Risk Factors for Falls among Hospitalized Trauma Patients.

Inpatient falls lead to an injury in 30 per cent of cases and serious injury in 5 per cent. Increasing staffing and implementing fall prevention programs can be expensive and require a significant use of resources. We hypothesized that trauma patients have unique risk factors to sustain a fall while hospitalized. This is a retrospective cohort study from 2005 to 2010 of all trauma patients admitted to an urban Level I trauma center. Patients who fell while hospitalized were compared with patients who did not fall to identify risk factors for sustaining an inpatient fall. There were 16,540 trauma patients admitted during the study period and 128 (0.8%) fell while hospitalized. Independent risk factors for a trauma patient to fall while hospitalized included older age (odds ratio [OR], 1.02 [1.01 to 1.03], P < 0.001), male gender (OR, 1.6 [1.0 to 2.4], P = 0.03), blunt mechanism (OR, 5.1 [1.6 to 16.3], P = 0.006), Glasgow Coma Score at admission (OR, 0.59 [0.35 to 0.97], P = 0.04), intensive care unit admission (OR, 2.3 [1.4 to 3.7], P = 0.001), and need for mechanical ventilation (OR, 2.2 [1.2 to 3.9], P = 0.01). Trauma patients who fell while hospitalized sustained an injury in 17 per cent of cases and a serious injury in 5 per cent. Inpatient falls in hospitalized trauma patients are uncommon. Risk factors include older age, male gender, blunt mechanism, lower Glasgow Coma Score, and the need for intensive care unit admission or mechanical ventilation. Trauma patients with these risk factors may require higher staffing ratios and should be enrolled in a formal fall prevention program.

Risk factors for riding and crashing a motorcycle unhelmeted.

BACKGROUND: Currently, less than half of all U.S. states require helmets for motorcycle operators. Although research has demonstrated the effectiveness of helmets, less is known about the characteristics of individuals who choose to ride motorcycles unhelmeted. OBJECTIVES: The specific aims of this study were to identify risk factors leading to riding and crashing a motorcycle without a helmet and to compare outcomes of helmeted vs. unhelmeted motorcyclists involved in a motorcycle crash. METHODS: This 13-year (1994-2006) retrospective study of adult motorcycle crashes admitted to a Level II trauma center compares helmeted to unhelmeted motorcyclists. RESULTS: There were 1738 motorcyclists admitted, including 978 (56%) helmeted (38 years old, 87% male) and 760 (44%) unhelmeted (38 years old, 85% male). Unhelmeted riders had a higher Injury Severity Score (16 vs. 13, p < 0.001), lower Glasgow Coma Scale score (13 vs. 14, p < 0.001), and more hypotension (6% vs. 4%, p = 0.03). Unhelmeted riders had worse outcomes, including higher rate of severe disability (16% vs. 10%, p < 0.001), more days in the hospital (7 vs. 6, p < 0.001) and intensive care unit (2 vs. 1, p < 0.001), incurred higher hospital charges ($44,744 vs. $31,369, p < 0.001), and had higher mortality (6% vs. 2%, p < 0.001). Independent predictors of riding without a helmet included alcohol intoxication, riding as a passenger, and lack of health insurance. CONCLUSIONS: Unhelmeted motorcyclists sustain more severe injuries and adverse outcomes. Motorcyclists who are intoxicated, uninsured, or passengers are less likely to wear a helmet. Education and prevention strategies should be targeted at these high-risk populations.