Serious falls in hospitalized patients: correlates and resource utilization

To evaluate the correlates of serious falls in hospitalized patients and the resource utilization associated with such falls.

This retrospective case-control study was performed in an urban tertiary care hospital. The 62 cases included all inpatients with available charts who were reported as having fallen with a resulting fracture (n = 22), dislocation (n = 1), or laceration or hematoma (n = 39) after being admitted between January 1987 and March 1991. The 62 controls were matched by date of hospitalization (within 3 months), age (within 5 years), gender, and length of stay up to the time of the fall.

Univariate correlates of falls (P < 0.05) included severity of underlying disease, Charlson comorbidity score, and Confusion Assessment Method (CAM) score. In multivariate conditional logistic regression analyses, only the Charlson index (P < 0.006) and the CAM score (P < 0.03) were independent correlates of a fall. Exposure to any of a number of drugs did not predict falls, but the power to detect drug effects was limited. A combination of the Charlson comorbidity and CAM scores identified a population at substantially increased risk of fall, including 50% (31/62) of fallers, versus 16% (10/62) of controls (odds ratio 5.2; 95% confidence interval, 2.4 to 12). In multivariate analyses, falls were also independently correlated with increases in length of stay (P < 0.004) and total charges (P < 0.008). Fallers stayed 12 days longer and had charges $4,233 higher than controls, after adjustment for potential clinical and nonclinical confounders.

Falls during hospitalization are commoner in confused patients and those with greater comorbidity. This profile differs from that of fallers in the community, probably because hospitalized patients are sicker. Injurious falls are associated with substantially increased resource utilization.