Methods: This was a retrospective study performed at Massachusetts General Hospital (MGH), a teaching tertiary healthcare institution in Boston. The computerized Research Patient Data Registry, a central clinical data repository containing health records of patients enrolled at MGH was employed by specifying the following search parameters for the period January 1, 2000, through December 31, 2014: age 18 years or greater, and search terms related to “fall” or “accidental fall”, and bacteremia, systemic inflammatory response syndrome (SIRS), or “sepsis”. Patients were included in the study if there was documentation of fall as their primary presenting complaint and CSI at the time of their presentation.
Results: Of 161 evaluable patients presenting with a fall and CSI during the study period, 85 (52.8%) were female; mean age was 76 years (range 35-102). Bacteremia was present in 73 (45.3%), urinary tract infection in 68 (42.2%), respiratory tract infection in 42 (26.1%), and endocarditis in 10 (6.2%). Of bacteremic cases, 22 ( 30.1%) were caused by Staphylococcus aureus, 11 (15.1%) by Escherichia coli, and 7 (9.6%) by Streptococcus pneumoniae. Less than 2 criteria for systemic inflammatory response syndrome was present in 90 (57.7%) evaluable patients. CSI was not suspected in 64 (40.5%) evaluable patients. Fall as a direct result of infection was suspected in 22 (13.9%) evaluable cases. In hospital mortality occured in 29 (18.0%) patients.
Conclusion: CSI in patients presenting with a chief complaint revolving around a fall is frequently associated with bacteremia, is often not clinically suspected, and is associated with significant in-hospital mortality. Given the importance of early diagnosis and treatment of sepsis, CSI may need to be considered in the differential diagnosis of conditions presenting as a fall.