Jiraporn Sri-on1, Gregory Philip Tirrell2, Lewis A Lipsitz3, Shan Woo Liu4. 1. Emergency Department, Massachusetts General Hospital, Boston, MA 02114, USA; Emergency Department, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, 10300. Electronic address: Jiraporn.rew@gmail.com. 2. Emergency Department, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: gregt89@yahoo.com. 3. Hebrew Senior Life, Institute for Aging Research, Boston, MA, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA. Electronic address: lipsitz@hls.harvard.edu. 4. Emergency Department, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: SLIU1@mgh.harvard.edu.
Abstract
OBJECTIVES: The term mechanical falls is commonly used in the emergency department (ED), yet its definition and clinical implications are not established. It may be used to attribute falls to extrinsic factors in the environment exonerating clinicians from conducting a thorough assessment of the fall's underlying intrinsic causes. We conducted this study to determine how clinicians assess "mechanical" and "nonmechanical" falls; we explored conditions, fall evaluation, and outcomes associated with these diagnoses. METHODS: This study was a secondary analysis of a retrospective study at 1 urban ED. Data were obtained from medical records of patients aged 65 years and older who presented to the ED for a fall. We compared the associated conditions/causes, the ED fall evaluation, mortality, ED revisits, subsequent hospitalizations, and recurrent falls between the 2 terms. RESULTS: We had a sample size of 350 patients: 218 (62.3%) with "mechanical falls" and 132 (37.7%) with nonmechanical falls. There was little difference among associated conditions between the 2 fall labels other than mechanical falls had more associated environmental causes but fewer syncope causes. However, more than a quarter of nonmechanical falls had associated environmental factors as well. Similarly, there was little difference in the fall evaluation, ED revisit rates, recurrent falls, subsequent hospitalizations, and death between the 2 groups. CONCLUSIONS: The term mechanical fall is unclear, inconsistently used, and not associated with a discrete fall evaluation and does not predict outcomes. We propose eliminating the term because it inaccurately implies that a benign etiology for an older person's fall exists.
OBJECTIVES: The term mechanical falls is commonly used in the emergency department (ED), yet its definition and clinical implications are not established. It may be used to attribute falls to extrinsic factors in the environment exonerating clinicians from conducting a thorough assessment of the fall's underlying intrinsic causes. We conducted this study to determine how clinicians assess "mechanical" and "nonmechanical" falls; we explored conditions, fall evaluation, and outcomes associated with these diagnoses. METHODS: This study was a secondary analysis of a retrospective study at 1 urban ED. Data were obtained from medical records of patients aged 65 years and older who presented to the ED for a fall. We compared the associated conditions/causes, the ED fall evaluation, mortality, ED revisits, subsequent hospitalizations, and recurrent falls between the 2 terms. RESULTS: We had a sample size of 350 patients: 218 (62.3%) with "mechanical falls" and 132 (37.7%) with nonmechanical falls. There was little difference among associated conditions between the 2 fall labels other than mechanical falls had more associated environmental causes but fewer syncope causes. However, more than a quarter of nonmechanical falls had associated environmental factors as well. Similarly, there was little difference in the fall evaluation, ED revisit rates, recurrent falls, subsequent hospitalizations, and death between the 2 groups. CONCLUSIONS: The term mechanical fall is unclear, inconsistently used, and not associated with a discrete fall evaluation and does not predict outcomes. We propose eliminating the term because it inaccurately implies that a benign etiology for an older person's fall exists.
Authors: Christopher R Carpenter; Mark D Scheatzle; Joyce A D'Antonio; Paul T Ricci; Jeffrey H Coben Journal: Acad Emerg Med Date: 2009-03 Impact factor: 3.451
Authors: Marna Rayl Greenberg; Michael C Nguyen; Brian Stello; Arnold R Goldberg; Robert D Barraco; Bernadette G Porter; Anita Kurt; Stephen W Dusza; Bryan G Kane Journal: J Emerg Med Date: 2014-10-02 Impact factor: 1.484
Authors: Gregory Tirrell; Jiraporn Sri-on; Lewis A Lipsitz; Carlos A Camargo; Christopher Kabrhel; Shan W Liu Journal: Acad Emerg Med Date: 2015-03-13 Impact factor: 3.451
Authors: Elizabeth M Goldberg; Sarah J Marks; Linda J Resnik; Sokunvichet Long; Hannah Mellott; Roland C Merchant Journal: Ann Emerg Med Date: 2020-08-25 Impact factor: 5.721
Authors: Laura C Blomaard; Simon P Mooijaart; Leonie J van Meer; Julia Leander; Jacinta A Lucke; Jelle de Gelder; Sander Anten; Jacobijn Gussekloo; Bas de Groot Journal: Scand J Trauma Resusc Emerg Med Date: 2021-03-04 Impact factor: 2.953
Authors: Punith Kempegowda; Joht Singh Chandan; Richard Hutton; Lauren Brown; Wendy Madden; June Webb; Alison Doyle; Jonathan Treml Journal: BMJ Open Qual Date: 2018-07-23