Stay Alert for Infection in ED Patients Who Have Fallen

SAN DIEGO — People who end up in the emergency department because of a fall often are tripped up by an infection, according to data being presented at IDWeek 2015.

Bloodstream, urinary and respiratory infections are the most common culprits for infection-related falls, according to the Massachusetts General Hospital study. 

The findings also suggest that while falls may be more common in the elderly, they shouldn’t be overlooked in younger people: 20% of patients in the study were younger than 65. 

“The majority of patients were not coming from institutions,” Farrin A. Manian, MD, MPH, principle investigator of the study, a clinician educator in the Division of General Medicine at Massachusetts General Hospital in Boston and a visiting associate professor at Harvard Medical School said during the presentation. “The majority were independent.  This distinguishes our study because these patients were living at home. My hope is that patients and caretakers will be more intentive in looking for symptoms of infection.”

Although it’s unclear how many falls are caused by infection overall – other research puts the number between 20 and 45% – it’s clear that many people, including family members, caregivers and even some healthcare providers, don’t recognize the connection. 

People can fall because the infection may cause low blood pressure – and therefore lightheadedness and dizziness – or because it adds to confusion in older patients with dementia, according to the researchers. 

Researchers analyzed 161 patients who went to the emergency department because they fell and were subsequently diagnosed with a coexisting infection. Of those, 71 had a urinary tract infection, 64 had a bloodstream infection, 37 had a respiratory infection and 9 had an infection of the heart valve. 

A coexisting infection was not initially suspected in 41% of the patients, likely because the majority had only one or none of the common signs of infection such as fever, rapid respiration rate, rapid heart rate, or abnormal white blood cell count. 

Specifically, only one in five had a fever and one in four did not have any criteria for significant inflammatory response. The findings suggest that family members, care givers and healthcare providers shouldn’t rush to judgement about the cause of a fall, particularly in an older person, and should consider whether the person was ill or not feeling well before the incident happened to ensure the patient is diagnosed appropriately and can receive timely treatment.

Reference

1. Manian FA. 13: Coexisting systemic infections (CSIS) in patients presenting with a fall: Tripped by objects or pathogens? Presented at: IDWeek 2015. Oct. 7-11, 2015. San Diego.