Older patients presenting with a fall and long lie; is there an opportunity to reduce unnecessary hospital admissions?

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.