Coexisting Systemic Infections in Patients Who Present With a Fall
1Harvard Medical School, Boston, Massachusetts.
The American Journal of the Medical Sciences
|January 21, 2017
Summary
Falls can be a sign of underlying systemic infections, not just mechanical issues. Many patients with coexisting systemic infections (CSI) and falls don't initially show signs of infection, highlighting a potential diagnostic challenge.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Internal Medicine
Background:
- Falls are common in older adults, but infectious causes are underreported.
- Investigated characteristics of patients presenting with falls and coexisting systemic infection (CSI).
- Retrospective study at Massachusetts General Hospital (2000-2014).
Purpose of the Study:
- To characterize patients presenting with falls who have a coexisting systemic infection (CSI).
- To understand the clinical presentation and common pathogens in fall-related infections.
Main Methods:
- Retrospective analysis of adult patients from January 1, 2000, to December 31, 2014.
- Screening using billing codes for 'fall,' 'sepsis,' 'bacteremia,' and 'systemic inflammatory response syndrome' (SIRS).
- Inclusion of patients with documented CSI in the context of a fall.
Main Results:
- 161 patients evaluated; 52.2% female, mean age 75.2 years.
- Most common infections: urinary (44.1%) and lower respiratory tract (23.0%).
- Bacteremia occurred in 39.8% of cases; Staphylococcus aureus was the most common pathogen.
Conclusions:
- Falls associated with CSI are often misdiagnosed as 'mechanical'.
- Systemic inflammatory response syndrome (SIRS) criteria were often not met initially.
- Falls can be an atypical presentation of systemic infection.
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