Risk Factors for Significant Injury After Inpatient Falls

Inpatient (IP) falls present substantial challenges to health care institutions. We aimed to characterize injuries after IP falls and evaluate if there were risk factors for these injuries. Adult inpatients who fell in an acute care hospital from 2018 to 2023 were studied. Severity of injury were retroactively assigned using the Abbreviated Injury Scale (AIS) for each of nine body regions and calculating the Injury Severity Score (ISS). The primary outcome was any significant injury (SI), which was defined as an ISS of ≥2. Patients with SI were matched 1:2 for age and whether the fall was witnessed to those without SI (controls). The risk of SI was estimated for each plausible variable using conditional logistic regression, with P < .05 considered significant. There were 2617 IP falls with 53 (2%) having SI. SI was associated with greater age (median, 73 vs 65 years, P = .002) but not with witnessed falls (2% vs 2%, P = .99). In the matched groups (n = 53 vs n = 106), signs of injury in the head, neck, back and extremities and new complaints after the fall were associated with SI. SI patients were more likely to require surgical intervention for injuries (36% vs 10%, P = .0001), and to die (9% vs 2%, P = .03). SI is uncommon after IP falls but portends increased resource utilization. Evaluation for SI requires a careful history and examination by providers at the time of the fall. Signs of injury on physical exam and new complaints should raise suspicion for SI.