Emergency Department Visits for Falls May Be Signs of an Impending Stroke Among Older Adults, Study Warns

Discharging older patients quickly after they suffer a fall, particularly if they had a head injury, may put them at increased stroke risk, researchers warn.

The findings of a new study suggests that older individuals treated in a hospital Emergency Department (ED) following a fall appear to have an increased risk of suffering an ischemic stroke in the near future, suggesting that these visits may be an opportunity to improve early stroke diagnostic accuracy and treatments.

Falls pose a serious risk for individuals over the age of 65, carrying a risk of head injuries, broken hips, and other complications that may lead to rapid deterioration of their health. However, in findings published last week in the medical journal Stroke, Dr. Ava Liberman and a team of researchers from the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine indicate that falls requiring emergency room treatment appear to be associated with an increased risk of stroke over the next six months.

One potential reason for the increased risks could be because falls serious enough to land someone in the emergency room often involve traumatic brain injuries (TBI). Prior research published in 2021 in the International Journal of Stroke has found a link between suffering head injuries and stroke risk.

That study indicated the risk of stroke was the highest during the first four months after a head injury, but stays elevated for up to five years. The research also found that people who suffer head injuries may benefit from stroke prevention methods, like lowering cholesterol and blood pressure.

Hospitals May Release Fall Patients Too Quickly

In this latest study, Liberman’s team conducted research on falls treated in the ER where the patient was discharged, instead of being admitted to the hospital for observation. They found specifically that these “treat-and-release” visits may be related to short-term ischemic stroke risks.

Ischemic stroke occurs when a person suffers a blood clot or blocked artery in the brain or to a blood vessel that supplies blood to the brain. Roughly 85% of all strokes are ischemic strokes.

The researchers used administrative data from the Healthcare Cost and Utilization Project on all hospital admissions and ED visits across 10 states from 2016 to 2020. They tracked hospitalized patients with a delayed diagnosis of ischemic stroke who were first treated in the ER for a fall and discharged.

The study included more than 90,000 hospitalized patients with ischemic stroke. Overall, 6% were treated in the ED for a fall and released and experienced a stroke within 180 days, or about six months.

Researchers say the findings indicate a strong link between patients who suffer falls, and possibly head injuries in the process, and a higher risk of stroke later. This was especially true if the patient was discharged and not monitored in the hospital for risk factors like high blood pressure.

The findings indicate patients treated in the ED for a fall and then  released were far more likely to have a stroke within 15 days when compared to a similar 15 day period a year earlier, when they had not suffered a fall.

Patients who fell and later suffered a stroke were, on average, 75 years old or older. About 62% of patients were female, and most of them had higher rates of vascular conditions, like carotid artery disease or aneurysm, compared to other stroke patients.

“ED treat-and-release visits for a fall are associated with significantly increased short-term ischemic stroke risks,” Liberman’s team concluded. “These visits may be opportunities to improve stroke diagnostic accuracy and treatment in the ED.”