Citation

Sri-On J, Tirrell GP, Kamsom A, Marill KA, Shankar KN, Liu SW. Acad. Emerg. Med. 2018; ePub(ePub): ePub.

Affiliation

The Department of Emergency Medicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA.

Copyright

(Copyright © 2018, Society for Academic Emergency Medicine, Publisher John Wiley and Sons)

DOI

10.1111/acem.13413

PMID

29575248

Abstract

OBJECTIVES: The objectives were to examine whether responses to the Stopping Elderly Accidents, Death, and Injuries (STEADI) questions responses predicted adverse events after an older adult emergency department (ED) fall visits and to identify factors associated with such recurrent fall.

METHODS: We conducted a prospective study at 2 urban, teaching hospitals. We included patients aged ≥ 65 who presented to the ED for an accidental fall. Data were gathered for fall relevant co-morbidities, high-risk medications for falls and the responses to 12 questions from the STEADI guideline recommendation. Our outcomes were the number of 6-month adverse events which were defined as mortality, ED revisit, subsequent hospitalization, recurrent falls and a composite outcome.

RESULTS: There were 548 (86.3%) patients who completed follow-up and 243 (44.3%) patients experienced an adverse event after a fall within 6 months. In multivariate analysis, 7-questions from the STEADI guideline predicted various outcomes. The question "Had previous fall" predicted recurrent falls (Odds ratio [OR= 2.45, 95% confidence interval [CI] =1.52 to 3.97), the question "Feels unsteady when walking sometimes" (OR= 2.34, 95% CI = 1.44 to 3.81) and "Lost some feeling in their feet" predicted recurrent falls. In addition to recurrent falls risk, supplemental questions "Use or have been advised to use a cane or walker", "Take medication that sometimes makes them feel light-headed or more tired than usual", "Take medication to help sleep or improve mood" and "Have to rush to a toilet" predicted other outcomes.

CONCLUSION: A STEADI score of ≥ 4 did not predict adverse outcomes though seven individual questions from the STEADI guidelines were associated with increased adverse outcomes within 6 months. These may be organized into three categories (previous falls, physical activity and high-risk medications) and may assist emergency physicians to evaluate and refer high-risk fall patients for a comprehensive falls evaluation. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en