title: Coexisting Systemic Infections in Patients Who Present With a Fall.
abstract: BACKGROUND
  Although the causes of falls are legion, infectious disease-related factors are not commonly reported in the published literature. We investigated the characteristics of patients presenting to the hospital because of a fall and who were subsequently found to have a coexisting systemic infection (CSI).
  
  
  METHODS
  This was a retrospective study performed at Massachusetts General Hospital, using the electronic database of adult patients receiving care during the period January 1, 2000 through December 31, 2014. Cases were initially screened by using billing codes for "fall," "sepsis," "bacteremia" and "systemic inflammatory response syndrome" (SIRS). Evaluable patients had documented CSI in the setting of a fall.
  
  
  RESULTS
  Of 161 evaluable patients, 84 (52.2%) were female. The mean age was 75. 2 years (range: 35-102 years, median = 78 years). Fall was considered "mechanical" (e.g., tripped by a rug) in 106 (65.8%) cases, with 126 (78.3%) patients living at home. SIRS criteria were met on initial healthcare encounters of 66 (40.1%) patients. Urinary and lower respiratory tract infections were the most common infectious disease conditions (71 [44.1%] and 37 [23.0%] cases, respectively). Bacteremia was seen in 64 (39.8%) cases. Staphylococcus aureus was the most common cause of bacteremia (21 cases, 31.3% of bloodstream isolates). CSI was not initially suspected by providing clinicians in 64 (39.8%) patients.
  
  
  CONCLUSIONS
  Falls associated with CSIs are often considered "mechanical" in nature, and they frequently fail to meet the SIRS criteria on initial presentation. Aside from its commonly recognized causes, falls may be an atypical manifestation of a systemic infection.
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Alex
authors.initials: A
authors.lastname: Blair
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: fmanian@mgh.Harvard.edu.
authors.forename: Farrin A
authors.initials: FA
authors.lastname: Manian
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology*; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology*
keywords: Bacteremia; Fall; Infections; Sepsis