). The percent of readmitted patients with bleeding complications was also not statistically different (12.2% with anticoagulation vs. 12.6% without anticoagulation, p=0.7629). However, the mortality rate was higher among those on anticoagulation (6.0% vs. 3.7% without anticoagulation, p=0.0211). Specifically, among patients readmitted with a bleeding complication, those on anticoagulation had a significantly higher mortality rate (24.8% vs. 7.0% without anticoagulation, p<0.0001).
Conclusion:
Among patients hospitalized for a fall, nearly 5% will be re-hospitalized for a subsequent fall within 6 months. Patients on anticoagulation do not have increased rates of bleeding complications when hospitalized for repeat falls; however, when they do have a bleed, they have far higher mortality rates than those not on anticoagulation. Given the high rate of repeat falls and the potential to fatally exacerbate injuries when on anticoagulation, caution should be exercised when restarting anticoagulation among elderly patients hospitalized for a fall.