Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
Arch Phys Med Rehabil. 2023 Aug;104(8):1209-1218. doi: 10.1016/j.apmr.2023.01.010. Epub 2023 Feb 1.
To (1) determine fall characteristics (eg, cause, location, witnesses) of inpatients with spinal cord injury (SCI) and whether they were different for ambulatory persons vs wheelchair users; (2) visualize the total number of daily falls per clock-hour for different inpatients' features (eg, cause of injury, age); (3) compare clinical and demographic characteristics of inpatients who experienced a first fall event vs inpatients who did not experience such event; and (4) identify first fall event predictors.
Retrospective observational cohort study.
Institution for inpatient neurologic rehabilitation.
Persons with SCI (N=1294) admitted to a rehabilitation facility between 2005 and 2022.
Not applicable.
Functional independence measure (FIM), Hospital Anxiety and Depression Scale (HADS), American Spinal Injury Association Impairment Scale (AIS), and Spinal Cord Independence Measure (SCIM) at admission. Kaplan-Meier survival curves and Cox proportional hazards models were used.
A total of 502 fall events were experienced by 369 ambulatory inpatients (19.8%) and wheelchair users (80.2%) in 63.9% of cases being alone, with cause, situation, and location significantly different in both groups. Clock-hour visualizations revealed an absolute peak at 12 AM (complete or incomplete injuries, with paraplegia or tetraplegia) but a relative peak at 9 AM mainly including incomplete patients with paraplegia. Of the (n=1294) included patients, 16.8% experienced at least 1 fall. Fallen patients reported higher levels of HADS depression, lower total SCIM, and longer time since injury to admission, with no differences in age, sex, educational level, FIM (quasi-significant), and AIS grade. Multivariable Cox proportional hazards identified time since injury to admission and AIS grade D as significant predictors of first fall event.
Falls identification, characterization, and clock-hour visualization can support decisions for mitigation strategies specifically addressed to inpatients with SCI. Fall predictors were identified as a first step for future research.
（1）确定脊髓损伤（SCI）住院患者的跌倒特征（例如，原因、地点、目击者），以及这些特征在活动和轮椅使用者之间是否存在差异；（2）可视化不同住院患者特征（例如，损伤原因、年龄）下的每日跌倒总次数；（3）比较经历首次跌倒事件和未经历此类事件的住院患者的临床和人口统计学特征；（4）确定首次跌倒事件的预测因素。
回顾性观察队列研究。
住院神经康复机构。
2005 年至 2022 年期间入住康复机构的 SCI 患者（N=1294）。
无。
入院时的功能独立性测量（FIM）、医院焦虑和抑郁量表（HADS）、美国脊髓损伤协会损伤量表（AIS）和脊髓独立性测量（SCIM）。使用 Kaplan-Meier 生存曲线和 Cox 比例风险模型。
369 名活动和轮椅使用者住院患者中共有 502 例跌倒事件（19.8%）发生，63.9%的情况下患者为独自一人，两组患者的跌倒原因、情况和地点均存在显著差异。时钟小时可视化显示，绝对高峰出现在 12 点（完全或不完全损伤，伴有截瘫或四肢瘫），但相对高峰出现在 9 点，主要包括不完全性截瘫患者。在纳入的（n=1294）患者中，16.8%的患者至少经历过 1 次跌倒。跌倒患者报告的 HADS 抑郁程度更高，SCIM 总分更低，受伤至入院时间更长，年龄、性别、教育程度、FIM（准显著）和 AIS 分级无差异。多变量 Cox 比例风险模型确定受伤至入院时间和 AIS 分级 D 是首次跌倒事件的显著预测因素。
跌倒识别、特征描述和时钟小时可视化可支持针对 SCI 住院患者的特定缓解策略决策。跌倒预测因素是未来研究的第一步。
