Critical Care Medicine : April 18, 2025.
Objective:
To explore the incidence of falls and associated risk
factors in the first year after hospital discharge in survivors of critical
illness.
Design:
Prospective single-site observational study.
Setting:
University-affiliated mixed ICU.
Patients:
One hundred ICU adults who required invasive ventilation for
48 hours and in an ICU for at least 4 days.
Interventions:
Not applicable.
Measurements and Main Results:
Falls were monitored prospectively for 1 year with
completion of monthly falls calendars. Falls data included the number of people
who had falls/no falls/recurrent falls, falls rate per person per year, and
time to first fall. Fall severity was classified according to the Schwenck
classification scheme to examine injurious falls requiring medical
intervention. Other outcomes considered included assessments of balance,
strength, function, cognition, psychologic health, and health-related quality
of life. One hundred participants (31% female) were recruited with a mean age
of 58.3 ± 16.2 years, and a median ventilation duration of 6.3 days [4.0–9.1].
Sixty-one percent fell at least once in the first year with the majority
sustaining two or more falls (81.4%) and one in four sustained an injurious
fall requiring medical attention. The falls incidence rate was 4.4 falls per
person-year (95% CI, 3.2–5.9), with the highest incidence occurring less than 3
months after hospital discharge (5.9 falls/person-year [95% CI, 4.4–7.8]). Time
to first fall or injurious fall was 36 [11–66] and 95 (95% CI, 40–155) days,
respectively. Key risk factors for falls at the time of hospital discharge
include comorbidities, higher discharge medications, balance, and muscle
strength.
Conclusions:
There was a high falls incidence in ICU survivors. The study
findings suggest a critical window may exist within the first 3 months after
hospital discharge and the need for screening, pharmacological optimization,
and exercise training in this patient group.
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