Falling Down and Falling Out: Management and Outcome Analysis

Background: This study compares young (< 65 years old) and elderly (≥ 65 years old) patients who fall secondary to syncope and seeks to determine whether syncope workups are being appropriately performed and whether they contribute new information that results in a change in management. Methods: A retrospective review of patients who fell and were admitted to a Level I trauma center was performed. Data included mechanism of injury, comorbidities, and severity scores in addition to details regarding a syncope workup in patients who had unclear reasons for falling. Outcome variables were mortality, intensive care unit and hospital lengths of stay, and whether each test resulted in a change in management. Results: The data set included 387 patients. Elderly patients who fell (n = 157) had significantly higher Injury Severity Scores and mortality, lower Glasgow Coma Scale scores, and longer intensive care unit and hospital lengths of stay than the younger cohort (n = 230). When a fall occurred secondary to syncope, however, there was no difference in injury severity or outcome. Patients who fell secondary to syncope (n = 61) had zero to six of the recommended tests ordered. Nineteen tests in the young group and 79 tests in the elderly patients had abnormal results. Overall, 37.8% of patients had specific interventions performed because of the abnormal test results Conclusion: Syncope workups were erratically performed in both young and older groups. These workups frequently resulted in abnormal findings that required intervention. Protocols are currently being developed at our institution to ensure complete assessment of trauma patients who fall for unknown reasons.