Syncope, “mechanical falls”, and the trauma surgeon

Biffl, Walter L.; Ferkich, Anthony; Biffl, Susan E.; Dandan, Tala

doi:10.1097/ta.0000000000002812

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Patients with non-syncope-related falls may be affected by internal (eg, gait, balance, cognition) and external factors (eg, environment, dress). The assessment and management of these two types of falls differ greatly 36. Overall, 23.9% of the patients who were included were assessed as having a fall because of stroke onset.…”

Section: Discussionmentioning

confidence: 99%

Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study

Zha

Lü

Jiang³

et al. 2023

BMJ Open

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ObjectivesThis study aimed to explore the potential risk factors associated with toileting-related falls in community-dwelling older adults who presented to the emergency department and were subsequently hospitalised.DesignThis was a cross-sectional study.Setting and participantsThis study was conducted in two teaching hospitals in Shanghai, China between October 2019 and December 2021 among community-dwelling adults aged ≥60 years.MethodsIn-person interviews, physical assessment and medical record review were performed to collect data on the characteristics and risk factors of falls. Associations of toileting-related falls with demographic characteristics and geriatric syndromes were examined using logistic regression models.Main outcome measuresPotential risk factors for toileting-related falls.ResultsThis study included 419 older patients with a mean age of 73.8±9.7 years. Among 60 (14.3%) patients with toileting-related falls (mean age: 78.8±9.2 years), 63.3% of toileting-related falls, mainly occurred between 00:00 and 05:59 hours, compared with 17.3% of non-toileting-related falls, which primarily occurred during the daytime. The rate of recurrent falls (35%) was significantly higher in the toileting-related falls group than in the non-toileting-related falls group (21.2%) (p=0.02). Logistic regression showed that visual impairment (OR 2.7, 95% CI 1.1 to 7.1), cognitive impairment (OR 3.3, 95% CI 1.3 to 8.4), gait instability (OR 3.1, 95% CI 1.1 to 8.8) and urinary incontinence (OR 3.4, 95% CI 1.2 to 9.9) were strongly associated with toileting-related falls. Twenty-three (38.3%) patients in the toileting-related falls group had moderate and severe injuries, compared with 71.7% in the non-toileting-related falls group (p<0.05).ConclusionsThis study revealed that patients who reported toileting-related falls were more likely to have cognitive impairment, urinary incontinence, gait instability, visual impairment than patients who fell during other activities. Social and healthcare professionals should prioritise the management of toileting activities in older patients and provide targeted interventions to those in the high-risk group.

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Section: Discussionmentioning

confidence: 99%

Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study

Zha

Lü

Jiang³

et al. 2023

BMJ Open

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“…A high proportion of routine trauma admissions are for patients in the geriatric age categories over 65. Comprehensive assessment and documentation of preceding and following symptoms may help identify possible causative factors relating to other systems, such as syncope or dizziness [ 18 ]. Clear demonstration of these factors on the admission note helps guide appropriate further investigation [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Improving Acute Orthopaedic Admission Note Documentation Standards at a Tertiary Centre Through Proforma Introduction: A Quality Improvement Initiative

O’Driscoll¹,

Condell²,

O’Sullivan³

et al. 2022

Cureus

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BackgroundClear, accurate written documentation plays an important role in the handover of medical information, helping to improve care efficiency and avoid medical errors. Both HSE and the Irish National Orthopaedic Models of Care guidelines include key documentation standards for admission notes. Standardised medical admission proforma can help improve documentation standards, but their usage across Irish orthopaedic units is limited to three centres. We evaluated whether an admission proforma improved the documentation standards of acute orthopaedic trauma admission notes within our regional trauma unit. MethodsCycle 1 consisted of a retrospective review of 50 consecutive acute orthopaedic trauma admissions. Exclusion criteria included planned admissions, age <16 years, spinal or pelvic trauma, and 'hip' fractures for whom an existing proforma was in use. Cycle 2 consisted of a prospective review of 50 consecutive acute trauma admissions using the new proforma. Each cycle was scored against a pre-determined checklist incorporating Irish Health Service Executive and Orthopaedic Models of Care documentation standards, with results collated and statistical analysis then performed using Fisher's exact test. FindingsSignificant improvements in admission note compliance with national documentation were observed. This encompassed multiple domains including clinical identification, e.g., consultant identification (78% to 100% p=0.0005), clinical history, time of injury (72% to 100% p=0.0001), medical history, smoking status (86% to 100% p=0.0001), and patient assessment, vital signs (28% to 70% p=0.0001). ConclusionImprovements in admission note compliance with national documentation standards followed the introduction of a standardised proforma. These findings may encourage the introduction of similar proforma in other units, with potential benefits in patient care.

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“…30 Research Figure 2 Algorithm for the management of falls and syncope evaluation. Credit to 'Syncope, "mechanical falls", and the trauma surgeon' by Biffl et al 16 Consent for image use provided by Wolters Kluwer health (CC-BY-NC). The discussion points A-F and table 1 can be sourced from the original article.…”

Section: Should Investigations Be Protocol Driven?mentioning

confidence: 99%

“…Biffl et al proposed a management algorithm for the assessment of traumatic falls and syncope (figure 2), adapted from the American and European cardiology societies’ guidance 16. The following sections will build on this framework though the analysis of the trauma evaluation in syncope with practical management considerations, the critical inclusion of UK blackout guidance in addition to European and American guidelines, and a discussion of the relevance of current syncope risk stratifications tools in trauma.…”

Section: Assessment Of Syncopementioning

confidence: 99%

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Trauma and syncope: looking beyond the injury

Kavi

Gall²

2023

Trauma Surg Acute Care Open

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Background42% of the population experience syncope by the age of 70, accounting for up to 6% of hospital admissions that frequently present as falls. The etiologies of some falls are benign, and others, such as cardiac syncope, are associated with a greater mortality and must be identified.MethodsThis review article aims to bridge the literature gap by providing a comprehensive practice review and critical summary of the current syncope guidance relating to the trauma patient.ResultsThe National Institute for Health and Care Excellence, the American College of Cardiology, and European Society of Cardiology published syncope risk stratification guidance. The inclusion of certain high-risk features represented in all three guidelines suggests their significance to identify cardiac syncope including heart failure, abnormal vital signs, syncope during exercise with little to no prodrome, family history of sudden cardiac death, and ECG abnormalities. Of 11 syncope risk stratification scoring systems based on these guidelines, only 2 are externally validated in the emergency department, neither of which are validated for major trauma use. Adherence to thorough history-taking, examination, orthostatic blood pressure recording, and an ECG can diagnose the cause of syncope in up to 50% of patients. ECG findings are 95% to 98% sensitive in the detection of serious adverse outcomes after cardiac syncope and should form part of a standardized syncope trauma assessment. Routine blood testing in trauma is often performed despite evidence that it is neither useful nor cost effective, where the screening of cardiac enzymes and D-dimer rarely influences management.DiscussionIn the absence of a gold-standard clinical test to identify the cause of a syncopal episode, standardized syncope guidelines as described in this review could be incorporated into trauma protocols to analyze high-risk etiologies, improve diagnostic accuracy, reduce unnecessary investigations, and develop an effective and safer management strategy.

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Syncope, “mechanical falls”, and the trauma surgeon

Cited by 8 publications

References 16 publications

Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study

Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study

Improving Acute Orthopaedic Admission Note Documentation Standards at a Tertiary Centre Through Proforma Introduction: A Quality Improvement Initiative

Trauma and syncope: looking beyond the injury

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