Inpatient falls in burn units

Inpatient falls are one of the most frequently reported adverse events. Existing literature describes both prediction and prevention strategies for falls but not specifically for burn patients. Severe burns are associated with a high mortality rate and significant mobility impairment. Pain, itching and dressings may influence the rate of falls among burn patients. We conducted a retrospective multicenter study enrolling a total of 494 patients. The burn patients who fell had a longer length of stay (LOS) (p < 0.05, odds ratio (OR) = 1.01). Patients who fell also more frequently had burns located on the head and neck (p = 0.001, OR = 6.33) or on the trunk (p = 0.01, OR = 4.71). Falls did not influence overall survival rates. Visual impairment due to facial burns and dressings may be associated with a higher incidence of falls. More studies of burn patients should be performed to evaluate additional risk factors and develop preventive and educational programs.

Inpatient fall; Burn; Adverse event

[1] Melin CM. Reducing falls in the inpatient hospital setting. International Journal of Evidence-Based Healthcare. 2018; 16: 25–31.

[2] Lamb SE, Jørstad-Stein EC, Hauer K, Becker C. Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. Journal of the American Geriatrics Society. 2005; 53: 1618–1622.

[3] Nakanishi T, Ikeda T, Nakamura T, Yamanouchi Y, Chikamoto A, Usuku K. Development of an algorithm for assessing fall risk in a Japanese inpatient population. Scientific Reports. 2021; 11: 17993.

[4] Tago M, Katsuki NE, Oda Y, Nakatani E, Sugioka T, Yamashita SI. New predictive models for falls among inpatients using public ADL scale in Japan: a retrospective observational study of 7,858 patients in acute care setting. PLOS ONE. 2020; 15: e0236130.

[5] Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall? JAMA. 2007; 297: 77–86.

[6] Castellini G, Demarchi A, Lanzoni M, Castaldi S. Fall prevention: is the STRATIFY tool the right instrument in Italian Hospital inpatient? A retrospective observational study. BMC Health Services Research. 2017; 17: 656.

[7] Abarca L, Guilabert P, Martin N, Usúa G, Barret JP, Colomina MJ. Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain. Scientific Reports. 2023; 13: 14364.

[8] Pieptu V, Moscalu R, Mihai A, Moscalu M, Pieptu D, Azoicăi D. Epidemiology of hospitalized burns in Romania: a 10-year study on 92,333 patients. Burns. 2022; 48: 420–431.

[9] Yakupu A, Zhang J, Dong W, Song F, Dong J, Lu S. The epidemiological characteristic and trends of burns globally. BMC Public Health. 2022; 22: 1596.

[10] Schaefer TJ, Tannan SC. Thermal burns. StatPearls Publishing: Treasure Island (FL). 2024.

[11] Zuo KJ, Medina A, Tredget EE. Important developments in burn care. Plastic and Reconstructive Surgery. 2017; 139: 120e–138e.

[12] Song J, Clark A, Wade CE, Wolf SE. Skeletal muscle wasting after a severe burn is a consequence of cachexia and sarcopenia. Journal of Parenteral and Enteral Nutrition. 2021; 45: 1627–1633.

[13] Herndon DN, Barrow RE, Rutan RL, Rutan TC, Desai MH, Abston S. A comparison of conservative versus early excision. Annals of Surgery. 1989; 209: 547–552.

[14] Desai MH, Herndon DN, Broemeling L, Barrow RE, Nichols RJ Jr, Rutan RL. Early burn wound excision significantly reduces blood loss. Annals of Surgery. 1990; 211: 753–762.

[15] De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, et al. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns. 2023; 49: 1816–1822.

[16] Gauglitz GG, Herndon DN, Jeschke MG. Insulin resistance postburn: underlying mechanisms and current therapeutic strategies. Journal of Burn Care & Research. 2008; 29: 683–694.

[17] Morris ME, Webster K, Jones C, Hill A, Haines T, McPhail S, et al. Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing. 2022; 51: afac077.

[18] Hill A, Jacques A, Chandler AM, Richey PA, Mion LC, Shorr RI. In-hospital sequelae of injurious falls in 24 medical/surgical units in four hospitals in the United States. The Joint Commission Journal on Quality and Patient Safety. 2019; 45: 91–97.

[19] Mikos M, Banas T, Czerw A, Banas B, Strzępek Ł, Curyło M. Hospital inpatient falls across clinical departments. International Journal of Environmental Research and Public Health. 2021; 18: 8167.

[20] Kaplan AT, Yalcin SO, Günaydın NT, Kaymak NZ, Gün RD. Ocular-periocular burns in a tertiary hospital: epidemiologic characteristics. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2023; 76: 208–215.

[21] Richardson A, Carter R. Falls in critical care: a local review to identify incidence and risk. Nursing in Critical Care. 2017; 22: 270–275.

[22] Stevenson B, Mills EM, Welin L, Beal KG. Falls risk factors in an acute-care setting: a retrospective study. Canadian Journal of Nursing Research. 1998; 30: 97–111.

[23] Deng H, Genovese TJ, Schneider JC. A narrative review of outcomes in burn rehabilitation based on the international classification of functioning, disability, and health. Physical Medicine and Rehabilitation Clinics of North America. 2023; 34: 867–881.

[24] Turner E, Robinson DM, Roaten K. Psychological issues. Physical Medicine and Rehabilitation Clinics of North America. 2023; 34: 849–866.

[25] Bryarly J, Kowalske K. Long-term outcomes in burn patients. Surgical Clinics of North America. 2023; 103: 505–513.

[26] Iglesias N, Campbell MS, Dabaghi E, Prasai A, Ben-Aissa A, Ozhathil D, et al. Post-traumatic stress disorder in burn patients—a large database analysis. Burns. 2024; 50: 561–568.

[27] Oliver D, Healey F, Haines TP. Preventing falls and fall-related injuries in hospitals. Clinics in Geriatric Medicine. 2010; 26: 645–692.