Abstract：
OBJECTIVE: To (a) compare characteristics of patients who fall with those of patients who did not fall; and (b) characterise falls (time, injury severity and location) through three fall reporting methods (incident system reports, medical notes and clinician reports).
METHODS: A substudy design within a stepped-wedge clinical trial was used: 3239 trial participants were recruited from two inpatient Geriatric Evaluation and Management Units and one general medicine ward in two Australian states. To compare the characteristics of patients who had fallen with those who had not, descriptive tests were used. To characterise falls through three reporting methods, bivariate logistic regressions were used.
RESULTS: Patients who had fallen were more likely than patients who had not fallen to be cognitively impaired (51% vs. 29%, p < 0.01), admitted with falls (38% vs. 28%, p = 0.01) and have poor health outcomes such as prolonged length of stay (24 [16-34] vs. 12 [8-19] days [IQR], p < 0.01) and less likely to be discharged directly to the community (62% vs. 47%, p < 0.01). Most falls were captured from medical notes (93%), with clinician (71%) and incident reports (68%) missing 21%-25% of falls. The proportion of injurious falls identified through incident reports was higher than medical records or clinician reports (40% vs. 34% vs. 37%).
CONCLUSIONS: This study reaffirms the need to improve reporting falls in incident systems and at clinical handover to the team leader. Research should continue to use more than one method of identifying falls, but include data from medical records. Many falls cause injury, resulting in poor health outcomes.
METHODS: A substudy design within a stepped-wedge clinical trial was used: 3239 trial participants were recruited from two inpatient Geriatric Evaluation and Management Units and one general medicine ward in two Australian states. To compare the characteristics of patients who had fallen with those who had not, descriptive tests were used. To characterise falls through three reporting methods, bivariate logistic regressions were used.
RESULTS: Patients who had fallen were more likely than patients who had not fallen to be cognitively impaired (51% vs. 29%, p < 0.01), admitted with falls (38% vs. 28%, p = 0.01) and have poor health outcomes such as prolonged length of stay (24 [16-34] vs. 12 [8-19] days [IQR], p < 0.01) and less likely to be discharged directly to the community (62% vs. 47%, p < 0.01). Most falls were captured from medical notes (93%), with clinician (71%) and incident reports (68%) missing 21%-25% of falls. The proportion of injurious falls identified through incident reports was higher than medical records or clinician reports (40% vs. 34% vs. 37%).
CONCLUSIONS: This study reaffirms the need to improve reporting falls in incident systems and at clinical handover to the team leader. Research should continue to use more than one method of identifying falls, but include data from medical records. Many falls cause injury, resulting in poor health outcomes.
摘要：
目的：（a）比较跌倒患者的特征与未跌倒患者的特征；（b）表征跌倒（时间，伤害严重程度和位置)通过三种跌倒报告方法(事故系统报告，医疗笔记和临床医生报告)。
方法：使用了楔形临床试验中的一个子研究设计：3239名试验参与者从澳大利亚两个州的两个老年评估和管理部门和一个普通医学病房招募。为了比较跌倒患者和没有跌倒患者的特征，使用描述性测试。通过三种报告方法来描述跌倒，使用双变量逻辑回归。
结果：跌倒的患者比没有跌倒的患者更容易出现认知障碍（51%vs.29%,p<0.01),因跌倒而入院(38%vs.28%,p=0.01），健康结果较差，如住院时间延长（24[16-34]vs.12[8-19]天[IQR]，p<0.01)，并且不太可能直接出院到社区(62%vs.47%,p<0.01)。大多数跌倒是从医疗记录中捕获的（93％），临床医生（71％）和事件报告（68％）遗漏了21％-25％的跌倒。通过事件报告确定的伤害性跌倒比例高于医疗记录或临床医生报告(40%vs.34%vs.37%）。
结论：本研究重申需要改进事故系统和临床移交给组长的报告。研究应继续使用一种以上的方法来识别跌倒，但包括医疗记录中的数据。许多跌倒会造成伤害，导致不良的健康结果。
方法：使用了楔形临床试验中的一个子研究设计：3239名试验参与者从澳大利亚两个州的两个老年评估和管理部门和一个普通医学病房招募。为了比较跌倒患者和没有跌倒患者的特征，使用描述性测试。通过三种报告方法来描述跌倒，使用双变量逻辑回归。
结果：跌倒的患者比没有跌倒的患者更容易出现认知障碍（51%vs.29%,p<0.01),因跌倒而入院(38%vs.28%,p=0.01），健康结果较差，如住院时间延长（24[16-34]vs.12[8-19]天[IQR]，p<0.01)，并且不太可能直接出院到社区(62%vs.47%,p<0.01)。大多数跌倒是从医疗记录中捕获的（93％），临床医生（71％）和事件报告（68％）遗漏了21％-25％的跌倒。通过事件报告确定的伤害性跌倒比例高于医疗记录或临床医生报告(40%vs.34%vs.37%）。
结论：本研究重申需要改进事故系统和临床移交给组长的报告。研究应继续使用一种以上的方法来识别跌倒，但包括医疗记录中的数据。许多跌倒会造成伤害，导致不良的健康结果。
