Citation

Ezaz G, Murphy SL, Mellinger J, Tapper EB. Am. J. Med. 2018; 131(6): 645-650.e2.

Affiliation

Veterans Affairs Hospital, Ann Arbor; Division of Gastroenterology and Hepatology, University of Michigan; Institute for Healthcare Policy and Innovation, Ann Arbor. Electronic address: etapper@umich.edu.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.amjmed.2018.01.026

PMID

29453941

Abstract

BACKGROUND: Injuries are more morbid and complicated to manage in patients with cirrhosis. However, data are limited regarding the relative risk of injury and severity of injury from falls in patients with cirrhosis compared to those without cirrhosis.

METHODS: We examined the nationally representative National Emergency Department Sample, an all-payer database including all patients presenting with falls 2009-2012. We determined the relative risks for and clinical associations with severe injuries. Outcomes included hospitalization, length of stay, costs, and in-hospital death. Outcomes were compared to patients with congestive heart failure.

RESULTS: We identified 102,977 visits involving patients with cirrhosis and 26,996,120 involving patients without cirrhosis who presented with a fall. Overall and compared to patients with congestive heart failure, the adjusted risk of severe injury was higher for patients with cirrhosis. These included intracranial hemorrhage (2.33 CI 2.02-2.68), skull fracture (1.75 CI 1.53-2.00) and pelvic fracture (1.71 CI 1.56-1.88) but lower for less severe injuries such as concussion (0.95, CI 0.86-1.06) and lower-leg fracture (0.86, CI 0.80-0.91). Risk factors significantly positively associated with severe injury on multivariate analysis were hepatic encephalopathy, alcohol abuse, and infection. Cirrhosis was associated with increased risk of in-hospital death, longer length of stay and higher costs after a fall. All outcomes were worse compared to patients with congestive heart failure CONCLUSION: Falls are common in patients with cirrhosis and they are more likely to incur severe injuries, with increased hospital costs and risk of death. Poor outcomes are most associated with ascites, hepatic encephalopathy, alcohol abuse, and infection, highlighting the subgroups at highest risk and most likely to benefit from preventative interventions.

Copyright © 2018. Published by Elsevier Inc.

Language: en

Keywords

Emergency Medicine; Hepatic Encephalopathy; Intracranial Hemorrhage; Liver Disease