Head Injury as a Risk Factor for Inpatient Mortality Among Fall Patients in Malawi

Introduction: Falls result in 700,000 deaths annually, with a high burden occurring in low- and middle-income countries (LMICs). Identifying patient risk factors associated with mortality following falls in a resource poor setting can help guide pre- and in-hospital care. This study aimed to identify factors associated with inpatient mortality and length of stay among fall patients in Malawi.

Methods: This was a retrospective cohort study of prospectively collective data on all patients admitted between January 2012 and December 2015 to Malawi’s Kamuzu Central Hospital (KCH) who were injured by falling. Bivariate analysis evaluated the effect of potential risk factors on inpatient mortality. Multivariable logistic regression assessed the direct effect of potential risk factors on length of stay. Factors assessed included age, sex, most severely injured body part, fall height, alcohol use, transfer status, and surgical interventions.

Results: Of the 2,572 patients admitted after a fall, 17 (1%) died. Patients who died in hospital were older (median 41 years, IQR 25-49) compared to those discharged alive (median 11 years, IQR 6-28), p=0.001. Head injury was associated with mortality in 6 (35%) of patients who died compared to 206 (8%) of patients discharged alive (p<0.001). After adjustment, older patients had longer lengths of stay, as did patients with abdominal/pelvis injuries or lower extremity injuries.

Conclusions: Patients with head injuries from falls are at higher risk of mortality compared to patients with other anatomic injury locations. This knowledge can be used to identify fall patients who may benefit from triage to a higher level of care in resource-poor settings.

Keywords: Trauma; Falls; Traumatic Brain Injury; Sub-Saharan Africa; inpatient mortality; Malawi.