Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting

• Published in: Journal of rehabilitation research and development 2010-01, Vol.47 (6), p.553-562
• Main Authors: Schmid, Arlene A, Wells, Carolyn K, Concato, John, Dallas, Mary I, Lo, Albert C, Nadeau, Steven E, Williams, Linda S, Peixoto, Aldo J, Gorman, Mark, Boice, John L, Struve, Frederick, McClain, Vincent, Bravata, Dawn M
• Format: Article
• Language: English
• Subjects: Accidental Falls - statistics & numerical data; Activities of Daily Living; Acute Disease; Aged; Aged, 80 and over; Clinical outcomes; Complications and side effects; Confidence Intervals; Falls; Falls (Accidents); Family medical history; Female; Health aspects; Health services; Hospitalization; Hospitals; Hospitals, Veterans; Humans; Inpatients - statistics & numerical data; Logistic Models; Male; Middle Aged; Nursing care; Odds Ratio; Older people; Patient outcomes; Patients; Prevalence; Retrospective Studies; Risk Factors; Severity of Illness Index; Stroke; Stroke (Disease); Stroke - epidemiology; Stroke - physiopathology; Stroke Rehabilitation; Treatment Outcome; Virginia - epidemiology
• ISSN: 0748-7711; 1938-1352
• DOI: 10.1682/JRRD.2009.08.0133

Falls are a serious medical complication following stroke. The objectives of this study were to (1) confirm the prevalence of falls among patients with stroke during acute hospitalization, (2) identify factors associated with falls during the acute stay, and (3) examine whether in-hospital falls were associated with loss of function after stroke (new dependence at discharge). We completed a secondary analysis of data from a retrospective cohort study of patients with ischemic stroke who were hospitalized at one of four hospitals. We used logistic regression to identify factors associated with inpatient falls and examine the association between falls and loss of function. Among 1,269 patients with stroke, 65 (5%) fell during the acute hospitalization period. We found two characteristics independently associated with falls: greater stroke severity (National Institutes of Health Stroke Scale [NIHSS] ≥8, adjusted odds ratio [OR] = 3.63, 95% confidence interval [CI]: 1.46-9.00) and history of anxiety (adjusted OR = 4.90, 95% CI: 1.70-13.90). Falls were independently associated with a loss of function (adjusted OR = 9.85, 95% CI: 1.22-79.75) even after adjusting for age, stroke severity, gait abnormalities, and past stroke. Stroke severity (NIHSS >8) may be clinically useful during the acute inpatient setting in identifying those at greatest risk of falling. Given the association between falls and poor patient outcomes, rehabilitation interventions should be implemented to prevent falls poststroke.