Use of Risk Assessment Tool for Inpatient Traumatic Intracranial Hemorrhage after Falls in Acute Care Hospital Setting

Shin-Ichi Toyabe

doi:10.5539/gjhs.v4n3p64

Abstract

Severe injuries such as intracranial hemorrhage (ICH) are the most serious problem after falls in hospital, but they have not been considered in risk assessment scores for falls. We tried to determine the risk factors for ICH after falls in 20,320 inpatients (696,364 patient-days) aged from 40 to 90 years who were admitted to a tertiary-care university hospital. Possible risk factors including STRATIFY risk score for falls and FRAX™ risk score for fractures were analyzed by univariate and multivariate analyses. Fallers accounted for 3.2% of the patients, and 5.0% of the fallers suffered major injuries, including peripheral bone fracture (59.6%) and ICH (23.4%). In addition to STRATIFY, FRAX™ was significantly associated not only with bone fractures but also ICH. Concomitant use of risk score for falls and risk score for fractures might be useful for the prediction of major injuries such as ICH after falls.

Highlights

Falls are very common accidents in hospitals (Nakai et al, 2006)
The FRAXTM score was originally developed as a tool for predicting osteoporotic fracture (Fujiwara et al, 2008; Kanis et al, 2005; WHO, 2008), we unexpectedly found a significant association between intracranial hemorrhage (ICH) after falls and high FRAXTM score
High FRAXTM score might be associated with fallers, especially fallers complicated with major injuries such as ICH

Summary

Introduction

Falls are very common accidents in hospitals (Nakai et al, 2006). Falls in a hospital often cause severe injuries such as bone fractures, soft tissue injuries and hematomas. One strategy to prevent these situations is targeted intervention for patients who are judged to be at high risk of falls by risk assessment tools for falls (Gates et al, 2008; Rubenstein, 2006; Haines et al, 2007). These risk assessment tools were developed to identify patients at high risk for falls, not to predict patients who would suffer physical injuries after falls. Risk assessment tools are needed to predict falls that are likely to be complicated with severe injuries. We have recently reported that risk assessment tools for osteoporotic fractures might be useful for prediction of fractures after falls (Toyabe, 2010)

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