Fall Risk Factors among Hospitalized Acute Post-Ischemic Stroke Patients in an Urban Public Healthcare System
Background: Falls remain an important benchmarking indicator for hospitals. The incidence of falls is a nursing-sensitive indicator, amenable to preventable measures. Research indicates factors associated with falls, but few studies specifically identify factors among hospitalized patients with acute ischemic stroke (AIS).
Purpose: Identify prevalence and risk factors for falls among acute, hospitalized AIS patients within an urban safety net hospital.
Methods: Retrospective cohort study. Data abstracted from stroke and fall registries, and medical records from 2013-2015 among all adult patients admitted for AIS. Variables included traditional risk factors for falls, as well as stroke-specific factors (NIHSS score, functional status, stroke location and vessel, administration of tPA).
Results: N=683 AIS stroke patients, with 1.6% fall rate. Falls among AIS patients accounted for 6% of all hospital falls. AIS patients who experienced an inpatient fall had a mean age of 67 (range 46-86), were mostly male (82%), and ambulating independently prior to arrival (91%). Mean NIHSS scores upon admission were higher among those who experienced a fall, when compared to AIS patients who did not fall (mean=8.73, 7.01, respectively). Most patients who experienced a fall demonstrated weakness and/or paresis upon initial exam (90%), with 64% experiencing small vessel ischemic changes, and 36% MCA strokes. Administration of tPA was not associated with increased falls. LOS was significantly increased among AIS patients who experienced a fall (7.7 vs. 4.8, respectively, p<0.01).
Conclusions: Fall rates among hospitalized AIS patients may be lower than earlier reports, reflecting increased vigilance among providers and widespread integration of fall prevention strategies. Elevated NIHSS scores and weakness/paresis upon initial exam may be important predictors of falls among newly diagnosed AIS patients who had previously been able to ambulate independently. Consistent with fall literature among other populations, the occurrence of a fall in the inpatient setting can substantially increase length of stay.