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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends and characteristics of emergency departments visits for fall-related injuries on older adults, 2003–2010.West J Emerg Med. 2017; 18: 785-793
- Interventions to prevent falls in community-dwelling older adults: a systematic review for the US Preventive Services Task Force. Evidence Synthesis No. 159. AHRQ Publication No. 17-05232-EF-1.Agency for Healthcare Research and Quality, Rockville, MD2018
- Coexisting systemic infections in patients who present with a fall.Am J Med Sci. 2017; 353: 22-26
- Factors related to the severity of delirium in the elderly patients with infection.Gerontol Geriatr Med. 2017; 3: 1-5
- Delirium, a symptom of UTI in the elderly: fact or fable? A systematic review.Can Ger J. 2014; 17: 22-26
- Predicting bacteremia based on nurse-assessed food consumption at the time of blood culture.J Hosp Med. 2012; 7: 702-705
- Acute confusional states in the elderly-diagnosis and treatment.Dtsch Arztebl Int. 2012; 109: 391-400
- Predicting geriatrics falls following an episode of emergency department care: a systematic review.Acad Emerg Med. 2014; 21: 1069-1082
- Urinary incontinences are related with fall and fragility fractures in elderly population: nationwide cohort study.J Bone Metab. 2018; 25: 267-274
- Why the elderly fall in residential care facilities, and suggested remedies.J Fam Pract. 2004; 53: 41-52
- Precipitating factors for falls among patients with dementia on a psychogeriatric ward.Int Psychogeriatr. 2010; 22: 641-649
- The relationship of urinary tract infections and falls in a nursing home.Director. 2007; 15: 22-26
- Mechanisms of striated muscle dysfunction during acute exacerbations of COPD.J Appl Physiol. 2013; 114: 1291-1299
- Increased morbidity and mortality associated with falls among patients with cirrhosis.Am J Med. 2018; 131: 645-650.e2
- Consequences of falling in older men and women and risk factors for health service use and functional decline.Age Ageing. 2004; 33: 58-65
- In-hospital mortality and unintentional falls among older adults in the United States.J Appl Gerontol. 2013; 32: 923-935
- Accuracy of data in computer-based patient records.J Am Med Inform Assoc. 1997; 4: 342-355
- Accuracy of administrative data versus clinical data to evaluate carotid endarterectomy and carotid stenting.J Vasc Surg. 2013; 58: 412-419
- Indicator and stratification methods for missing explanatory variables in multiple linear regression.J Am Stat Assoc. 1996; 91: 222-230
Article info
Publication history
Published online: March 21, 2020
Accepted:
January 20,
2020
Received in revised form:
January 8,
2020
Received:
October 7,
2019
Footnotes
Presented in part at the Society of Hospital Medicine Annual Conference, March 24–27, 2019, National Harbor, MD, Abstract no. 596567.
The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University, its affiliate academic health care centers, or its corporate contributors, or Cambridge Health Alliance.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
