In-Hospital Falls and Fractures: Underreported, Overlooked, and Lethal

Abstract

Introduction: In-hospital falls are a persistent issue and the most frequently reported adverse event among older patients. Fall rates typically range from 3 to 11 per 1,000 patient-days, with 25–40% causing injury and up to 10% resulting in serious harm. In Portugal, falls account for 21% of all hospital-reported incidents, according to the National Incident Identification System, highlighting the need for effective prevention.

Objectives: To evaluate the prevalence and severity of in-hospital falls at a tertiary hospital in 2023 and the number of associated fractures.

Methods: Retrospective observational study of all hospitalized patients who sustained a fall between January and December 2023. Falls were identified through nursing reports and the internal risk management system, then cross-referenced with orthopedic referrals to confirm fractures. For these cases, outcomes such as mortality, length of stay, and discharge destination were assessed. Data were extracted from electronic records and statistically analyzed.

Results: A total of 277 falls were reported by nurses (0.6 per 1,000 patient-days), but only 126 were recorded in the internal reporting system (RISI), with 5 classified as severe. Eight patients sustained fractures (3% of reported falls), with a median age of 73.5 years; 65% were male. Fractures included 4 proximal femur, 2 humerus, 1 malleolus, and 1 vertebra. Outcomes were severe: 50% in-hospital mortality, 88% mortality at 120 days, median stay of 55 days, and none regained independent living.

Conclusion: This study reveals not only a likely underreporting of in-hospital falls but also the serious clinical consequences associated with fall-related fractures