In order to compare the OBI diagnostic protocol to the usual care diagnostic work-up, we retrospectively analysed all the patients with the same characteristics of the study population that consecutively presented to the same ER during a four months period of the year before (March to June 2014). All the patients where treated in accordance with the local standard of care for these kind of problems, as described above. The causes of fall were then extrapolated from the ER medical reports and divided into
the 4 mechanisms (causes) listed below.
This diagnostic work-up was considered the “usual care”.
In both groups, in agreement with the study objectives, patients with head trauma secondary to causes different from fall (ie. street accidents, aggressions, etc.) have been excluded.
Causes of fall have been divided into 4 categories listed below:
1. Syncopal (certain and very likely)
2. Accidental (due to environmental/external causes)
3. Other determinate causes of fall (specified)
Each fall in either group, at the end of the diagnostic work-up, has been attributed to one of the above mentioned four mechanisms.
The control group comprised 134 patients, 65 years old or more (mean age 77 +/- 4; males 44%), consecutively presented at the same ER from March to June 2014 for head trauma secondary to fall and treated in accordance with the local head trauma protocol (standard of care). The distribution of the causes of falls extrapolated from ED medical reports was as follow: 76 accidental, 19 syncopal, 17 others, 22 indeterminate. Syncopal episodes accounted for only 14% of total, whereas accidental falls,
accounting for the 57% of causes, were the most frequent (Fig. 3).
No further investigation aimed to find syncope aetiology was reported in this retrospective group.
|Causes of fall (diagnosis)||Study Group n=24 (%)||Control Group n=134 (%)|
|Accidental||6 (25)||76 (57)|
|Syncopal||10 (42)||19 (14)|
|Other||5 (21)||17 (13)|
|Indeterminate||3 (12)||22 (16)|
|OBI diagnostic protocol
- Thompson HJ et al. Traumatic Brain Injury in Older Adults: Epidemiology, Outcomes, and Future Implications. J Am Geriatr Soc . 2006 October ; 54(10): 1590–1595.
- Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med 2003;348:42–49.
- Langlois, JA et al. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. National Center for Injury Prevention and Control; Atlanta, GA: 2004.
- US Bureau of the Census. US Administration on Aging. Older Population by Age, 1900–2050 [August 11,2005]. www.aoa.gov/prof/Statistics/online_stat_data/AgePop2050.asp
- Magaziner J et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol Med Sci 1990;45:M101– 7.
- Sattin RW et al. The incidence of fall-injury events among the elderly in a defined population. Am J Epidemiol 1990;131: 1028– 37.
- McKevitt EC et al. Geriatric trauma: Resource use and patient outcomes. Can J Surg 2003;46:211–215.
- Traumatic Brain Injury in the United States. A Report to Congress. Centers for Disease Control and Prevention; Atlanta, GA: 2001.
- Hukkelhoven CW et al. Patient age and outcome following severe traumatic brain injury: An analysis of 5,600 patients. J Neurosurg 2003;99:666–673.
- Kenny RA et al. “Transient loss of consciousness, syncope and falls in the elderly”. Blackwell Publishing Company, Inc. Armonk, New York, 2001.
- High Diagnostic Yield and Accuracy of History, Physical Examination, and ECG in Patients with Transient Loss of Consciousness in FAST: The Fainting Assessment Study Van Dijk N et al. J Cardiovasc Electrophysiol, 2008; 19:48-5
- Guidelines for the diagnosis and management of syncope. European Heart Journal (2009) 30, 2631–2671
- F. E. Shaw, R. A. Kenny. The overlap between syncope and falls in the elderly. Postgrad Med J 1997;73:635-639.
- Masud T, Morris RO. Epidemiology of falls. Age and Ageing 2001; 30-S4: 3–7.
- Nevitt MC et al. Risk factors for injurious falls: a prospective study. J Gerontol 1991;46:M164–70.