Injuries and Outcomes of Ground-level Falls Among Older Patients: A Retrospective Cohort Study.

Abstract

Study objective: We sought to determine the overall rates of traumatic injuries and whether the rates of traumatic injuries and various clinical outcomes differed among older patients presenting to a tertiary-care emergency department (ED) after a ground-level fall (GLF) and who underwent whole-body computed tomography.

Methods: We conducted a retrospective cohort study of patients ≥65 years of age who presented to the ED with a GLF and received a whole-body CT from January 1-December 31, 2021. Age was stratified into age groups: 65-74; 75-84; and 85+. We presented a descriptive analysis of traumatic injuries, intensive care unit (ICU) admissions, and all-cause mortality rates. We used multivariable logistic regression to determine the association between increasing age, traumatic injuries, and clinical outcomes.

Results: Of 638 patients in the cohort, 120 (18.9%) sustained thoracic injuries and 80 (12.5%) sustained intracranial hemorrhages. Only five (0.8%) patients sustained an intra-abdominal injury, while 134 (21.0%) were admitted to the ICU, and 31 (4.8%) died during their index hospitalization. Head injuries (odds ratio [OR] 6.21, 95% CI 3.65-10.6, P < 0.001) and thoracic injuries (OR 5.25, 95% CI 3.30-8.36, P < 0.001) were associated with increased odds of ICU admission, whereas head injuries (OR 3.21, 95% CI 1.41-7.31, P < 0.01) and cervical injuries (OR 3.37, 95% CI 1.08-10.5, P < 0.05) were associated with increased odds of in-hospital, all-cause mortality. There were no statistically significant differences in the rates of injuries sustained between the respective age groups. There was no association between increasing age and ICU admissions or in-hospital, all-cause mortality rates.

Conclusion: Among patients aged ≥65 years of age who presented to the ED after a ground-level fall and underwent whole-body CT, thoracic injuries and intracranial hemorrhages were associated with increased odds of ICU admissions. We found no significant differences in injury rates or outcomes across age groups, indicating that age alone should not guide ICU admission decisions. These findings suggest that the use of whole-body CT in this population should be selective and guided by clinical judgment rather than applied universally.