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J Am Geriatr Soc. 2007 Apr;55(4):577-82.

The consequences of falls in acute and subacute hospitals in Australia that cause proximal femoral fractures.

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Rehabilitation Department, Southern Network, Southeastern Sydney and Illawarra Area Health Service, Sydney, Australia.



To compare consequences for patients with proximal femoral fractures (PFFs) sustained in the hospital with patients who sustained PFFs in the community.


Data were collected from inpatient notes and incident reports of patients admitted to hospitals over a 6-year period. All patients aged 75 and older sustaining a PFF in the hospital were identified and matched according to sex, age, and fracture date with patients who sustained a PFF in the community.


Illawarra region hospitals, New South Wales, Australia.


Forty-three patients with a hospital-acquired PFF and 43 patients with a community-acquired PFF; mean age was 84.0 (range 75-92), and 67% were women.


Outcomes at hospital discharge and circumstances of hospital-acquired PFF.


Comparing outcomes of subjects with hospital versus community-acquired PFF revealed that 12 versus four died in the hospital (P=.03), 14 versus five were discharged to long-term nursing care facilities (P=.02), six versus 18 returned to preadmission ambulation (P=.004), and four versus 24 returned to preadmission activity of daily living status (P<.001). The median postfracture length of stay was 46 days for subjects with hospital-acquired PFF versus 32 days for those sustaining a PFF in the community (P<.01). Review of circumstances of the 43 hospital-acquired fractures revealed that 26 occurred in subacute wards, 25 occurred in bedrooms, 25 occurred at night, and 38 occurred while unsupervised.


Patients with hospital-acquired PFF have poor outcomes. Adequate supervision, provision of hip protectors in the hospital, and strategies that address fracture circumstances may hold the keys to prevention.

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