Estimating the incidence of hospitalized injurious falls: impact of varying case definitions.
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ABSTRACT: Aim
To assess the validity of widely used approaches to estimate the incidence of hospitalized falls.Methods
Internal probabilistic data linkage of the 2000-01 New South Wales Inpatient Statistics Collection was used to identify first admissions for injurious falls.Results
Using data linkage techniques, a total of 20,883 (93.9%, 95% CI 93.5 to 94.2) cases were identified as first admission for injurious falls corresponding to an incidence rate of 1161.4 per 100,000. The exclusion of non-acute admissions approach provided the best estimate of incidence (1185.4 per 100,000 people). When comparing the performance of different approaches to identifying first admissions to that of the data linkage "gold standard", the method based on the transfer variable performed best in terms of sensitivity and specificity.Conclusions
All the examined approaches have relatively low specificity raising questions about their use. The introduction of a unique patient identifier and the date of injury in hospital discharge datasets would facilitate the identification of incident cases of fall related hospitalizations.
SUBMITTER: Boufous S
PROVIDER: S-EPMC1730302 | biostudies-literature | 2005 Dec
REPOSITORIES: biostudies-literature
Publications
Estimating the incidence of hospitalized injurious falls: impact of varying case definitions.
Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention 20051201 6
<h4>Aim</h4>To assess the validity of widely used approaches to estimate the incidence of hospitalized falls.<h4>Methods</h4>Internal probabilistic data linkage of the 2000-01 New South Wales Inpatient Statistics Collection was used to identify first admissions for injurious falls.<h4>Results</h4>Using data linkage techniques, a total of 20,883 (93.9%, 95% CI 93.5 to 94.2) cases were identified as first admission for injurious falls corresponding to an incidence rate of 1161.4 per 100,000. The e ...[more]
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Project description:Background and objectivesAt least four definitions of AKI have recently been proposed. This study sought to characterize the epidemiology of AKI according to the most recent consensus definition proposed by the Kidney Disease Improving Global Outcomes (KDIGO) Work Group, and to compare it with three other definitions.Design, setting, participants, & measurementsThis was a retrospective cohort study of 31,970 hospitalizations at an academic medical center in 2010. AKI was defined and staged according to KDIGO criteria, the Acute Dialysis Quality Initiative's RIFLE criteria, the Acute Kidney Injury Network (AKIN) criteria, and a definition based on a model of creatinine kinetics (CK). Outcomes of interest were incidence, in-hospital mortality, length of stay, costs, readmission rates, and posthospitalization disposition.ResultsAKI incidence was highest according to the KDIGO definition (18.3%) followed by the AKIN (16.6%), RIFLE (16.1%), and CK (7.0%) definitions. AKI incidence appeared markedly higher in those with low baseline serum creatinine according to the KDIGO, AKIN, and RIFLE definitions, in which AKI may be defined by a 50% increase over baseline. AKI according to all definitions was associated with a significantly higher risk of death and higher resource utilization. The adjusted odds ratios for in-hospital mortality in those with AKI were highest with the CK definition (5.2; 95% confidence interval [95% CI], 4.1 to 6.6), followed by the RIFLE (2.9; 95% CI, 2.2 to 3.6), KDIGO (2.8; 95% CI, 2.2 to 3.6), and AKIN (2.6; 95% CI, 2.0 to 3.3) definitions. Concordance in diagnosis and staging was high among the KDIGO, AKIN, and RIFLE definitions.ConclusionsThe incidence of AKI in hospitalized individuals varies depending on the definition used. AKI according to all definitions is associated with higher in-hospital mortality and resource utilization. AKI may be inappropriately diagnosed in those with low baseline serum creatinine using definitions that incorporate percentage increases over baseline.
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Project description:BackgroundThis study aimed to determine whether the number of anti-hypertensive medication classes or any change in anti-hypertensive medication were associated with injurious fall among the community-dwelling older population of low socioeconomic status.MethodsUsing data from electronic medical records, we performed a nested case-control study among older Singapore residents (≥60) of low socioeconomic status (N = 210). Controls (n = 162) were matched to each case (n = 48) by age and gender. Variables with p < 0.10 in univariate analysis were included in multivariate analysis. We used conditional logistic regression to assess the associations of the number of anti-hypertensive medication classes and change in anti-hypertensive medication with injurious falls. We also performed stepwise regressions as sensitivity analyses. p < 0.05 was considered statistically significant.ResultsThe mean (±SD) age of participants was 78.1 (± 8.33) years; 127 (60.4%) were female, 189 (90.0%) were Chinese. Those on ≥2 anti-hypertensive medication classes had an increased risk of experiencing an injurious fall compared to those not on any anti-hypertensive medication (OR = 5.45; CI:1.49-19.93; p = 0.01). Among those who were taking anti-hypertensive medication, those who had a change in the medication 180-day prior to injurious fall had a significantly increased risk of experiencing an injurious fall compared to those that did not report any change in anti-hypertensive medication (OR = 3.88; CI:1.23-12.19; p = 0.02). Sensitivity analyses generated consistent findings.ConclusionBoth ≥2 anti-hypertensive medication classes and change in anti-hypertensive medication were associated with an increased risk of experiencing an injurious fall among the older population of low socioeconomic status. Our findings could guide prescribers to exercise caution in the initiation of anti-hypertensive medications or in making medication changes, especially among the older population of low socioeconomic status.
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Project description:Background and purposeFalls are a major health problem in the elderly community; however, questions regarding incidence, risk factors, and provider response to falls exist. The purpose of this study was to examine the incidence of falls, associated factors, health care costs, and provider response to falls among Medicare beneficiaries.ParticipantsThe participants were 12,669 respondents to the Medicare Current Beneficiaries Survey (MCBS).MethodsCategories of number of falls (none, one, recurrent) and injury type (medically injurious versus not medically injurious) were created from the falls supplement to the MCBS. Means and proportions for the entire Medicare population were estimated using sampling weights. The association between sociodemographic variables and fall status was modeled using ordinal or binary logistic regression. Aggregate health costs by fall category were estimated from claims data.ResultsPopulation estimates of falls reported in 2002 ranged from 3.7 million (single fall) to 3.1 million (recurrent falls), with an estimated 2.2 million people having a medically injurious fall. Recurrent falls were more likely with increased age, being female, being nonwhite, reporting fair or poor health, and increased number of limitations in personal activities of daily living and instrumental activities of daily living and comorbidities. Although estimates of the actual costs of falls could not be determined, "fallers" consistently had larger utilization costs than "nonfallers" for the year 2002. Fewer than half (48%) of the beneficiaries reported talking to a health care provider following a fall, and 60% of those beneficiaries reported receiving fall prevention information.Discussion and conclusionFalls are common and may be associated with significant health care costs. Most importantly, health care providers may be missing many opportunities to provide fall prevention information to older people.
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