Outcomes in older emergency patients after ground level falls
Introduction
Falls are a major problem in the older emergency department (ED) population and are very common, with about 30% of community dwelling older people falling every year in developed countries. Retrospective studies showed that 19-26 % of patients died within a year after falling. The aim of this study is to prospectively identify the outcomes of older patients presenting with falls.
Methods
We conducted this trial as a prospective international multicentre, cross-sectional observational study. Data collection was performed from November 2014 until January 2018. Study centres were University Hospital Basel, Hospital Bruderholz, Charite Berlin Campus Benjamin Franklin as tertiary care hospitals,and Hospital of Liestal, a secondary care hospital. Patients older than 65 years presenting within 24 hours to ED after a fall and giving informed consent to participate, were enrolled in the study. Upon presentation, medical history and presenting complaints were collected. Follow-up analyses were performed after 30 days, 90 days, 6 months and 1 year. The primary outcome of this study was 30 day mortality; the secondary outcomes were 90 day, 6 month and 1 year mortality, and institutionalisation.
Results
Of 825 screened patients, 587 patients could be included in the study. 394 patients were female (67%) and median age was 84 years, with a range from 65 to 104 years at time of the presentation. Beside from the acute fall, the three most common presenting complaints were pain (54%), of which 23% were unrelated to the fall, gait disturbance (51%) and fatigue (44%). In patients with completed follow-up the mortality rates were: 3.5% for 30 days, 6.8% for 90-days, 12.5% for 6 months and 20.7% for 1 year, suggesting that trajectory of mortality is a steady process over a year.
Discussion
To our knowledge, this trial is the first prospective study investigating the mortality of older patients presenting in the emergency department after falling. Fortunately, we could indeed confirm the high mortality of retrospective studies. Interestingly concerning the presenting complaints, besides the fall and pain related to the fall, nonspecific complaints are often reported.
