Medication-related inpatient falls: a critical review

Abstract Falls are the second leading cause of accidental and unintentional injury deaths worldwide. Inpatient falls in hospital settings are likely to prolong the length of stay of patients in nearly 6.3 days, leading to increased hospitalization costs. The causes of fall incidents in healthcare facilities are multifactorial in nature and certain medications use could be associated with these incidents. This review seeks to critically evaluate the available literature regarding the relationship between inpatient falls and medication use. A comprehensive search was performed on MEDLINE, EMBASE and Lilacs with no time restriction. The search was filtered using English, Spanish or Portuguese languages. Our study evaluated medication use and inpatients falls that effectively happen, considering all ages and populations. An assessment of bias and quality of the studies was carried out using an adapted tool from the literature. The drugs were classified according to the Anatomic Therapeutics Chemical Code. The search strategy retrieved 563 records, among which 23 met the eligibility criteria; ninety three different pharmacological subgroups were associated with fall incidents. Our critical review suggests that the use of central nervous system drugs (including anxiolytics; hypnotics and sedatives; antipsychotics; opioids; antiepileptics and antidepressants) has a greater likelihood of causing inpatient falls. A weak relationship was found between other pharmacological subgroups, such as diuretics, cardiovascular system-related medications, and inpatient fall. Remarkably, several problems of quality were encountered with regard to the eligible studies. Among such quality problems included retrospective design, the grouping of more than one medication in the same statistical analysis, limited external validity, problems related to medication classifications and description of potential confounders.

【摘要】跌倒为全球范围内第二大意外伤害致死原因。住院患者在医疗机构内发生跌倒，可使患者住院时长延长近6.3天，进而增加住院治疗成本。医疗机构内跌倒事件的诱因具有多源性，部分药物的使用或与这类事件存在关联。本综述旨在批判性评估现有关于住院患者跌倒与药物使用之间关联的相关文献。研究未设时间限制，在MEDLINE、EMBASE及LILACS数据库中开展了全面检索，且限定检索文献的语言为英语、西班牙语或葡萄牙语。本研究纳入所有年龄段及人群，对实际发生的药物使用情况与住院患者跌倒事件进行了分析评估；采用经文献改编的工具，对纳入研究的偏倚风险与研究质量进行了评估，并依据解剖治疗化学分类系统（Anatomic Therapeutics Chemical Code，ATC）对药物进行分类。本次检索共获取563条记录，其中23条符合纳入标准；共计93个不同的药理学亚类与跌倒事件存在关联。本批判性综述结果显示，中枢神经系统药物（central nervous system drugs，包括抗焦虑药、催眠镇静药、抗精神病药、阿片类药物、抗癫痫药及抗抑郁药）的使用与住院患者跌倒的相关性更为显著。其余药理学亚类，如利尿剂、心血管系统用药，与住院患者跌倒的相关性较弱。值得注意的是，纳入的符合标准的研究均存在若干质量缺陷，包括回顾性研究设计、同一项统计分析中纳入多种药物分组、外部效度有限、药物分类相关问题以及潜在混杂因素描述不清等。