Abstracts

Rationale: Fall is an important adverse event encountered in the Epilepsy Monitoring unit (EMU). Risk factors or predictors of fall have never been studied among patients admitted to an epilepsy monitoring unit. The development of successful EMU-based interventions to decrease fall rates and fall-related injury requires large, well-designed studies to characterize the nature of falls and identify predictors of fall related injury. Methods: A retrospective case control study through evaluation of patient medical record and incident reporting following fall in patients admitted in the Barrow Neurological Institute Adult Epilepsy Monitoring Unit. Cases were defined as patients admitted in EMU and had a fall. Controls were patients who had a fall during inpatient stay in neurology ward but did not have seizures. Time period of study was from 2006 to 2009. Results: A total of 54 patients had 61 falls during the study period. 18 patients (cases) with 18 falls in EMU were studied against 36 inpatients (controls) with 43 falls. The mean age for cases and controls were 48 years and 59 years respectively. Of the 18 patients who had fall during EMU admission: 11 (61%) had average 3-10 seizures per month, 14 (77%) were on 1-3 antiepileptic medications, and 13 (72%) had prior seizure related falls( in comparison to 0% patient with no prior fall in control group). Majority of the falls happened during the first 3 days of EMU admission (N=11; 61%) and in evening 3 PM-11 PM (N 15; 83%). Toilet or bathroom is the commonest place to have fall (N=13; 72%) and most of them happened during ambulation (N=11; 61%). 94 % (N=17) of patient did not have any serious injury. All the patients (N=18, 100%) were identified as high risk for fall prior to EMU admission by using standardized fall risk assessment protocol adopted by the hospital. However in spite of this falls were not prevented. When compared to controls, there was no significant difference in number of risk factors identified by the assessment protocol. Conclusions: Risk factors of fall among patients admitted in EMU are not significantly different from as that of general inpatient admission. Despite the fact that high-risk patients were identified by using standardized fall risk assessment, falls were not prevented. Therefore, this study indicates that implementation of policy should be addressed more rigorously in high-risk patients for fall.