title: Prevalence and cost of imaging in inpatient falls: the rising cost of falling.
abstract: OBJECTIVE
  To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging.
  
  
  METHODS
  Single-center retrospective cohort study of inpatient falls. Data were collected from the hospital's adverse event reporting system, DrQuality. Age, sex, date, time, and location of fall, clinical service, Morse Fall Scale/fall protocol, admitting diagnosis, and fall-related imaging studies were reviewed. Cost included professional and facilities fees for each study.
  
  
  METHODS
  Four hundred and fifteen bed urban academic hospital over 3 years (2008-2010).
  
  
  METHODS
  All adult inpatient falls during the study period were included. Falls experienced by patients aged <18 years, outpatient and emergency patients, visitors to the hospital, and staff were excluded.
  
  
  RESULTS
  Five hundred and thirty inpatient falls occurred during the study period, average patient age 60.7 years (range 20-98). More than half of falls were men (55%) and patients considered at risk of falls (56%). Falls were evenly distributed across morning (33%), evening (34%), and night (33%) shifts. Of 530 falls, 178 (34%) patients were imaged with 262 studies. Twenty percent of patients imaged had at least one positive imaging study attributed to the fall and 82% of studies were negative. Total cost of imaging was $160,897, 63% ($100,700) from head computed tomography (CT).
  
  
  CONCLUSIONS
  Inpatient falls affect patients of both sexes, all ages, occur at any time of day and lead to expensive imaging, mainly from head CTs. Further study should be targeted toward clarifying the indications for head CT after inpatient falls and validating risk models for positive and negative imaging, in order to decrease unnecessary imaging and thereby limit unnecessary cost and radiation exposure.
authors.affiliation: Department of Medicine, Tufts Medical Center, Boston, MA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Fields
authors.affiliation: Department of Radiology, Tufts Medical Center, Boston, MA, USA.
authors.forename: Tahani
authors.initials: T
authors.lastname: Alturkistani
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Neal
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Arjun
authors.initials: A
authors.lastname: Kanuri
authors.affiliation: Department of Medicine, Tufts Medical Center, Boston, MA, USA.
authors.forename: Deeb N
authors.initials: DN
authors.lastname: Salem
authors.affiliation: Department of Radiology, Tufts Medical Center, Boston, MA, USA.
authors.forename: Samson
authors.initials: S
authors.lastname: Munn
authors.affiliation: Department of Medicine, Tufts Medical Center, Boston, MA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Blazey-Martin
keywords: diagnostic imaging; falls; health care costs; incident reporting; inpatients