Emergency Medical Service Attendances for Adults with Repeat Falls in Western Australia: A State-Wide Retrospective Cohort Study

Figures & data

Figure 1. The total number of subsequent EMS-attended falls for the 77,087 adults who sustained an index EMS-attended fall between 1 January 2016 and 31 December 2020.

Table 1. Characteristics of all 77,087 EMS-attended patients who fell.

	Sustained one fall (only fall) (n = 54,554)		Patients who sustained repeat falls (first fall of multiple) (n = 22,533)
	Index fall		Index fall		Total number of falls sustained (data from final fall)
					2		3		4		5+
			n = 22,533		n = 11,815		n = 4,848		n = 2,310		n = 3,560
Age at first call, mean (SD) years
	68 (21)		80 (14)		79 (14)		81 (13)		81 (12)		79 (13)
Age at first call, median (IQR) years
	73 (55-84)		83 (74-89)		83 (73-89)		84 (76-89)		83 (75-89)		82 (74-88)
Age at first call (years) (n %)
< =65	19,254	35	2,658	12	1,413	12	417	9	194	8	299	8
65-75	9,536	17	3,254	14	1,531	13	552	11	266	12	474	13
75-85	12,773	23	7,328	33	3,477	29	1,378	28	623	27	1,041	29
85+	12,392	23	9,261	41	5,379	46	2,495	51	1,227	53	1,745	49
Sex (n %)
Female	30,280	56	13,248	59	6,961	59	2,883	60	1,368	59	2,032	57
Male	23,768	44	9,255	41	4,839	41	1,958	40	942	41	1,527	43
Dispatch priority (n %)
1	13,941	26	4,070	18	2,343	20	871	18	392	17	504	14
2	28,299	52	12,308	55	5,938	50	2,487	51	1,183	51	1,819	51
3	12,215	22	6,135	27	3,486	30	1,472	30	729	32	1,222	34
Reportedly injured (n %)^a
Yes	29,825	55	10,456	46	5,593	47	2,224	46	1,004	43	1,422	40
Head/neck	12,750	23	4,503	20	2,428	21	942	19	437	19	609	17
Trunk/back/pelvis	5,492	10	1,881	8	1,003	8	372	8	189	8	259	7
Hip/foot	9,745	18	4,142	18	1,809	15	729	15	328	14	457	13
Shoulder/hand	11,824	22	3,362	15	2,206	19	914	19	385	17	591	17
First GCS (n, %)
13-15	50,611	93	21,676	96	11,118	94	4,547	94	2,164	94	3,327	93
9-12	1,171	2	350	2	358	3	153	3	85	4	126	4
6-8	230	<1	46	<1	60	1	15	<1	9	<1	14	<1
3-5	232	<1	19	<1	34	<1	16	<1	6	<1	6	<1
Treatments (n, %)^b
Any medication	19,570	39	5,322	24	3,033	26	1,100	23	429	19	664	19
IV cannulation	5,603	10	1,683	7	754	6	277	6	101	4	130	4
ECG	4,213	8	2,148	10	1,336	11	534	11	269	12	403	11
Oxygen	1,518	3	537	2	323	3	103	2	45	2	41	1
Pain score (n, %)
0	29,666	54	14,944	66	7,967	67	3,482	72	1,716	74	2,770	78
1-3	6,755	12	2,934	13	1,467	12	586	12	255	11	377	11
4-6	5,968	11	1,772	8	914	8	316	7	135	6	185	5
7-9	8,187	15	2,051	9	1,017	9	325	7	154	7	163	5
10	3,472	6	802	4	435	4	132	3	50	2	64	2
Transported (n %)
Yes	48,046	88	18,075	80	9,960	84	3,980	82	1,816	79	2,567	72
Transport urgency (n %)
1	1,158	2	186	1	152	1	47	1	15	1	25	1
2	11,187	21	3,087	14	1,711	14	623	13	274	12	358	10
3	29,108	53	11,745	52	6,435	54	2,640	54	1,197	52	1,726	48
4-5	5,887	11	2,887	13	1,593	13	647	13	324	14	447	13
Transport destination – State Trauma Services (n %)
Other	12,309	23	4,188	19	2,266	19	899	19	376	16	538	15
Urban Trauma	14,282	26	5,844	26	3,210	27	1,271	26	647	28	891	25
Metropolitan Trauma	14,470	27	5,820	26	3,259	28	1,323	27	563	24	812	23
Major Trauma	6,985	13	2,223	10	1,225	10	487	10	230	10	326	9
Not transported (n %)
Yes	6,508	12	4,458	20	1,855	16	868	18	494	21	993	28
Died within (days) of ‘index fall’ (n %)
30 days	3,012	6	206	1	183	2	18	<1	3	<1	2	<1
365 days	8,604	16	2,614	12	1,789	15	508	10	202	9	115	3
Died within (days) of ‘final fall’ (n %)
30 days	3,012	6	2,103	9	1,090	9	492	10	230	10	291	8
365 days	8,604	16	6,473	29	3,285	28	1,488	31	711	31	989	28
Second fall within (days) (n %)
30 days	-		3,103	14	1,522	13	666	14	348	15	567	16
365 days	-		13,363	59	6,270	53	2,998	62	1,515	66	2,580	72

This table shows a summary of 77,087 SJWA attended patients. Patients who sustained more than or equal to 2 falls: All patients’ data from their first fall of those who sustained multiple falls, is reported in “Index fall (first fall of multiple)”.

Transport destination level was coded according to the Western Australian state trauma service organizational chart. 536 (0.007%) patients had unknown sex demographic data. Glasgow Coma Scale (GCS). 2,752 (0.03%) patients had unknown GCS data at first fall. Due to some patients having incomplete demographic and/or clinical data, some reported characteristics may be unknow. All patients who sustained exactly two falls are reported in “2 falls”. All patients who sustained exactly three falls are reported in “3 falls”. All patients who sustained exactly four falls are reported in “4 falls”. All patients who sustained five or more falls are reported in “5+ falls”. The reported data reflects what information was recorded at the patient’s final fall, whether they had 2, 3, 4, or 5+ falls total.

^aThe injury locations are not mutually exclusive. Injury location was extracted and allocated into the following categories: head and neck (cervical, forehead, ear, eye, mouth, nose, occipital, parietal; and throat regions); hip to foot (groin, ankle, foot, knee, lower leg, neck of femur and upper leg regions); trunk, back and pelvis (central front, back, buttock, flank, lower chest, lower quadrant, upper chest, pelvis, sacral, thoracic, upper quadrant, and lumbar regions); and shoulder to hand (elbow, hand, lower arm, shoulder, upper arm, and wrist), as described in the ePCR.

^bThese groups are not mutually exclusive. Electrocardiogram (ECG) includes 3 lead and 12 lead. IV – intravenous. Oxygen administered via nasal cannula.

Table 2. Repeat transport to hospital within 30 days and 12 months of index fall in patients who sustained repeat falls.

	Patients who sustained repeat falls (multiple falls)	Repeated transport in 30 days	Repeated transport in 31 days to 12 months	Repeated transport total (12 months)
	Index fall, n = 22,533 (first fall of multiple)
All transports	n = 18,075 (80)	1,714 (9)	6,922 (38)	8,636 (48)
Age (Mean, SD)	80 (14)	80 (14)	81 (13)	81 (14)
Age (Median, IQR)	83 (75-89)	84 (75-89)	84 (76-90)	84 (76-89)
Sex (female), (n %)	10,648 (59)	920 (54)	4,030 (58)	4,950 (57)
Injured (n %)	9,699 (54)	892 (52)	3,708 (54)	4,600
Transport urgency (n %)
1	186 (1)	9 (<1)	74 (1)	83 (1)
2	3,087 (17)	245 (14)	1,109 (16)	1,354 (16)
3	11,745 (65)	1,093 (64)	4,586 (66)	5,679 (66)
4&5	2,887 (15)	341 (20)	1,091 (16)	1,432 (17)
Transport destination – State Trauma Services (n %)
Other	4,188 (23)	408 (24)	1,580 (23)	1,988 (23)
Urban Trauma	5,844 (33)	573 (33)	2,258 (33)	2,831 (33)
Metropolitan Trauma	5,820 (32)	526 (31)	2,243 (32)	2,769 (32)
Major Trauma	2,223 (12)	207 (12)	841 (12)	1,048 (12)

This table shows a summary of 22,533 SJWA attended patients. 170 (0.007%) patients had a Non-Australian Triage scale case (scheduled transfer to residential aged care facility or home) and are not included under transport urgency. Transport destination level was coded according to the Western Australian state trauma service organizational chart.

Figure 2. Days between subsequent falls for patients who experienced between 1 and 5 EMS-attended repeat falls. As the p-value for the log-rank test is <0.001, we conclude that there is a significant difference in the time to event between the four different groups.

Table 3. Factors associated with a second EMS-attended fall within 30 days and 31 to 365 days following the index fall: a Multivariable logistic regression model.

Patients who sustained a second ambulance-attended fall within 30 days or 12-months of their initial ambulance-attended fall
	Second ambulance-attended fall within 30 days				Second ambulance-attended fall within 31 to 365 days
	aOR	p value	95%CI		aOR	p value	95%CI
Sex
Female	1				1
Male	1.31	<0.001	1.22	1.42	1.24	<0.001	1.19	1.30
Age (years)
< =64.9	1				1
65-74.9	2.29	<0.001	1.99	2.63	2.89	<0.001	2.65	3.14
75-84.9	3.81	<0.001	3.38	4.31	5.33	<0.001	4.95	5.74
> =85	5.31	<0.001	4.71	5.98	9.73	<0.001	9.04	10.47
Dispatch priority
1	1				1
2	1.33	<0.001	1.19	1.48	1.20	<0.001	1.13	1.27
3	1.46	<0.001	1.29	1.64	1.18	<0.001	1.10	1.27
Shoulder to hand injury
No reported injury	1				1
Yes	0.85	0.005	0.76	0.95	0.93	0.019	0.87	0.99
Head and neck injury
No reported injury	1				1
Yes	0.84	<0.001	0.76	0.92	0.84	<0.001	0.79	0.89
Trunk, back and pelvis injury
No reported injury	1				1
Yes	0.80	0.002	0.69	0.92	0.95	<0.001	0.77	0.91
Hip to foot injury
No reported injury	1				1
Yes	0.84	0.001	0.76	0.93	0.82	<0.001	0.77	0.87
Transported status and Urgency
Not transported	1				1
Urgency 1	0.17	<0.001	0.10	0.27	0.45	<0.001	0.36	0.57
Urgency 2	0.20	<0.001	0.18	0.23	0.45	<0.001	0.41	0.49
Urgency 3	0.27	<0.001	0.25	0.30	0.59	<0.001	0.56	0.63
Urgency 4&5	0.37	<0.001	0.32	0.42	0.67	<0.001	0.62	0.73

aOR: Adjusted odds ratio. Patient data from their first ambulance-attended fall was used for this model. 95%CI: 95% confidence interval.

Reference group: patients who sustained one ambulance-attended fall during the study period and survived to 30 days (model 1) and 365 days (model 2). A total of n = 3,103 patients sustained a second ambulance attended fall within 30 days of their index fall and n = 10,260 within 31 to 365 days. A total of n = 51,542 patients who sustained one ambulance attended fall survived to 30 days without a second fall, and n = 45,950 survived to 365 days without a second fall.

Head and neck refer to injuries of the: cervical, forehead, ear, eye, mouth, nose, occipital, parietal; and throat regions.

Hip to foot refers to injuries of the: groin, ankle, foot, knee, lower leg, neck of femur and upper leg regions.

Trunk, back and pelvis refers to injuries of the: central front, back, buttock, flank, lower chest, lower quadrant, upper chest, pelvis, sacral, thoracic, upper quadrant, and lumbar.

Shoulder to hand refers to injuries of the: elbow, hand, lower arm, shoulder, upper arm, and wrist.