School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
School of Physiotherapy and Institute of Health Research, The University of Notre Dame Australia, Fremantle.
J Gerontol A Biol Sci Med Sci. 2020 Sep 25;75(10):e152-e158. doi: 10.1093/gerona/glaa032.
Hospital falls remain common and approximately 30% of falls in hospital result in injury. The aims of the study were the following: (i) to identify the association between fall interventions present at the time of the injurious fall and injurious faller characteristics and (ii) to identify the association between fall preventive interventions present at the time of the injurious fall and the injurious fall circumstances.
Secondary data analysis of deidentified case series of injurious falls across 24 acute medical/surgical units in the United States. Variables of interest were falls prevention interventions (physical therapy, bed alarm, physical restraint, room change, or a sitter) in place at the time of fall. Data were analyzed using logistic regression and hazard ratios.
There were 1,033 patients with an injurious fall, occurrence peaked between Day 1 and Day 4, with 46.8% of injurious falls having occurred by Day 3 of admission. Injurious fallers with a recorded mental state change 24 hours prior to the fall were more likely to have a bed alarm provided (adjusted odds ratio [OR] 2.56, 95% confidence interval [CI] 1.61, 4.08) and receive a physical restraint as fall prevention interventions (adjusted OR 6.36, 95% CI 4.35, 9.30). Injurious fallers restrained fell later (stay Day 6) than those without a restraint (stay Day 4) (p = .007) and had significantly longer lengths of stay (13 days vs 9 days).
On medical/surgical units, injurious falls occur early following admission suggesting interventions should be commenced immediately. Injurious fallers who had a physical restraint as an intervention had longer lengths of stay.
医院跌倒仍然很常见，大约 30%的医院跌倒会导致受伤。本研究的目的如下：(i) 确定受伤跌倒时存在的跌倒干预措施与受伤跌倒者特征之间的关联，以及 (ii) 确定受伤跌倒时存在的跌倒预防干预措施与受伤跌倒情况之间的关联。
对美国 24 个急性内科/外科病房的受伤跌倒病例系列进行二次数据分析。关注的变量是跌倒预防干预措施（物理治疗、床报警、身体约束、房间更换或护工）在跌倒时的使用情况。使用逻辑回归和风险比进行数据分析。
共有 1033 名患者发生了受伤跌倒，跌倒发生率在入院第 1 天至第 4 天达到高峰，其中 46.8%的受伤跌倒发生在入院第 3 天。在跌倒前 24 小时记录到精神状态变化的受伤跌倒者更有可能获得床报警（校正优势比 [OR] 2.56，95%置信区间 [CI] 1.61,4.08）和接受身体约束作为跌倒预防干预措施（校正 OR 6.36，95% CI 4.35,9.30）。使用约束的受伤跌倒者的住院天数（第 6 天）晚于未使用约束的受伤跌倒者（第 4 天）（p =.007），并且住院时间明显更长（13 天 vs 9 天）。
在内科/外科病房，受伤跌倒发生在入院后早期，这表明应立即开始干预措施。作为干预措施使用身体约束的受伤跌倒者的住院时间更长。
