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Coexisting Systemic Infections in Patients Hospitalized Because of a Fall: Prevalence and Risk Factors

      Highlights

      • Coexisting systemic infections (CSIs) are diagnosed in 1 of 5 adults admitted to the hospital because of a fall or its complications.
      • Age 50 years or older, preexisting symptoms, inability to get up on own after a fall, systemic inflammatory response syndrome or confusion on presentation are significantly associated with the presence of CSIs.
      • Compared to fall patients without CSI, patients with CSI have longer duration of hospitalization (mean 8.8 days vs 6.5 days, p < 0.0001) and higher in-hospital mortality (6.9% vs 3.8%, p = 0.03).
      • Among patients 50 years of age or older admitted because of a fall, pneumonia and bacteremia are independently associated with in-hospital mortality.

      Abstract

      Background

      Infectious disease–related factors that may contribute to or complicate falls have received relatively little attention in the literature.

      Objective

      Our aim was to determine the prevalence of, and risk factors for, coexisting systemic infections (CSIs) in patients admitted to the hospital because of a fall or its complications.

      Methods

      We conducted a retrospective cohort study of adult patients seen at a tertiary care hospital emergency department and subsequently hospitalized because of a fall or its complications.

      Results

      Of 1,456 evaluable cases, 775 patients (53.2%) were female. Mean age was 71.6 years (range 18–104 years). CSI was diagnosed in 303 patients (20.8%), of which 166 (54.8%) were urinary tract infections and 108 (35.6%) were pneumonia cases; 14 patients (4.6%) were bacteremic. CSI was not initially suspected by providers in 98 (32.5%) subsequently diagnosed cases. Age ≥50 years (odds ratio [OR] 5.6; 95% confidence interval [CI] 1.2–24.9), inability to get up on own after the index fall (OR 2.1; 95% CI 1.2–3.6), preexisting symptom(s) (OR 3.0; 95% CI 1.8–5.2), and systemic inflammatory response syndrome (SIRS) (OR 2.9; 95% CI 1.5–5.4), or confusion at presentation (OR 3.0; 95% CI 1.5–6.0) were independently associated with CSI. In-hospital mortality rate was significantly higher among patients with CSI (6.9% vs. 3.8 %, OR 1.9; 95% CI 1.1–3.3).

      Conclusions

      CSIs are common among patients admitted to the hospital after a fall or its complications. Age ≥ 50 years, inability to get up on own, preexisting symptom(s), and the presence of SIRS or confusion at presentation are potential predictors of CSI in this patient population.

      Keywords

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