OBJECTIVES: 

To determine the incidence of falls, risk factors, and adverse outcomes, among patients admitted to the ICU.

DESIGN: 

Retrospective cohort study.

SETTING: 

Seventeen ICUs in Alberta, Canada.

PATIENTS: 

Seventy-three thousand four hundred ninety-five consecutive adult patient admissions between January 1, 2014, and December 31, 2019.

MEASUREMENTS AND MAIN RESULTS: 

A mixed-effects negative binomial regression model was used to examine risk factors associated with falls. Linear and logistic regression models were used to evaluate adverse outcomes. Six hundred forty patients experienced 710 falls over 398,223 patient days (incidence rate of 1.78 falls per 1,000 patient days [95% CI, 1.65–1.91]). The daily incidence of falls increased during the ICU stay (e.g., day 1 vs day 7; 0.51 vs 2.43 falls per 1,000 patient days) and varied significantly between ICUs (range, 0.37–4.64 falls per 1,000 patient days). Male sex (incidence rate ratio [IRR], 1.37; 95% CI, 1.15–1.63), previous invasive mechanical ventilation (IRR, 1.82; 95% CI, 1.40–2.38), previous sedative and analgesic medication infusions (IRR, 1.60; 95% CI, 1.15–2.24), delirium (IRR, 3.85; 95% CI, 3.23–4.58), and patient mobilization (IRR, 1.26; 95% CI, 1.21–1.30) were risk factors for falling. Falls were associated with longer ICU (ratio of means [RM], 3.10; 95% CI, 2.86–3.36) and hospital (RM, 2.21; 95% CI, 2.01–2.42) stays, but lower odds of death in the ICU (odds ratio [OR], 0.09; 95% CI, 0.05–0.17) and hospital (OR, 0.21; 95% CI, 0.14–0.30).

CONCLUSIONS: 

We observed that among ICU patients, falls occur frequently, vary substantially between ICUs, and are associated with modifiable risk factors, longer ICU and hospital stays, and lower risk of death. Our study suggests that fall prevention strategies should be considered for critically ill patients admitted to ICU.

中文翻译：

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关于入住 ICU 患者跌倒的多中心队列研究*

目标： 

确定入住 ICU 的患者跌倒的发生率、危险因素和不良结果。

设计： 

回顾性队列研究。

环境： 

加拿大艾伯塔省有 17 个 ICU。

患者： 

2014年1月1日至2019年12月31日期间，连续入院73,495名成年患者。

测量和主要结果： 

使用混合效应负二项式回归模型来检查与跌倒相关的风险因素。使用线性和逻辑回归模型来评估不良结果。640 名患者在 398,223 个患者日内经历了 710 次跌倒（发生率为每 1,000 个患者日 1.78 次跌倒 [95% CI，1.65–1.91]）。在 ICU 住院期间，每日跌倒发生率有所增加（例如，第 1 天与第 7 天；每 1,000 个患者日 0.51 次跌倒与 2.43 次跌倒），并且在 ICU 之间差异显着（范围为每 1,000 个患者日 0.37–4.64 次跌倒）。男性（发病率比[IRR]，1.37；95% CI，1.15–1.63），既往有创机械通气（IRR，1.82；95% CI，1.40–2.38），既往镇静和镇痛药物输注（IRR，1.60；95% CI，1.40–2.38）。 95% CI，1.15–2.24）、谵妄（IRR，3.85；95% CI，3.23–4.58）和患者活动（IRR，1.26；95% CI，1.21–1.30）是跌倒的危险因素。跌倒与 ICU 停留时间较长（均值比 [RM]，3.10；95% CI，2.86–3.36）和住院时间（RM，2.21；95% CI，2.01–2.42）有关，但 ICU 的死亡几率较低（比值比 [OR]，0.09；95% CI，0.05–0.17）和医院（OR，0.21；95% CI，0.14–0.30）。

结论： 

我们观察到，在 ICU 患者中，跌倒发生频率很高，不同 ICU 之间差异很大，并且与可改变的危险因素、更长的 ICU 和住院时间以及较低的死亡风险相关。我们的研究表明，对于入住 ICU 的重症患者应考虑预防跌倒的策略。