University of California, San Diego, School of Medicine, San Diego, California.
University of California, San Diego, Department of Emergency Medicine, San Diego, California.
West J Emerg Med. 2022 Sep 12;23(5):734-738. doi: 10.5811/westjem.2022.6.55666.
Falls are the leading cause of traumatic injury among elderly adults in the United States, which represents a significant source of morbidity and leads to exorbitant healthcare costs. The purpose of this study was to characterize elderly fall patients and identify risk factors associated with seven-day emergency department (ED) revisits.
This was a multicenter, retrospective, longitudinal cohort study using non-public data from 321 licensed, nonfederal, general, and acute care hospitals in California obtained from the Department of Healthcare Access and Information from January 1-December 31, 2017. Included were patients 65 and older who had a fall-related ED visit identified by International Classification of Diseases codes W00x to W19x. Primary outcome was a return visit to the ED within a seven-day window following the index encounter. Demographics collected included age, gender, ethnicity/race, patient payer status, Charlson Comorbidity Index (CCI), psychiatric diagnoses, and alcohol/substance use disorder diagnoses. We performed multivariate logistic regression to identify characteristics associated with seven-day ED revisit.
We identified a total of 2,758,295 ED visits during the study period with 347,233 (12.6%) visits corresponding to fall-related injuries. After applying exclusion criteria, 242,572 index ED visits were identified, representing 206,612 patients. Of these, 24,114 (11.7%) patients returned to an ED within seven days (revisit). Within this revisit population, 6,161 (22.6%) presented to a facility that was distinct from their index visit, and 4,970 (18.2%) were ultimately discharged with the same primary diagnosis as their index visit. Characteristics with the largest independent associations with a seven-day ED revisit were presence of a psychiatric diagnosis (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.69 to 1.80), presence of an alcohol or substance use disorder (OR 1.70; 95% CI 1.64 to 1.78), and CCI ≥ 3 (OR 2.79; 95% CI 2.68 to 2.90).
In this study we identified 24,114 elderly fall patients who experienced a seven-day ED revisit. Patients with multiple comorbidities, a substance use disorder, or a psychiatric diagnosis exhibited increased odds of experiencing a return visit to the ED within seven days of a fall-related index visit. These findings will help target at-risk elderly fall patients who may benefit from preventative multidisciplinary intervention during index ED visits to reduce ED revisits.
在美国，老年人跌倒导致的创伤是导致受伤的主要原因，这是发病率的一个主要来源，并导致高昂的医疗保健费用。本研究的目的是描述老年跌倒患者，并确定与七天内急诊部（ED）复诊相关的风险因素。
这是一项多中心、回顾性、纵向队列研究，使用加利福尼亚州 321 家持牌非联邦、普通和急性护理医院从 2017 年 1 月 1 日至 12 月 31 日从医疗保健获取和信息部获得的非公开数据。包括年龄在 65 岁及以上的患者，他们通过国际疾病分类代码 W00x 至 W19x 识别为与跌倒相关的 ED 就诊。主要结果是在指数就诊后的七天内返回 ED。收集的人口统计学数据包括年龄、性别、族裔/种族、患者支付者身份、Charlson 合并症指数（CCI）、精神科诊断和酒精/物质使用障碍诊断。我们进行了多变量逻辑回归，以确定与七天 ED 复诊相关的特征。
在研究期间，我们共确定了 2758295 次 ED 就诊，其中 347233（12.6%）就诊与跌倒相关的伤害相对应。在应用排除标准后，确定了 242572 次指数 ED 就诊，代表 206612 名患者。在这些患者中，有 24114 名（11.7%）患者在七天内返回 ED（复诊）。在这个复诊人群中，有 6161 名（22.6%）患者到了与指数就诊不同的医疗机构就诊，有 4970 名（18.2%）最终以与指数就诊相同的主要诊断出院。与七天内 ED 复诊有最大独立关联的特征是存在精神科诊断（优势比[OR]1.75；95%置信区间[CI]1.69 至 1.80）、存在酒精或物质使用障碍（OR 1.70；95% CI 1.64 至 1.78）和 CCI ≥ 3（OR 2.79；95% CI 2.68 至 2.90）。
在这项研究中，我们确定了 24114 名经历七天 ED 复诊的老年跌倒患者。患有多种合并症、物质使用障碍或精神科诊断的患者出现跌倒相关指数就诊后七天内返回 ED 的几率增加。这些发现将有助于确定高危老年跌倒患者，他们可能受益于在指数 ED 就诊期间进行预防多学科干预，以减少 ED 复诊。
