Abstract WMP97: Stroke Risk After Emergency Department Treat-and-Release Visit for Fall

Introduction: Previous cohort studies of hospitalized patients with a delayed diagnosis of ischemic stroke have found that these patients often had an initial admitting diagnosis of fall from the ED. We sought to evaluate whether ED visits resulting in discharge to home (i.e., treat-and-release) after a fall were associated with increased short-term stroke risk. Methods: A case-crossover design was used to compare ED visits for falls during case periods (0-15, 16-30, 31-90, 91-180, and 181-365 days prior to stroke) and control periods (equivalent time periods exactly 1 year prior to stroke) using administrative data from the Healthcare Cost and Utilization Project on all hospital admissions and ED visits across New York and Florida from 2016-2018. To identify ED treat-and-release visits for falls, we used previously validated ICD-10-CM injury codes. To identify patients hospitalized for ischemic stroke, we used previously validated ICD-10-CM codes. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression. Results: We identified 62,849 hospitalized ischemic stroke patients, of whom 4,693 (7.5%) had an ED treat-and-release visit for fall one year prior to their stroke. Patients with an ED treat-and-release visit for fall were older (mean age 77 years [SD 14] vs 71 years [SD 15]), more often female (63% vs 49%), and had similar prevalence of vascular comorbidities as other stroke patients. ED treat-and-release visits for fall were significantly more common in the 15 days before stroke compared to the 15-day control period 1 year earlier (OR, 4.5; 95% CI, 3.8-5.5; P= 0.008). The association between stroke and a preceding ED visit for fall decreased in magnitude with increasing temporal distance from stroke but remained significantly elevated in all case periods compared to control periods as well as during the entire year prior to stroke hospitalization (0-365 days) (OR, 3.3; 95% CI, 3.1-3.6; P=0.049). Conclusion: ED treat-and-release visits for falls are associated with significantly increased stroke risk.