Coexisting Systemic Infections in Patients Who Present with a Fall

Abstract Background Although the causes of falls are legion, infectious disease-related factors are not commonly reported in the published literature. We investigated the characteristics of patients presenting to the hospital because of a fall and who were subsequently found to have a coexisting systemic infection (CSI). Methods This was a retrospective study performed at Massachusetts General Hospital, using the electronic data base of adult patients receiving care during the period January 1, 2000, through December 31, 2014. Cases were initially screened by using billing codes for “fall”, ”sepsis”, “bacteremia”, and “systemic inflammatory response syndrome” (SIRS). Evaluable patients had documented CSI in the setting of a fall. Results Of 161 evaluable patients, 84 (52.2%) were female. The mean age was 75. 2 years (range 35–102 years, median 78 years). Fall was considered “mechanical” (e.g. tripped by a rug) in 106 (65.8%) cases, with 126 (78.3%) patients living at home. SIRS criteria were met on initial healthcare encounters of 66 (40.1%) patients. Urinary and lower respiratory tract infections were the most common infectious disease conditions (71[44.1%], and 37[23.0%] cases, respectively). Bacteremia was present in 64 (39.8%) cases. Staphylococcus aureus was the most common cause of bacteremia ( 21 cases, 31.3% of bloodstream isolates). CSI was not initially suspected by providing clinicians in 64 (39.8%) patients. Conclusion Falls associated with CSIs are often considered “mechanical” in nature, and frequently fail to meet the SIRS criteria on initial presentation. Aside from its commonly-recognized causes, falls may be an atypical manifestation of a systemic infection.