After an older patient falls, look beyond the hip and the head

Design

Narrative review of PubMed literature over 50 years

Population

Older adults after ground-level falls

Primary outcome

Range of fall-related harms beyond fracture and brain injury

Effect

Five under-recognised domains identified; each infrequent but often diagnosed late

This narrative review searched 50 years of literature on harm after ground-level falls in older people. Fractures and brain injury are common and routinely sought. The review grouped the less obvious harms into five domains: chest injury, internal abdominal injury, vascular events (cardiac, stroke, vessel injury and venous thromboembolism), reactivation of herpesviruses such as zoster, and psychological harm.

Apart from the psychological impact, each was uncommon, but each was often recognised late and associated with more illness and death. The author argues that point-of-care whole-body CT may be justified because examination and plain films miss more.

For the admitting physician, the practical lesson is a wider checklist after a fall rather than routine whole-body imaging, which this review cannot justify on its own. Re-examine the chest and abdomen when a patient is slow to recover, keep thromboembolism prophylaxis under review in an immobile patient, and ask about fear of falling before discharge.

• After a fall, examine the chest and abdomen as well as the hips and head — rib and organ injuries are easy to miss in older patients.
• Reconsider the diagnosis when an older patient is slow to recover after a 'simple' fall.
• Review venous thromboembolism risk when a fall leaves a patient immobile.
• A new vesicular rash in the days after a fall may be zoster reactivation.
• Ask about fear of falling before discharge; it drives loss of independence.

Why it matters

The injuries that go unrecognised after a fall are the ones that later turn a short admission into a long one.

Don't overread it

This is a narrative review — it cannot show how often these harms occur or that whole-body CT improves outcomes.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.