SERIOUS FALLS IN HOSPITALIZED-PATIENTS - CORRELATES AND RESOURCE UTILIZATION

PURPOSE: TO evaluate the correlates of serious falls in hospitalized p atients and the resource utilization associated with such falls. PATIE NTS AND METHODS: This retrospective case-control study was performed i n an urban tertiary care hospital. The 62 cases included all in-patien ts with available charts who were reported as having fallen with a res ulting fracture (n = 22), dislocation (n = 1), or laceration or hemato ma (n = 39) after being admitted between January 1987 and March 1991. The 62 controls were matched by date of hospitalization (within 3 mont hs), age (within 5 years), gender, and length of stay up to the time o f the fall. RESULTS: Univariate correlates of falls (P <0.05) included severity of underlying disease; Charlson comorbidity score, and Confu sion Assessment Method (CAM) score, in multivariate conditional logist ic regression analyses, only the Charlson index (P <0.006) and the CAM score (P <0.03) were independent correlates of a fall. Exposure to an y of a number of drugs did not predict falls, but the power to detect drug effects was limited. A combination of the Charlson comorbidity an d CAM scores identified a population at substantially increased risk o f fall, including 50% (31/62) of fallers, versus 16% (10/62) of contro ls (odds ratio 5.2; 95% confidence interval, 2.4 to 12). In multivaria te analyses, fails were also independently correlated with increases i n length of stay (P <0.004) and total charges (P <0.008). Fallers stay ed 12 days longer and had charges $4,233 higher than controls, after a djustment for potential clinical and nonclinical confounders. CONCLUSI ON: Falls during hospitalization are commoner in confused patients and those with greater comorbidity. This profile differs from that of fal lers in the community, probably because hospitalized patients are sick er. Injurious falls are associated with substantially increased resour ce utilization.