B. J. Hasjim2, A. Grigorian2, C. M. Kuza3, S. Schubl2, C. Barrios2, T. Chin2, J. Nahmias2 2University Of California – Irvine,Department Of Surgery,Orange, CA, USA 3University Of Southern California,Department Of Anesthesiology And Critical Care,Los Angeles, CA, USA
Introduction:
Nearly 60% of residents at skilled nursing facilities (SNFs) suffer a ground-level fall (GLF) at least once per year, resulting in serious injuries and increased healthcare costs. We sought to examine difference in injuries, such as traumatic brain injury (TBI) and lower extremity (LE) injury, between patients suffering GLFs at SNFs compared to those at residential homes. We hypothesized that SNF residents have an increased risk for a serious TBI and LE injury after a GLF, compared to those at home.
Methods:
The Trauma Quality Improvement Program was used to identify patients sustaining a GLF at a private residence or SNF between 2015-2016 and determined the incidence of serious TBIs and LE injuries defined as an abbreviated injury scale >3. A multivariable logistic regression model was used to determine the risk for severe head and LE injury in SNF vs. home.
Results:
From 15,873 patients with GLFs, 14,306 (90.1%) occurred at home and 1,567 (9.9%) occurred at a SNF. Patients with GLFs at a SNF were older (median 82-years-old vs. 73-years-old, p<0.001). Compared to those at home, patients with GLFs at SNFs had a lower median injury severity score (9 vs. 10, p<0.001), and higher rates of dementia (45.5% vs. 9.1%, p<0.001), congestive heart failure (13.2% vs. 7.6%, p<0.001), diabetes (24.3% vs. 21.5%, p=0.01), and chronic obstructive pulmonary disease (13.7% vs. 11.6%, p=0.01). GLFs at SNFs resulted in a higher incidence of femur fracture (55.1% vs. 38.9%, p<0.001) but lower incidence of TBI (28.0% vs. 33.4%, p<0.001). After adjusting for covariates (female, end-stage renal disease, smoker, dementia), patients falling at SNFs were at an increased risk of sustaining a serious LE injury (OR=1.66, CI=1.48-1.87, p<0.001), but had no difference in serious TBI (p=0.11).
Conclusion:
Compared to patients falling at home, those falling at a SNF have a 66% higher risk for a serious LE injury, but similar risk for a serious TBI. Femur fractures were the most common orthopedic injury overall. Future studies that evaluate the implementation of preventative measures, such as environmental safe-guards and pharmacologic/physical therapies, to reduce LE injuries at SNFs are warranted.