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Circumstances of Patient Falls and Injuries In 9 Hospitals In a Midwestern Healthcare System

  • Melissa J. Krauss (a1), Sheila L. Nguyen (a1), Wm. Claiborne Dunagan (a1) (a2), Stanley Birge (a1), Eileen Costantinou (a3), Shirley Johnson (a3), Barbara Caleca (a2) and Victoria J. Fraser (a1)...



Preventing hospital falls and injuries requires knowledge of fall and injury circumstances. Our objectives were to determine whether reported fall circumstances differ among hospitals and to identify predictors of fall-related injury.


Retrospective cohort study. Adverse event data on falls were compared according to hospital characteristics. Logistic regression was used to determine adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for risk factors for fall-related injury.


Nine hospitals in a Midwestern healthcare system.


Inpatients who fell during 2001-2003.


The 9 hospitals reported 8,974 falls that occurred in patient care areas, involving 7,082 patients; 7,082 falls were included in our analysis. Assisted falls (which accounted for 13.3% of falls in the academic hospital and 9.8% of falls in the nonacademic hospitals; P <.001) and serious fall-related injuries (which accounted for 3.7% of fall-related injuries in the academic hospital and 2.2% of fall-related injuries in the nonacademic hospitals; P <.001) differed by hospital type. In multivariate analysis for the academic hospital, increased age (aOR, 1.006 [95% CI, 1.000-1.012]), falls in locations other than patient rooms (aOR, 1.53 [95% CI, 1.03-2.27]), and unassisted falls (aOR, 1.70 [95% CI, 1.23-2.36]) were associated with increased injury risk. Altered mental status was associated with a decreased injury risk (aOR, 0.72 [95% CI, 0.58-0.89]). In multivariate analysis for the nonacademic hospitals, increased age (aOR, 1.007 [95% CI, 1.002-1.013]), falls in the bathroom (aOR, 1.46 [95% CI, 1.06-2.01]), and unassisted falls (aOR, 1.83 [95% CI, 1.37-2.43]) were associated with injury. Female sex (aOR, 0.83 [95% CI, 0.71-0.97]) was associated with a decreased risk of injury.


Some fall characteristics differed by hospital type. Further research is necessary to determine whether differences reflect true differences or merely differences in reporting practices. Fall prevention programs should target falls involving older patients, unassisted falls, and falls that occur in the patient's bathroom and in patient care areas outside of the patient's room to reduce injuries.


Corresponding author

Washington University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, 660 South Euclid Avenue, Campus Box 8051, St. Louis, MO 63110 (
Washington University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, 660 South Euclid Avenue, Campus Box 8051, St. Louis, MO 63110 (


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1. Sutton, JC, Standen, PJ, Wallace, WA. Patient accidents in-hospital: incidence, documentation and significance. Br J Clin Pract 1994;48:63–6.
2. Hitcho, EB, Krauss, MJ, Birge, S, et al. Characteristics and circumstances of falls in a hospital setting. J Gen Intern Med 2004;19:732739.
3. Bates, DW, Pruess, K, Souney, P, Platt, R. Serious falls in hospitalized patients: correlates and resource utilization. Am J Med 1995;99:137143.
4. Aditya, BS, Sharma, JC, Allen, SC, Vassallo, M. Predictors of a nursing home placement from a non-acute geriatric hospital. Clin Rehabil 2003;17:108113.
5. Scaf-Klomp, W, Sanderman, R, Ormel, J, Kempen, GIJM. Depression in older people after fall-related injuries: a prospective study. Age Ageing 2003;32:8894.
6. Kempen, GIJM, Sanderman, R, Scaf-Klomp, W, Ormel, J. The role of depressive symptoms in recovery from injuries to the extremities in older persons: a prospective study. Int J Geriatr Psychiatry 2003;18:1422.
7. Tinetti, ME, Williams, CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci 1998;53:M112M119.
8. Kong, KS, Lee, Fk FK, Mackenzie, AE, Lee, DT. Psychosocial consequences of falling: the perspective of older Hong Kong Chinese who had experienced recent falls. J Adv Nurs 2002;37:234242.
9. Murphy, J, Isaacs, B. The post-fall syndrome: a study of 36 elderly patients. Gerontology 1982;28:265270.
10. Krauss, MJ, Evanoff, B, Hitcho, E, et al. A case-control study of patient, medication, and care-related risk factors for inpatient falls. J Gen Intern Med 2005;20:116122.
11. Tinetti, ME. Clinical practice: preventing falls in elderly persons. N Engl J Med 2003;348:4249.
12. Rubenstein, LZ, Powers, CM, MacLean, CH. Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Ann Intern Med 2001;135:686693.
13. Tinetti, ME, Doucette, JT, Claus ЕB. The contribution of predisposing and situational risk factors to serious fall injuries. J Am Geriatr Soc 1995;43:12071213.
14. Tinetti, ME, Doucette, J, Claus, E, Marottoli, R. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995;43:12141221.
15. Tinetti, ME, Liu, WL, Ginter, SF. Mechanical restraint use and fall-related injuries among residents of skilled nursing facilities. Ann Intern Med 1992;116:369374.
16. Myers, AH, Baker, SP, Van Natta, ML, Abbey, H, Robinson, EG. Risk factors associated with falls and injuries among elderly institutionalized persons. Am J Epidemiol 1991;133:11791190.
17. Rubenstein, LZ, Josephson, KR, Robbins, AS. Falls in the nursing home. Ann Intern Med 1994;121:442451.
18. Krueger, PD, Brazil, K, Lohfeld, LH. Risk factors for falls and injuries in a long-term care facility in Ontario. Can J Public Health 2001;92:117120.
19. Fischer, I, Krauss, MJ, Dunagan, WC, et al. Patterns and predictors of inpatient falls and fall injuries in a large academic hospital. Infect Control Hosp Epidemiol 2005;26:8227.
20. Morris, EV, Isaacs, B. The prevention of falls in a geriatric hospital. Age Ageing 1980;9:181185.
21. Kellogg International Work Group, Gibson, MJ, Andres, RO, Isaacs, B, Radebaugh, T, Worm-Petersen, J. The prevention of falls in later life: a report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull 1987;34:124.
22. Florida Hospital Association Patient Safety Steering Committee. Building the foundations for patient safety. November 2001. Available at: Access August 31, 2005.
23. Mayo, NE, Korner-Bitensky, N, Levy, AR. Risk factors for fractures due to falls. Arch Phys Med Rehabil 1993;74:917921.
24. Nevitt, MC, Cummings, SR, Hudes, ES. Risk factors for injurious falls: a prospective study. J Gerontol 1991;46:M164M170.
25. Vassallo, M, Vignaraja, R, Sharma, JC, Briggs, R, Allen, S. The relationship of falls to injury among hospital in-patients. Int J Clin Pract 2005;59:1720.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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