Identifying Risk Factors for Inpatient Falls in Burn Patients: A Retrospective Cohort Analysis

Abstract Inpatient falls are associated with prolonged hospital stays, increased complications, and substantial economic burden. Burn patients face unique risks due to impaired mobility. Yet, risk factors and outcomes in burn units remain underexplored. This retrospective cohort study evaluated the impact of inpatient falls on adult burn outcomes. Predictors of fall risk to guide prevention strategies were identified. Adult patients admitted for burn injuries from January 1, 2015, to July 31, 2024, were included. Fallers were identified through an internal auditing system and matched 1:2 to non-fall controls based on age, sex, total burn surface area (TBSA), and inhalation injury. Demographics, comorbidities, medication use, Fall Risk Assessment Score (FRAS), physical and occupational therapy assessments, and fall safety measures were collected. Univariate, receiver operating characteristic (ROC) curve, and multivariate logistic regression analyses were performed; p<0.05 was considered significant. One hundred thirty-two patients were included, 45 fallers and 87 non-fallers. Fallers were more likely to use antihypertensives (62.2% vs. 39.1%, p = 0.016) and antiarrhythmics (75.6% vs. 52.9%, p=0.014) than non-fallers. They required greater mobility assistance at admission (Basic mobility score 16 [11.3–20] vs. 20 [14–24], p=0.002). Fallers required more help for activities of daily living (Daily activity score 16 [12–19] vs. 19 [14–22], p=0.004). The FRAS predictive value was moderate (AUC=0.653, p=0.009). Burn surgery requirement (Odds Ratio (OR)=3.35 [1.12–10.1], p=0.031) and FRAS (OR=1.12 [1.04–1.20], p=0.003) were independently associated with fall risk. These findings underscore the value of functional assessment and proactive, tailored fall prevention.