Benzodiazepines on Admission UDS: Indicator of Worse Outcomes After Geriatric Falls

Abstract

Background

Unintentional falls are the leading cause of injury among adults 65 years and older. It’s believed that adverse benzodiazepine side effects increase the risk and frequency of falls. We hypothesize that geriatric patients taking benzodiazepines prior to admission experience worse clinical outcomes compared to those without preadmission use.

Methods

Using our level 1 trauma database, patients 65 years or older admitted following a ground level fall were divided into 2 groups, benzodiazepines positive on admission urine drug screen (+Benzo) and negative (−Benzo). Primary outcomes included in-hospital complications with additional outcomes including ICU admission rates, ICU LOS, overall hospital LOS, injury pattern data, and Injury Severity Score (ISS).

Results

11 133 patients were included with 764 in the +Benzo group. There was no difference in Injury Severity Score between the two groups (6.1 vs 5.7, P = .140). The + Benzo group had a higher percentage of TBI (39.7% vs 29.8%, P < .001), rib fractures (12.7% vs 9.1%, P = .001), and extremity fractures (49.9% vs 43.2%, <.001) with no difference in ISS (6.1 vs 5.7, P = .140). The + Benzo group had higher ICU admission rates (25.8% vs 17.7%, P < .001) and experienced more cardiac arrests (2.2% vs 1.0%, P = .004), pulmonary embolus (4.6% vs 3.1%, P = .032), and pneumonia/VAP (0.65% vs 0.15%, P = .008). On multivariable analysis, benzodiazepines prior to admission were an independent predictor of in-hospital complications (OR: 1.60, CI: 1.18-2.17, P = .003).

Discussion

Our study identifies pre-hospital benzodiazepine use and its association with worse in-hospital outcomes. Our findings can be used to identify high-risk fall patients on admission to mobilize additional resources to reduce the risk of adverse in-hospital outcomes.