Risk Factors for Falls with Injury for Patients Admitted for Hematopoietic Stem Cell Transplant

Introduction: Falls are a common cause of morbidity and mortality among hospitalized patients in the United States. Patients with cancer are vulnerable to falls with injury as a result of complex medical regimens, impaired performance status, and chemotherapy toxicities such as neuropathy. Predictors of falls in the general oncology population include abnormal gait, presence of metastasis, antidepressant and antipsychotic medication use, and blood product use. Risk factors for falls in the hematopoietic stem cell transplant (HSCT) population are not as well understood.

Methods: We performed a retrospective review of patients admitted to Dana-Farber/Brigham and Women’s Cancer Center from 01/2011 to 12/2012, who had a fall during their admission to a HSCT service. Patients were classified as either fall or fall with injury (FWI).  Our primary objective was to describe characteristics of hospitalized HSCT patients who experience a FWI, including medications administered in the 24 hours prior to the fall.

Results: There were 91 falls identified in 81 patients. One patient was excluded from the analysis due to incomplete electronic medical records. Nine patients had more than one fall. Thirty-two falls resulted in FWI. Fifty-seven falls (62.6%) occurred during an index admission for HSCT. This represents 5.48% of our index admissions. Patients had a history of HSCT or were undergoing myeloablative HSCT (n=25), reduced intensity conditioning HSCT (n=19) or autologous HSCT (n=36). Patient and transplant characteristics were compared between patients who had falls without injury and patients who had FWI. There was no significant difference in age (p=0.99), gender (p=0.65), cancer diagnosis (p=0.84), hospital admission team (p=0.99), admission type (p=0.14) or transplant type (p=0.80) between patients with falls and FWI. In multivariate analysis, benzodiazepine use (p=0.016) and Morse Fall score ≥ 45 (p=0.031) were associated with increased risk of FWI, whereas diuretic use (p=0.029), presence of heart disease (p=0.023) and prior fall (p=0.015) were associated with decreased risk of FWI.

Conclusions: Falls are common in patients hospitalized for HSCT. Benzodiazepine use and high Morse Fall score predict for an increased risk of injury after a fall event. Adequate assessment and management of these modifiable fall risk factors, including decreasing our benzodiazepine use and early identification of at risk patients may help prevent FWI in our HSCT population.