Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features: A multicenter study in southern Brazil

ObjectivesTo evaluate the incidence and risk factors of pressure ulcers (PU) in adult patients admitted to intensive care units (ICUs), as well as the outcome (including ICU and hospital mortality) of these patients.MethodsEpidemiological cohort multicenter prospective study, evaluating patients admitted for a period of 31 days (June 01 to July 01, 2015) until hospital discharge. Epidemiological and clinical data were collected daily until ICU discharge, as was the incidence of PU, either new or present on admission.Setting10 general adult ICUs.ResultsWe evaluated 332 patients, 52.1% male, mean age 63.1 years. The most common cause of admission was medical diseases (50.3%), and the mean APACHE II score was 14.9. A total of 45 patients (13.6%) had PU; the most common sites were sacral, calcaneal, ears, and trochanter. The incidence of PU was related to predictive factors, such as the Braden Scale and length of lack of nutrition. The presence of PU was strongly related to unfavorable outcomes, such as Mechanical Ventilation (MV) duration and ICU and hospital mortality.ConclusionsPU incidence is related to severity of the patient’s condition and predicted by Braden Scale score. The presence of PU is also related to adverse outcomes, such as MV duration and ICU and hospital mortality. It was also shown that patients with PU have a higher incidence of medical complications, such as acute renal failure, pneumonia, and the need for vasoactive drugs.     

The effects of peppermint gel on prevention of pressure injury in hospitalized patients with head trauma in neurosurgical ICU: A double-blind randomized controlled trial

ObjectiveThis study aimed to evaluate the effect of peppermint gel on the prevention of pressure injuries in patients with head trauma admitted to neurosurgical intensive care units.DesignThis double blind, randomized, controlled clinical trial study was conducted on 150 patients with head trauma admitted to the ICU. Using sealed envelopes, patients were assigned randomly into two intervention (n = 75) and control (n = 75) groups.SettingThe study was conducted in the ICUs of a university hospital and a general hospital in Shiraz, Iran.InterventionThe intervention group received peppermint gel three times a day up to 14 days during the skin care as a layer on the skin areas exposed to the risk of pressure injuries. The control group used a placebo gel.Primary outcomesThe expected outcome in this study was the incidence of pressure injuries stage I, which once daily was evaluated by pairs of observers with the National Pressure Ulcer Advisory Panel.ResultsThe incidence rate of pressure injuries was 22.8% and 77% in the intervention and the control groups, respectively. The chi-square test result showed a significant deference between two groups (P < 0.001). Sacrum was the most common site for incidence of the pressure injuries.ConclusionThe findings showed that the peppermint gel has a positive effect in the prevention of pressure injuries in the patients with head trauma admitted to ICUs. So, the use of this gel is suggested as an easy and low-cost method for prevention of pressure injuries in the patients admitted to ICUs.     

Úlceras por presión en el enfermo crítico: detección de factores de riesgo

IntroductionPatients admitted to intensive care units (ICU) are more vulnerable to the appearance of pressure ulcers. This is the reason why the highest rates of pressure ulcers (PU) incidence and prevalence are found in the ICU. This study has aimed to identify risk factors related to the appearance of PU in critically ill patients.Patients and methodThis was a prospective and observational study that included all patients admitted for more than 24 h from October 2009 to June 2010. Dependent variable: Appearance of PU. Independent variables: APACHE II score, risk assessment score (EMINA), body mass index (BMI), support surface, nutrition, norepineprhine, sedation and care support devices. Data analyses: Kaplan-Meyer survival and Cox regression analysis. Significance p < 0.05.ResultsA total of 236 patients were included. A significant association was found to BMI≥30 (RR: 2.51), EMINA >10 (RR: 2.96), hyperproteic nutrition (RR: 0.946), turning (RR: 0.88), sedation (RR: 0.95), polyurethane nasogastric feeding tube (RR: 0.94), dynamic support surface (RR:0.88). Significant association of p < 0.1 for Norepinephrine (RR: 2.34).ConclusionsBMI≥ 30, EMINA and norepinephrine are predictive factors of risk for PU development. Sedation days, dynamic support surfaces, hyperproteic nutrition, turning, and polyurethane nasogastric feeding tube were established as protective factors against PU.     

Characterization of electric scooter injuries over 27 months at an urban level 1 trauma center

BackgroundElectric scooters (e-scooters) have become a widespread method of transportation. The purpose of this study is to provide risk stratification tools for modifiable risk factors associated with e-scooter injury morbidity.MethodsPatients at an urban Level 1 Trauma center sustaining e-scooter injuries between November 2017 through March 2020 were identified. Primary outcomes of interest were major trauma, as defined by an Injury Severity Score (ISS) >15, or hospital admission.ResultsA total of 442 patients sustained orthopaedic (51%), facial (31%), cranial (13%), and chest/abdominal injuries (4.5%). Rate of helmet use was 2.5%, hospital admission was 40.7%, and intensive care was 3%. Patients with facial injuries were half as likely to sustain major trauma as compared to orthopaedic injuries (p < 0.05). Factors with higher likelihood of hospital admission included age > 40 years (OR 4.20, p < 0.01), alcohol or other substance intoxication (OR 4.14 and 9.87, p < 0.001), loss of consciousness (OR 2.72, p < 0.003), or transport to the hospital by ambulance (OR 4.47, p < 0.001).ConclusionsThere is a substantial proportion of major trauma within e-scooter injuries. Modifiable risk factors for hospital admission include use of head protection and substance use while riding e-scooters.     

Factors affecting the occurrence of pressure injuries among patients receiving targeted temperature management after cardiac arrest

BackgroundPressure injuries (PIs) are a well-known complication of critically ill patients admitted to the intensive care unit with targeted temperature management (TTM) after cardiac arrest (CA). However, little is known about the factors that impact the occurrence of PIs among these patients.ObjectivesThis study aimed to examine factors related to the occurrence of PIs among patients after CA treated with TTM.MethodsThis retrospective observational study collected data from 126 patients after CA aged 18 years or older from a single tertiary hospital admitted between January 2017 and December 2019. Demographic, clinical, and medical device–related characteristics were collected by patient chart review. Multivariable logistic regression analysis was performed to identify factors related to the occurrence of PIs.ResultsThe study showed that the incidence of PIs was 31.8%. Patients who were male (odds ratio [OR], 4.80; 95% confidence interval [CI], 1.21–19.08), developed diarrhoea (OR, 4.90, 95% CI, 1.31–18.41), or were subjected to physical restraint (OR, 6.03; 95% CI, 1.52–23.96) were at a higher risk of developing PIs. A lower risk of developing PIs was associated with the Glasgow Coma Scale score greater than 13 on the third day of admission (OR, 0.08; 95% CI, 0.01–0.52), higher haemoglobin level (OR, 0.65; 95% CI, 0.49–0.86), or low nutritional risk index (≤100) (OR, 0.10; 95% CI, 0.02–0.57).ConclusionsNurses should be aware that patients treated with TTM after CA are at a high risk of developing PIs from the moment of admission and should be closely monitored.     

Retrospective analysis of forensic cases in refugees admitted to emergency department

IntroductionThe aim of this study was to compare the distribution and frequency of forensic medical events in a refugee group with that of the general population, and thus, extrapolate the problems encountered in the immigrant population.MethodsThose cases admitted to the emergency department (ED) for any reason that required a forensic examination between January 2016 and June 2018 were investigated retrospectively.ResultsA total of 310 refugees were admitted to the ED for forensic medical events. The most common nations of origin of the refugees were Iraq (n = 167), Syria (n = 65), and Afghanistan (n = 28). The median age of the refugees was 24 years old (interquartile range = 17–33). With regard to forensics, the most common reasons for the refugees to present to the ED were motor vehicle accidents 27.4%, assaults 25.8%, employment and industrial accidents 16.1%, and suicide attempts 10.3%. Other than suicide attempts, all of the forensic presentations were more common in the males. The outcomes of the refugee group were as follows: 92.3% were discharged, 5.8% were admitted to the hospital, 1% were admitted to the intensive care unit (ICU), and 1% were transferred. Suicide attempts were the most common reasons for the ICU admissions, while the most common reasons for the hospital admissions were orthopedic injuries.ConclusionIn general, the forensic event frequency in the refugee group was lower (p = 0.001); however, this was a single center study, and there could have been unrecorded cases due to an inability to access healthcare assistance, so these results may not be reliable.     

Risk factors influencing the outcome of peptic ulcer bleeding in end stage renal diseases after initial endoscopic haemostasis

Background and Aims: Patients suffering from peptic ulcer (PU) bleeding who have end‐stage renal disease (ESRD) may encounter more adverse outcomes. The primary objective is to investigate the risk factors that influence the outcomes of ESRD and chronic kidney disease (CKD) patients with PU bleeding after successful initial endoscopic haemostasis. Methods: A total of 540 patients with PU bleeding after initial endoscopic haemostasis in a tertiary hospital were investigated retrospectively. They were sorted into three groups after randomised age‐matched adjustment: ESRD group (n = 90), CKD group (n = 90) and control group (n = 360). Main outcome measurements were rebleeding, requirement for blood transfusion and surgery, length of hospital stay and mortality. Results: The rebleeding rates were 43% for the ESRD group vs. 21% for the CKD group vs. 12% for the control group (overall p = < 0.001). Multivariate analysis showed the predictors of rebleeding were ESRD, time to endoscope, and non‐high‐dose proton‐pump inhibitors (PPI) users. The risk factors for bleeding‐related mortality were presence of moderate degree of CKD and ESRD group, time to endoscope, and Rockall score. All‐cause mortality was related to presence of moderate degree of CKD and ESRD group, platelet count, time to endoscope, Rockall score and length of hospital stay. Conclusions: ESRD patients who suffered from PU bleeding were at risk of excessive rebleeding and mortality with frequent occurrence of delayed rebleeding. This study suggests that early endoscopy for initial haemostasis and high‐dose intravenous PPI are associated with the reduction of rebleeding risk especially in patients with high Rockall scores.     

Scene Transport of Pediatric Patients Injured at Winter Resorts

Objective. To examine the characteristics of pediatric patients (age ≤16 years) injured at winter resort scenes andtransported by helicopter emergency medical services (HEMS) or ground EMS (GEMS) ambulance services to regional trauma centers. Methods. Between 1997 and2001, a total of 119 patients (GEMS = 69; HEMS = 50) were identified from trauma registries andHEMS transport records. Demographic data, initial vital signs, hospital interventions, anddischarge status of the two groups were examined. Results. The distributions of gender, initial vital signs, Injury Severity Score (ISS; either ≤ or > 15), intensive care unit (ICU) length of stay (LOS), total hospital LOS, andhome discharge status were similar between the two groups (p ≥ 0.05). Patients transported by HEMS were older (14 ± 2 vs. 10 ± 4, p < 0.001), less likely to be admitted to the hospital (73% vs. 98.5%; p < 0.001), andmore likely to have multiple injuries [13 (27%) vs. 8 (11.6%), p ≤ 0.032]. The GEMS patients had a higher rate of isolated extremity [33 (80.5%) vs. 8 (19.5%)] andthoracoabdominal [11 (73.3%) vs. 4 (26.7%)] injuries. The high orthopedic injury rate in the GEMS patients contributed to a higher rate of surgery in this group (45% vs. 24%, p ≤ 0.028). Regardless of transport mode, patients requiring immediate interventions (intubation, chest tube placement, or blood product administration) had either a depressed level of consciousness (GCS = 12) on emergency department arrival or thoracoabdominal injuries. No deaths were recorded. Conclusions. Patients transported by HEMS andGEMS had similar hospital characteristics but different injury patterns. A prospective study examining the initial triage of pediatric patients injured at winter resorts would help to determine which subset of patients are best served by HEMS transport.     

Inpatients Admitted with a Chief Complaint of Pain Have Lower In-Hospital Mortality: A Single-Center Study of 645,998 Inpatients

BackgroundThe relationship between pain and mortality risk has not been well established.AimsThis study aimed to assess the possible association between a chief complaint of pain and in-hospital mortality.DesignRetrospective cohort study using 11-year hospital administrative data.SettingSouthwest Hospital of Third Military Medical University (Chongqing, China).ParticipantsA total of 645,998 adult inpatients admitted without department limitation between January 1, 2003, and December 31, 2013.MethodsInformation on the chief complaint at admission was obtained, and the main outcome measure was in-hospital mortality.ResultsThe crude overall in-hospital mortality rate for patients admitted with chief complaint of pain was 958 (3.9%), which was significantly lower than that of patients without pain (1,970, 4.9%). The risk of hospital death for inpatients admitted with pain was 21% lower compared to inpatients admitted without pain (p < .001). Female patients with a chief complaint of pain had a lower risk of in-hospital mortality (p < .001) compared with male patients (p < .001). When stratified by location of pain, patients with chest pain had a significantly higher risk of in-hospital mortality compared with those without complaint of pain (p < .001), whereas for patients with a chief complaint of waist, abdominal, limb, or joint pain, the risk of hospital death was lower compared with cases without pain.ConclusionsThe present study suggested that inpatients admitted with a chief complaint of pain might have a significantly lower risk of in-hospital mortality compared with those admitted without a chief complaint of pain.     

Initial ED oxygen saturation ≤90% increases the risk of a complicated hospital course in pediatric asthmatics requiring admission

Emergency physicians are responsible for admitting children with asthma who do not respond to initial therapy. We examined the hypothesis that an initial room air pulse oximetry ≤90% elevates the risk of a complicated hospital course in children who require admission with acute asthma.MethodsCharts of all patients ages 2 years–17 years admitted for asthma from January 2017 to December 2017 were reviewed. An explicit chart review was performed by trained data extractors using a standardized form. Results: A total of 244 children meeting inclusion criteria were admitted for asthma from the ED during the study period. All patients had an initial room air pulse oximetry documented. Sixty-five were admitted to PICU status (27%), and 179 (73%) were admitted to floor status. The relative risk of a complicated course in those patients presenting with a saturation of ≤90% was 11.3 (95% CI 3.9–32.6). The mean initial pulse oximetry on patients with a complicated course was 85% versus 93% for those without a complicated course (p < 0.005).ConclusionOur data suggest that in pediatric asthmatics that require admission from the ED, those with pulse oximetry readings less than or equal to 90% on presentation are at higher risk of a complicated hospital course.     

Intensive care unit admission for patients with pulmonary hypertension presenting to U.S. Emergency Departments

IntroductionPulmonary hypertension (PH) is an important contributor to morbidity and mortality in patients seeking emergency care, resulting in high acuity presentations and resource utilization. The objective was to characterize the rate of intensive care unit (ICU) admission for PH among adult patients presenting to the emergency department (ED) along with other important clinical outcomes.MethodsWe analyzed data from the State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) from two geographically separated U.S. states (New York and Nebraska). The primary outcome measure was admission to an ICU. Other measures of interest included the hospital admission rate, hospital length of stay (LOS), inpatient mortality, and rate of critical care procedures performed.ResultsFrom 2010 to 2014, in a sample of 34 million ED visits, patients with a diagnosis of PH accounted for 0.71% of all ED visits. Of the PH visits, 20.2% were admitted to the ICU, compared to 2.6% of all other visits (P < 0.001), with an aOR of 1.74 (95% CI 1. 72–1.76). The vast majority (94.6%) of PH patients were admitted to the hospital, compared to 20.5% for all other ED visits (P < 0.001). Hospital LOS and hospital-based mortality were higher in the PH group than for other ED patients. With the exception of invasive mechanical ventilation, a significantly higher percentage of patients with PH admitted to the ICU than other patients underwent all critical care procedures evaluated.ConclusionsIn this study, patients with PH who sought emergency care in U.S. EDs from 2010 to 2014 were significantly more likely to require ICU admission than all other patients. They were also significantly more likely to be admitted to the hospital than all other patients, had longer hospital LOS, increased risk of inpatient mortality, and underwent more critical care procedures. These findings indicate the high acuity of PH patients seeking emergency care and demonstrate the need for additional research into this population.     

Moving average as a method of assessing risk of pressure injury using the COMHON index (Conscious level,Mobility, Hemodynamic,Oxygenation, Nutrition) for patients in intensive care units

BackgroundMoving average is the continuously updated arithmetic mean of the pressure injury (PI) risk score values measured with the COMHON Index (Conscious level, Mobility, Hemodynamics, Oxygenation, Nutrition).ObjectiveThe objective of this study was to validate the moving average as a method to measure the level of risk of PI.MethodThis is a cohort study of adult patients admitted for a duration of more than 24 h in an intensive care unit (ICU) of a tertiary-level university hospital, between June 1, 2018, and December 31, 2019. The risk of PI was obtained with the COMHON Index, and its 3-day moving average was used to monitor the risk of PI. To assess the predictive ability of the moving average score, a receiver operating characteristic curve analysis was performed, obtaining the area under the curve, and the Youden Index to determine the optimal cut-off point of the PI risk moving average score using the COMHON Index.ResultsA total of 1335 patients (94.6% of admissions) were included, and 82 developed PI (cumulative incidence of 6.1%) in the 18 months of the study. The highest incidence of PI was in the sacrum (49%) followed by the heel (17.6%). The median age was 65 (54–73) years, and the median length of stay was 3.8 (1.9–9) days. The moving average score had an area under the receiver operating characteristic curve of 87% (95% confidence interval: 85%–89%), with a cut-off point of the moving average score ≥11, and the negative predictive value was 99.6%.ConclusionsThe moving average score combined with a validated scale is a useful method to predict potential PI of patients admitted to the ICU. Its use is suggested for decision-making during the implementation of the care plan related to the prevention of PI in patients admitted to the ICU.     

Exploring medical device-related pressure injuries in a single intensive care setting: A longitudinal point prevalence study

ObjectivesTo report longitudinal prevalence rates of device-related pressure injuries in critically ill adult patients in the intensive care unit and to explore the patient characteristics associated with the development of device related pressure injuries.Research designA prospective observational design where observations of patients’ skin integrity were conducted on one day each week for 52 weeks.SettingThe study was conducted in the 36-bed intensive care unit of a major metropolitan tertiary referral hospital in Queensland, Australia. The sample included all patients aged 18 years or older admitted to the intensive care unit before midnight on the day preceding the observation, with a medical device in situ.Main outcome measuresThe primary outcome measure was device related pressure injuries identified at the weekly observations and defined as a pressure injury found on the skin or mucous membrane with a history of medical device in use at the location of the injury. Patient demographic and clinical characteristics were recorded.ResultsOver the study period, 11.3% (71/631) of patients developed at least one hospital-acquired DRPI.The most common devices associated with injury were nasogastric/nasojejunal tubes (41%) and endotracheal tubes (27%). Significant predictors of device related pressure injuries were the total number of devices (OR 1.230, 95% CI 1.09–1.38, p < 0.001), the length of time in the ICU (OR 1.05, 95% CI 1.02–1.09, p = 0.003), male sex, (OR 2.099, 95% CI 1.18–3.7, p = 0.012), and increased severity of illness score on admission (OR 1.044, 95% CI 1.01–1.09, p = 0.013).ConclusionDevice related pressure injuries are an all-too-common iatrogenic problem for this vulnerable patient cohort.     

Diabetes mellitus,glycaemic control,and severe COVID-19 in the Australian critical care setting: A nested cohort study

BackgroundInternationally, diabetes mellitus is recognised as a risk factor for severe COVID-19. The relationship between diabetes mellitus and severe COVID-19 has not been reported in the Australian population.ObjectiveThe objective of this study was to determine the prevalence of and outcomes for patients with diabetes admitted to Australian intensive care units (ICUs) with COVID-19.MethodsThis is a nested cohort study of four ICUs in Melbourne participating in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia project. All adult patients admitted to the ICU with COVID-19 from 20 February 2020 to 27 February 2021 were included. Blood glucose and glycated haemoglobin (HbA1c) data were retrospectively collected. Diabetes was diagnosed from medical history or an HbA1c ≥6.5% (48 mmol/mol). Hospital mortality was assessed using logistic regression.ResultsThere were 136 patients with median age 58 years [48–68] and median Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 14 [11–19]. Fifty-eight patients had diabetes (43%), 46 patients had stress-induced hyperglycaemia (34%), and 32 patients had normoglycaemia (23%). Patients with diabetes were older, were with higher APACHE II scores, had greater glycaemic variability than patients with normoglycaemia, and had longer hospital length of stay. Overall hospital mortality was 16% (22/136), including nine patients with diabetes, nine patients with stress-induced hyperglycaemia, and two patients with normoglycaemia.ConclusionDiabetes is prevalent in patients admitted to Australian ICUs with severe COVID-19, highlighting the need for prevention strategies in this vulnerable population.     

Delayed Diagnosis of Injury in Pediatric Trauma Patients at a Level I Trauma Center

BackgroundTrauma care per Advanced Trauma Life Support addresses immediate threats to life. Occasionally, delays in injury diagnosis occur. Delayed diagnosis of injury (DDI) is a common quality indicator in trauma care, and pediatric DDI data are sparse.ObjectiveOur aim was to describe the DDI rate in a severely injured pediatric trauma population and identify any factors associated with DDI in the pediatric population.MethodsA prospective cohort of trauma activations in 0- to 16-year-old patients admitted to a pediatric level I trauma center over 12 months with injuries prospectively recorded were followed during admission to identify DDI.ResultsA total of 170 trauma activations were enrolled. Twelve patients had type I DDI (7.1%), 15 patients had type II DDI (8.8%), and 5 patients had both type I and type II DDI (2.9%). DDI patients had twice as many injuries and higher Injury Severity Scores (ISS) as non-DDI patients. DDI patients were more likely to require intensive care unit (ICU) admission, longer hospital stay, and ventilator support. Controlling for age and ISS in multivariate analysis, the number of injuries found and requiring a ventilator were significantly associated with DDI.ConclusionsThis prospective study found a type I DDI rate of 7.1% and a type II DDI rate of 8.8% in the pediatric population. DDI patients had a greater number of injuries, higher ISS, higher rate of ICU admission, and were more likely to require mechanical ventilation. This study adds prospective data to the pediatric DDI literature, increases provider awareness of pediatric DDI, and lays the foundation for future study and quality improvement.     

Sepsis in end-stage renal disease patients: are they at an increased risk of mortality?

ObjectivesThis study aims to examine the outcome of end-stage renal disease (ESRD) patients admitted with sepsis to the intensive care unit (ICU).DesignSingle centre, retrospective cohort studySettingThe study was conducted in the Intensive Care Department of King Abdulaziz Medical City, Riyadh, Saudi Arabia.ParticipantsData were extracted from a prospectively collected ICU database from 2002 to 2017. Patients were considered to have sepsis based on the sepsis-3 definition and were stratified into 2 groups based on the presence or absence of ESRD.Primary and secondary outcomesThe primary outcome of the study was in-hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital lengths of stay, and mechanical ventilation duration.ResultsA total of 8803 patients were admitted to the ICU with sepsis during the study period. 730 (8.3%) patients had ESRD. 49.04% of ESRD patients with sepsis died within their hospital stay vs. 31.78% of non-ESRD patients. ESRD septic patients had 1.44 greater odds of dying within their hospital stay as compared to septic non-ESRD patients (OR 1.44, 95% CI 1.03–1.53). Finally, the predictors of hospital mortality in septic ESRD patients were found to be mechanical ventilation (OR 3.36; 95% CI 2.27–5.00), a history of chronic liver disease (OR 2.26; 95% CI 1.26–4.07), and use of vasopressors (OR 1.74; 95% CI 1.19–2.54). Among patients with ESRD, hospital mortality was higher in subgroups of patients with chronic cardiac (OR 1.86 (1.36–2.53) vs. 1.19 (0.96–1.47)) and chronic respiratory illnesses (OR 2.20 (1.52–3.20) vs. 1.21 (0.99–1.48)).ConclusionESRD patients admitted to the intensive care unit with sepsis are at greater odds of mortality compared to patients with non-ESRD. This risk is particularly increased if these patients have a concomitant history of chronic cardiac and respiratory illnesses.

Key Messages

• Sepsis and bacterial infections are very common in ESRD patients and following cardiovascular disease; sepsis is the second leading cause of death in patients with ESRD.
• This study aims to examine the outcome of patients with end-stage renal disease (ESRD) patients admitted with sepsis to the intensive care unit (ICU).
• The results of this study have shown that end-stage renal disease is associated with greater odds of ICU and hospital mortality among septic patients admitted to an intensive care unit.
• ESRD patients were also more likely to be started on vasopressors and mechanical ventilation.

     

Coexisting Systemic Infections in Patients Hospitalized Because of a Fall: Prevalence and Risk Factors

BackgroundInfectious disease–related factors that may contribute to or complicate falls have received relatively little attention in the literature.ObjectiveOur aim was to determine the prevalence of, and risk factors for, coexisting systemic infections (CSIs) in patients admitted to the hospital because of a fall or its complications.MethodsWe conducted a retrospective cohort study of adult patients seen at a tertiary care hospital emergency department and subsequently hospitalized because of a fall or its complications.ResultsOf 1,456 evaluable cases, 775 patients (53.2%) were female. Mean age was 71.6 years (range 18–104 years). CSI was diagnosed in 303 patients (20.8%), of which 166 (54.8%) were urinary tract infections and 108 (35.6%) were pneumonia cases; 14 patients (4.6%) were bacteremic. CSI was not initially suspected by providers in 98 (32.5%) subsequently diagnosed cases. Age ≥50 years (odds ratio [OR] 5.6; 95% confidence interval [CI] 1.2–24.9), inability to get up on own after the index fall (OR 2.1; 95% CI 1.2–3.6), preexisting symptom(s) (OR 3.0; 95% CI 1.8–5.2), and systemic inflammatory response syndrome (SIRS) (OR 2.9; 95% CI 1.5–5.4), or confusion at presentation (OR 3.0; 95% CI 1.5–6.0) were independently associated with CSI. In-hospital mortality rate was significantly higher among patients with CSI (6.9% vs. 3.8 %, OR 1.9; 95% CI 1.1–3.3).ConclusionsCSIs are common among patients admitted to the hospital after a fall or its complications. Age ≥ 50 years, inability to get up on own, preexisting symptom(s), and the presence of SIRS or confusion at presentation are potential predictors of CSI in this patient population.