First Fall-Related Injuries Requiring Hospitalization Increase the Risk of Recurrent Injurious Falls: A Nationwide Cohort Study in Taiwan

Carlos Lam; Jiunn-Horng Kang; Hsiao-Yu Lin; Hung-Chang Huang; Chia-Chieh Wu; Ping-Ling Chen

doi:10.1371/journal.pone.0149887

First Fall-Related Injuries Requiring Hospitalization Increase the Risk of Recurrent Injurious Falls: A Nationwide Cohort Study in Taiwan

PLoS One. 2016 Feb 22;11(2):e0149887. doi: 10.1371/journal.pone.0149887. eCollection 2016.

Authors

Carlos Lam^{1

2

3}, Jiunn-Horng Kang^{4

5}, Hsiao-Yu Lin⁶, Hung-Chang Huang⁷, Chia-Chieh Wu¹, Ping-Ling Chen²

Affiliations

¹ Emergency Department, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
² Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
³ Department of Emergency Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
⁵ Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁶ Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan.
⁷ Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.

Abstract

Objectives: Recurrent falls not only have risk factors different from those of single falls but also have less favorable outcomes. The aim of our study was to determine the association between the injury characteristics of a first fall and the likelihood of recurrent injurious falls in a cohort of hospitalized patients.

Methods: We designed a nationwide retrospective cohort study and selected hospitalized patients who had injurious falls between 2001 and 2010. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of recurrent injurious falls requiring hospitalization in the following year on the basis of the patients' demographic characteristics, comorbidities, and the characteristics of injuries from the first injurious fall requiring hospitalization.

Results: Among the 504 512 patients hospitalized for injurious falls, 19 442 experienced recurrent injurious falls requiring hospitalization. The 1-year incidence of recurrent injurious falls requiring hospitalization was 3.85%. The incidence density was the highest within the 3-month period after the first injurious fall. The risk of recurrent injurious falls among patients aged 40 to 64, 65 to 74, and ≥ 75 years increased progressively (HR: 2.11, 95% confidence interval [CI]: 1.90-2.34; HR: 2.80, 95% CI: 2.51-3.11; and HR: 3.80, 95% CI: 3.42-4.23, respectively). The length of hospitalization (LOH) ≥ 15 or ≥ 31 days (HR: 1.39, 95% CI: 1.30-1.48; and HR: 1.59, 95% CI: 1.43-1.77, respectively) and injury to the head (HR: 1.59, 95% CI: 1.53-1.65) or spine (HR: 1.66, 95% CI: 1.59-1.74) were also found to be major risk factors.

Conclusions: Our findings show that the LOH and head and spine injuries are associated with an increased risk of recurrent injurious falls leading to hospitalization. The risk of recurrent injurious falls requiring hospitalization increased significantly among adults older than 40 years. We suggest further research on the effects of injury characteristics associated with the first injurious fall requiring hospitalization and resultant anatomical damages on the risk of recurrent injurious falls requiring hospitalization. High-risk patients should receive tailored rehabilitation addressing their respective injuries within 3 months after hospital discharge.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Accidental Falls / statistics & numerical data*
Aged
Cohort Studies
Comorbidity
Demography
Female
Hospitalization / statistics & numerical data*
Humans
Male
Middle Aged
Recurrence
Risk Factors
Taiwan / epidemiology

Grants and funding

This research was supported by grants from the Health Promotion Administration, Ministry of Health and Welfare, Executive Yuan, Taiwan (grant number E1020766). PLC received the funding (the funder’s website: http://www.hpa.gov.tw/Bhpnet/Web/Index/Index.aspx); and grants from the Wan Fang Hospital, Taipei Medical University (grant number 103-wf-eva-26). CL received the funding (the funder’s website: http://www.wanfang.gov.tw/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.