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. 2021 Jan 6;16(1):e0244862.
doi: 10.1371/journal.pone.0244862. eCollection 2021.

When falls become fatal-Clinical care sequence

Stacy A Drake  1 , Sadie H Conway  2 , Yijiong Yang  3 , Latarsha S Cheatham  3 , Dwayne A Wolf  4 , Sasha D Adams  5   6 , Charles E Wade  5   6 , John B Holcomb  7
Affiliations

When falls become fatal-Clinical care sequence

Stacy A Drake et al. PLoS One. .

Abstract

Objectives: This study encompassed fall-related deaths, including those who died prior to medical care, that were admitted to multiple healthcare institutions, regardless of whether they died at home, in long-term care, or in hospice. The common element was that all deaths resulted directly or indirectly from injuries sustained during a fall, regardless of the temporal relationship. This comprehensive approach provides an unusual illustration of the clinical sequence of fall-related deaths. Understanding this pathway lays the groundwork for identification of gaps in healthcare needs.

Design: This is a retrospective study of 2014 fall-related deaths recorded by one medical examiner's office (n = 511) within a larger dataset of all trauma related deaths (n = 1848). Decedent demographic characteristics and fall-related variables associated with the deaths were coded and described.

Results: Of those falling, 483 (94.5%) were from heights less than 10 feet and 394 (77.1%) were aged 65+. The largest proportion of deaths (n = 267, 52.3%) occurred post-discharge from an acute care setting. Of those who had a documented prior fall, 216 (42.3%) had a history of one fall while 31 (6.1%) had ≥2 falls prior to their fatal incident. For the 267 post-acute care deaths, 440 healthcare admissions were involved in their care. Of 267 deaths occurring post-acute care, 129 (48.3%) were readmitted within 30 days. Preventability, defined as opportunities for improvement in care that may have influenced the outcome, was assessed. Of the 1848 trauma deaths, 511 (27.7%) were due to falls of which 361 (70.6%) were determined to be preventable or potentially preventable.

Conclusion: Our data show that readmissions and repeated falls are frequent events in the clinical sequence of fall fatalities. Efforts to prevent fall-related readmissions should be a top priority for improving fall outcomes and increasing the quality of life among those at risk of falling.

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Conflict of interest statement

Dr. Holcomb is a co-founder and on the Board of Directors of Decisio Health, on the Board of Directors of Zibrio and QinFlow, a Co-inventor of the Junctional Emergency Tourniquet Tool and an adviser to PotentiaMetrics, Cellphire and Arsenal Medical. Updated: Dr. Wade is a co-founder and on the Board of Directors of Decisio Health. All other authors have indicated they have no financial conflicts of interest to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow diagram of fall deaths.
Fig 2
Fig 2. Initial acute care setting and discharge location post-acute care (n = 265).
See this image and copyright information in PMC

References

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