Older patients presenting with a fall and long lie; is there an opportunity to reduce unnecessary hospital admissions?
Abstract
Introduction
Older people who suffer a fall and long lie present a significant challenge to the pre-hospital and front door services. The guidance and definition are controversial with little evidence on the incidence and complications of long lie. There is limited data on reliable lie times which are usually unrecorded and hard to collate. To address this, we did a study on assessment and management of falls, long lie and rhabdomyolysis in a single tertiary centre.
Methods
A retrospective case note review of patients aged over 80 who attended the emergency department acutely with a fall and long lie without trauma from 1st December 2021 to 31st July 2022. We reviewed evidence of documented long lie, creatinine kinase (CK) results and acute kidney injury warnings (AKI).
Results
The study analysed data of 370 eligible patients. 84% (311) had documented evidence of long lie. 65% (242) had a documented CK. 39% (146) of which was within a normal range CK. 35% (128) had no documented CK during their admission. 16% (60) of patients had no documented lie time. 4% (15) had triggered an AKI presence. 25% (93) were discharged the same day. There was no strong correlation in length of lie and CK results. The hospital admissions were associated with prolonged stays (an average of 8 days).
Conclusion
There was significant variation in practice for documenting the time of lie and assessing the risk of rhabdomyolysis. Despite this, most patients with a documented long lie had evidence of a CK rise but most without complication, although, admissions for a variety of other reasons were identified. Notwithstanding the limitations of this study, development of pre-hospital pathways for rapid risk assessment for those with long lie may provide an opportunity to reduce admissions for this vulnerable group living with frailty.
Comments
Interesting topic and…
Interesting topic and findings!
Long lie
This is an important and clinically relevant study, particularly given the increasing number of older adults presenting after falls and prolonged periods on the floor. I wondered whether the authors could clarify their definition of "long lie", as definitions vary considerably across the literature and may influence both inclusion criteria and interpretation of the findings. Given the lack of correlation between lie time and CK elevation, I also wonder whether factors beyond rhabdomyolysis may be more useful in determining admission risk and management decisions. For example, frailty, comorbidity burden, cognitive impairment, dehydration, pressure injuries, baseline and post-fall functional status, and availability of support at home may be stronger determinants of outcomes and need for hospital admission. Were any of these factors collected or considered in the analysis?