Análises descritivas e fatores prognósticos associados a queda em pacientes durante a internação hospitalar

Abstract

Introduction: The fall is an adverse event, with an incidence in Brazil ranging from 1.37 to 12.6 for every 1,000 patients per day. Hospital falls result in prolonged hospitalization, increased care costs and complications of the patient's clinical condition, and in serious cases can cause chronic pain, functional impairment, permanent disability or death, especially when associated with prognostic factors that favor the outcome of the event. Objective: The objective of this study was to investigate the epidemiological, clinical and pharmacological prognostic factors associated with the outcome of falls in adult patients, approaching the influence and time for the occurrence of these outcomes through a survival curve. Methodology: This is an observational retrospective cohort study, consisting of a sample of 176 patients affected by the main outcome of falling during hospital stay. The sample was divided into 2 groups, according to the age range of the participants: Adults under the age of 60, and elderly people aged over 60 years. The association between variables was analyzed using the binomial test, while the logistic regression model was used to evaluate the combined probability between factors. The survival analysis was conducted with the implementation of Kaplan-Meier curves and Cox proportional hazards regression model. Results: There was an association between adults under the age of 60: previous history of alcohol (p=0.0276), during the fall “alone” (p=0.0002), use of benzodiazepines (p=0.0001), antiarrhythmic/antihypertensive drugs (p=0.0005), antipsychotics (p=0.0001). In relation to the elderly group, the associated factors were: fall from their own height (p=0.0112), situation during the fall “accompanied by a caregiver” (p=0.0595), hypertension (p=0.0032), diabetes (p=0.0195), arterial diseases (p=0.0177), muscle weakness (p=0.0183), gait disorders (p=0.0443), use of vasodilators (p=0.0107), antihistamines (p=0.0003) and hypoglycemic agents (p=0.0041). The comparison between survival curves gender related indicated that women under the age of 60 had a worse prognosis for the occurrence of falls when compared to those who were elderly (Log Rank, p=0.038; Breslow, p=0.013; Tarone-Ware , p=0.017). In relation to the elderly group, the opioid use (Log Rank, p=0.045; Breslow, p=0.050; Tarone-Ware, p= 0.046), and muscle weakness (Log Rank, p=0.037; Breslow, p=0.052; Tarone-Ware, p= 0.043), represented a poor prognostic factor for the elderly when compared to adults under the age of 60. In Cox regression, in a multivariate model, only the female sex in patients under the age of 60 years presented a higher risk (HR=1.47) for occurrences in relation to women over the age of 60 years (p=0. 0014), although muscle weakness (paresis) and opioid use were not significant in the multivariate analysis, the proportional risks were 1.37 (p=0.066) and 1.12 (p=0.0545), respectively, when comparing participants aged 60 or over and those aged under 60. Conclusion: Our results point to the female sex as a poor prognostic factor in adult women under the age of 60 years. In relation to the elderly group, the use of opioids and muscle weakness represented a worse prognostic factor. Such factors are important criteria in the elaboration and implementation of future care protocols, in order to stratify the patient's risk or prognosis regarding the event of a fall during hospitalization, as well as in the creation of effective strategies for preventing and controlling this problem in care in health.