Accidental falls in home care hematological patients

Dear Editor, Accidental falls are a major concern in patients with both medical and surgical illness for twomain reasons: (1) potential complications, such as bone fractures, leading to hospitalization requirement and direct or indirect cost increase; (2) medico-legal and insurance implications of a fall and its complications, above all in controlled environments, such as hospital wards, nursing homes, and home care (HC). HC management is a special area of application in advancedterminal onco-hematological and older hematological patients, which is concerned with several factors, such as difficulty with access to a hospital and obtaining considerable benefits from HC, when compared with inpatient management. HC management allows the assistance of hematological patients at home, furnishing the health services that usually would be supplied in a hospital to treat hematological diseases and their complications (e.g., medical examinations, blood tests, transfusions, chemotherapy, etc.) [1–3]. Hematological patients, due to the underlying disease, their treatment, or associated comorbidities, are faced with several pathological processes, which may increase the risk of accidental falls in comparison to the general population. Risk factors for accidental falls have been extensively analyzed, both in the general population (children [4], elderly [5]) and in certain diseases (dialysis [6], stroke [7], cancer [8]), as well as in various settings (such as hospitals [9] and nursing homes [10]). An extensive literature search was conducted through database scanning, revealing lack of evidence regarding falls and injury in hematological HC patients. HC hematological patients could be considered at high risk both for accidental falls (due to age [8] and clinical features, such as anemia [11], fatigue, disability [12–16], cognitive impairment [17], and drugs [18, 19]), and for subsequent complications, such as fractures (due to osteolysis, treatment-induced/enhanced osteoporosis [20]), bleeding (due to hemostasis disorders), and infection. The aim of the present study was to retrospectively evaluate fall frequency and fall injury in hematological HCmanaged patients. Clinical data of 193 patients admitted in our HC service from January 2010 to June 2011 (median follow-up, 74 days (range, 15–500)) were retrospectively reviewed. Among these, 133 patients, with properly recorded clinical data, were considered evaluable for further analysis; 60 patients were excluded due to incomplete data recording (e.g., lack of registration of physical examination data). Accidental fall events (defined as “unexpected descent to the floor”) were extracted and analyzed, as well as complications and their outcome. Evaluable patient data were the following: 54 males (41 %), 79 females (59 %); diagnosis and disease stage are shown in Table 1. Median age was 83 years (20–98); age range details are shown in Table 2. Twenty-six fall events were identified in 23/133 pts (17 %). A total of 18,886 days A. Tendas : L. Cupelli :M. M. Trawinska : L. Lentini Hematology Unit, S. Eugenio Hospital, Home Care Service of the Rome Section of the Italian Association Against Leukemias (RomAIL), Rome, Italy