BACKGROUND: In North Carolina (NC), unintentional falls are the leading cause of injury and death for residents ages 65 and older. Currently, the state is monitoring fall related injuries through death certificate, hospital discharge, and emergency department (ED) data. Pre-hospital Medical Information System (PreMIS) data is not currently used, however many residents are treated in the field by Emergency Medical Services (EMS) personnel for injuries that are not captured in other data sources. Utilization of PreMIS data in addition to other data sources will provide greater insight into the burden of unintentional falls among older adults in NC.
METHODS: Fifteen in-depth interviews were conducted with key stakeholders at the local, state, and national levels to understand the limitations, strengths, and potential opportunities of using PreMIS data for public health surveillance purposes. An analysis of unintentional falls will be completed comparing numbers of unintentional falls identified within the 2014 ED data to those identified within the 2014 PreMIS data. ED unintentional falls cases were determined by a primary diagnosis or external cause of injury ICD-9-CM code, and a primary external cause of injury code specific to unintentional fall (E800-E886, E888). Identified cases were limited to NC residents ages 65 and older. Cases will be identified within the PreMIS data based on primary and secondary provider impressions and then compared to the number of cases found in the ED data.
RESULTS: Seventy percent of stakeholders agreed or strongly agreed that PreMIS data is a valuable tool for public health surveillance. All stakeholders agreed that PreMIS data provides valuable information not available in other data sources that would be beneficial when used in combination with ED data. Seven stakeholders specifically mentioned the added value of using PreMIS data for falls surveillance. In 2014, there were 70,217 ED unintentional falls visits among older adults. 44.0% of those cases were transported to the ED by EMS. Of those transported, 70.5% were female, 39.8% were 85 or older, and 74.2% were insured by Medicare. Further PreMIS data analyses will be generated.
CONCLUSIONS: It is expected that PreMIS data is capturing additional cases of unintentional falls compared to ED data alone, since all EMS responses do not require transport and all ED patients are not transported by EMS. PreMIS data used in combination with ED data for injury surveillance offers a more complete picture of the unintentional falls burden among older adult residents in NC.