Beyond Just Another Fall: Coexisting Systemic Infections in Patients Hospitalized Because of a Fall

Abstract

Purpose: To determine the prevalence of and risk factors for coexisting systemic infections (CSIs) in patients admitted following a fall. Methods: This was a retrospective cohort study of adults who presented to the Massachusetts General Hospital (MGH) emergency department and were admitted because of a fall or its complications between January 1, 2015-September 30, 2015. Diagnosis of CSI was based on clinical, laboratory and/or radiographic assessment and treatment with systemic antimicrobials within 48 hours of admission. Results: Of 1250 evaluable cases in 1178 unique patients during the study period, 633 (53.7%) were female. Mean age was 71.5 years (range 18-104 years). CSI was diagnosed in 258 (20.6%) cases, of which 146 (56.6%) were urinary tract infections, 89 (34.5%) pneumonias, 9 (3.5%) bacterial skin and soft tissue infections, and 11 (4.3%) bloodstream infections. Among CSIs, 88 (34.1%) cases were not suspected by providers on initial encounter. The presence of the following was significantly associated with CSIs in multivariate logistic regression analysis: age ≥50 years (O.R. 3.6, 95% C.I. 1.0-12.4), inability to get up on own (O.R. 3.4, 95% C.I. 1.4-4.1), preexisting symptoms (2.5, 95% C.I. 1.5-4.4), systemic inflammatory response syndrome (SIRS) (2.6, 95% C.I. 1.5-4.4), and confusion at presentation (3.2, 95% C.I. 1.8-5.5). Presence of fracture or intracranial hemorrhage was negatively associated with CSIs (O.R. 0.5, 95% C.I. 0.3-0.9, and O.R. 0.4, 95% C.I. 0.2-0.9, respectively). In-hospital mortality was significantly higher in the CSI group (7.4% vs 4.1 %, P=0.03). Pneumonia and bloodstream infections were independently associated with in-hospital mortality among patients ≥50 years of age (O.R. 4.4, 95% C.I. 1.7-11.6 and O.R. 7.7, 95% C.I. 1.2-50.2, respectively). Conclusions: CSIs are not uncommon among patients admitted to the hospital following a fall or its complications, with pneumonia and bloodstream infections independently associated with increased in-hospital mortality. Age ≥50 years, inability to get up on own, pre-existing symptoms, presence of SIRS, and confusion at presentation may be helpful in the timely identification and treatment of CSIs in this patient population.