Clinical Consequences and Factors Associated With Clinically Significant Injury After In-Hospital Falls: A Long-Term Retrospective Cohort Study

Abstract Purpose In-hospital falls remain common despite preventive efforts, but factors associated with clinically significant injury after a fall are less well characterized. We evaluated the incidence, clinical consequences, and factors associated with injury severity after in-hospital falls. Methods This single-center retrospective cohort included 497 adults with one reported in-hospital fall between July 2016 and August 2025. Injury severity was classified as None, Minor, Moderate, Major, or Death. Clinically significant fall-related injury (CSFI) comprised Moderate, Major, or Death, and major or fatal fall-related injury (MFFI) comprised Major or Death. Multivariable logistic regression evaluated both outcomes. Results Overall fall incidence was 0.39 per 1,000 patient-days and CSFI incidence was 0.06 per 1,000 patient-days. CSFI occurred in 82 patients (16.5%) and MFFI in 59 (11.9%). Each 10-year increase in age was independently associated with CSFI (adjusted odds ratio [OR], 1.312; 95% confidence interval [CI], 1.052–1.636; P = 0.016) and MFFI (adjusted OR, 1.396; 95% CI, 1.068–1.824; P = 0.015). Male sex was associated with lower odds of MFFI (adjusted OR, 0.484; 95% CI, 0.274–0.854; P = 0.012). Fall timing, location, anticoagulant use, antiplatelet use, and exposure to three or more CNS-active medication classes were not independently associated with either outcome. Conclusions Older age was consistently associated with more severe injury after in-hospital falls. Fall prevention should be complemented by injury mitigation and post-fall assessment, particularly in older patients.