title: Falling down and falling out: management and outcome analysis.
abstract: BACKGROUND
  This study compares young (< 65 years old) and elderly (> or = 65 years old) patients who fall secondary to syncope and seeks to determine whether syncope workups are being appropriately performed and whether they contribute new information that results in a change in management.
  
  
  METHODS
  A retrospective review of patients who fell and were admitted to a Level I trauma center was performed. Data included mechanism of injury, comorbidities, and severity scores in addition to details regarding a syncope workup in patients who had unclear reasons for falling. Outcome variables were mortality, intensive care unit and hospital lengths of stay, and whether each test resulted in a change in management.
  
  
  RESULTS
  The data set included 387 patients. Elderly patients who fell (n = 157) had significantly higher Injury Severity Scores and mortality, lower Glasgow Coma Scale scores, and longer intensive care unit and hospital lengths of stay than the younger cohort (n = 230). When a fall occurred secondary to syncope, however, there was no difference in injury severity or outcome. Patients who fell secondary to syncope (n = 61) had zero to six of the recommended tests ordered. Nineteen tests in the young group and 79 tests in the elderly patients had abnormal results. Overall, 37.8% of patients had specific interventions performed because of the abnormal test results
  
  
  CONCLUSIONS
  Syncope workups were erratically performed in both young and older groups. These workups frequently resulted in abnormal findings that required intervention. Protocols are currently being developed at our institution to ensure complete assessment of trauma patients who fall for unknown reasons.
authors.affiliation: Department of Surgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
authors.forename: Laurel
authors.initials: L
authors.lastname: Omert
authors.forename: Sam
authors.initials: S
authors.lastname: Zakhary
authors.forename: Richard
authors.initials: R
authors.lastname: Wilson
authors.forename: Chris
authors.initials: C
authors.lastname: Diminno
authors.forename: Aurelio
authors.initials: A
authors.lastname: Rodriguez
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013575:Syncope / Q000150:complications* / Q000175:diagnosis; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000209:etiology* / Q000401:mortality / Q000628:therapy