Risk of post-discharge fall-related injuries among adult patients with syncope: A nationwide cohort study

• Published in: PloS one Vol. 13; no. 11; p. e0206936
• Main Authors: Numé, Anna-Karin, Carlson, Nicolas, Gerds, Thomas A, Holm, Ellen, Pallisgaard, Jannik, Søndergaard, Kathrine B, Hansen, Morten L, Vinther, Michael, Hansen, Jim, Gislason, Gunnar, Torp-Pedersen, Christian, Ruwald, Martin H
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.11.2018; Public Library of Science (PLoS)
• Subjects: Adults; Biology and Life Sciences; Cardiology; Cohort analysis; Confidence intervals; Consciousness; Cross-linkage; Crosslinking; Dementia; Discharge; Engineering and Technology; Family medical history; Fractures; Head injuries; Health risks; Heart; Hip; Hospitals; Injuries; Injury analysis; Internal medicine; Medicine and Health Sciences; Mental depression; Older people; Patients; People and Places; Population; Public health; Regression analysis; Risk analysis; Statistical analysis; Studies; Syncope; Denmark
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0206936

Syncope could be related to high risk of falls and injury in adults, but documentation is sparse. We examined the association between syncope and subsequent fall-related injuries in a nationwide cohort. By cross-linkage of nationwide registers, all residents ≥18 years with a first-time diagnosis of syncope were identified between 1997-2012. Syncope patients were matched 1:1 with individuals from the general population. The absolute one-year risk of fall-related injuries, defined as fractures and traumatic head injuries requiring hospitalization, was calculated using Aalen-Johansen estimator. Ratios of the absolute one-year risk of fall-related injuries (ARR) were assessed by absolute risk regression analysis. We identified 125,763 patients with syncope: median age 65 years (interquartile range 46-78). At one year, follow-up was complete for 99.8% where a total of 8394 (6.7%) patients sustained a fall-related injury requiring hospitalization, of which 1606 (19.1%) suffered hip fracture. In the reference group, 4049 (3.2%) persons had a fall-related injury. The one-year ARR of a fall-related injury was 1.79 (95% confidence interval 1.72-1.87, P<0.001) in patients with syncope compared with the reference group; however, increased ARR was not exclusively in older patients. Factors independently associated with increased ARR of fall-related injuries in the syncope population were: injury in past 12 months, 2.39 (2.26-2.53, P<0.001), injury in relation to the syncope episode, 1.62 (1.49-1.77, P<0.001), and depression, 1.37 (1.30-1.45, P<0.001). Patients with syncope were at 80% increased risk of severe fall-related injuries within the year following discharge. Notably, increased risk was not exclusively in older patients.