Assessing Fall Mortality by Field-Relevant Categories at an Urban Level I Trauma Center.

INTRODUCTION: Little research has focused on assessing the mortality for fall height based on field-relevant categories like falls from greater than standing (FFGS), falls from standing (FFS), and falls from less than standing. METHODS: This retrospective observational study included patients evaluated for a fall incident at an urban Level I Trauma Center or included in Medical Examiner's log from January 1, 2015, to June 31, 2017. Descriptive statistics characterized the sample based on demographic variables such as age, race, sex, and insurance type, as well as injury characteristics like relative fall height, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), traumatic brain injury, intensive care unit length of stay, and mortality. Bivariate analysis included Chi-square tests for categorical variables and Student t-tests for continuous variables. Subsequent multiple logistic regression modeled significant variables from bivariate analyses, including age, race, insurance status, fall height, ISS, and GCS. RESULTS: When adjusting for sex, age, race, insurance, ISS, and GCS, adults ≥65 who FFS had 1.93 times the odds of mortality than those who FFGS. However, those <65 who FFGS had 3.12 times the odds of mortality than those who FFS. Additionally, commercial insurance was not protective across age groups. CONCLUSIONS: The mortality for FFS may be higher than FFGS under certain circumstances, particularly among those ≥65 y. Therefore, prehospital collection should include accurate assessment of fall height and surface (i.e., water, concrete). Lastly, commercial insurance was likely a proxy for industrial falls, accounting for the surprising lack of protection against mortality.

In-hospital mortality and unintentional falls among older adults in the United States.

PURPOSE OF THE STUDY: To estimate the odds of death associated with documented unintentional falls and acute care hospitalization among older adults in the United States. DESIGN AND METHOD: Data were abstracted from the 2005 Nationwide Inpatient Sample (NIS) and odds of death were modeled using logistic regression. RESULTS: The age 65 and older fall rate per 1,000 discharges was 53.0 while the mortality rate for those who fell was 33.2. Older-old (odds ration [OR] = 2.93; confidence interval [CI] = [2.50, 3.43]), men (OR = 1.64, CI = [1.54, 1.75]), and non-White (OR = 1.09; CI = [1.01, 1.19]) had higher odds of death compared to younger-old, women, and Whites. Additional comorbidity (OR = 3.41, CI = [3.05, 3.82]), dehydration (OR = 1.14; CI = [1.05, 1.25]) and intracranial fractures (OR = 4.46; CI = [4.02, 4.95]) resulted in greater odds of death. IMPLICATIONS: Among older adults who experienced a fall and hospitalization, odds of mortality appear influenced by factors beyond injury severity related to falling. Additional research is necessary to delineate the mechanisms behind these phenomena to inform the public about falls-prevention programs.