Identifying Risk Factors for Fall‐Related Injuries Among Inpatients at a Tertiary Hospital in China: A Retrospective Cohort Study

AIM: Although extensive research has identified many risk factors for falls, less attention has been given to those influencing fall-related injuries after a fall occurs. This retrospective study aimed to bridge this gap by identifying modifiable risk factors, with the goal of mitigating fall-related injuries. DESIGN: A retrospective cohort study. METHODS: We retrospectively reviewed data from 145 inpatient falls reported to the hospital's electronic adverse event reporting system between January 2020 and December 2022 at a tertiary hospital in China. This study examined intrinsic (patient-related) and extrinsic (environmental) factors associated with fall occurrence. Multiple logistic regression analyses were conducted to identify factors associated with fall-related injuries specific to fall events. RESULTS: The peak times for falls ranged from 6:00-8:00, 16:00-18:00, and 22:00-24:00. Patients aged over 65 years, those in bathroom settings, and those with independent mobility demonstrated higher incidences of both falls and moderate-to-severe fall-related injuries. Analysis of fall causation revealed that toilet-associated activities accounted for the highest proportion of incidents (35.43%), followed by ambulation (20.47%). Multiple logistic regression analysis revealed three reduced risk factors for fall-related injuries: appropriate footwear use (adjusted ORs = 0.38, 95% CI 0.14-0.99), self-care ability (adjusted ORs = 0.97 per 1-point increase, 95% CI 0.95-0.99), and no (adjusted ORs = 0.09, 95% CI 0.01-0.74) or partial mobility (adjusted ORs = 0.23, 95% CI 0.07-0.74). CONCLUSION: Inpatient falls were clustered in the early morning, late afternoon, and night and occurred most frequently during toileting and ambulation. These findings support targeted prevention during identified peak periods and high-risk activities, prioritizing appropriate footwear, the preservation or improvement of functional independence, and context-sensitive supervision. Future studies could further elucidate targeted interventions, including rounding during high-risk periods, supervised mobilization and toileting, and the provision of appropriate footwear, to determine their efficacy in mitigating fall-related injuries. PATIENT OR PUBLIC CONTRIBUTION: Although patients were not actively involved in study design due to its retrospective nature, their clinical records provided critical insights into fall-related injuries.