The definition and classification of injurious falls varied substantially and most trials did not provide a reference for their definition. Injurious falls usually included diverse consequences, ranging from relatively minor injuries such as bruises or abrasions to fractures or other serious injuries requiring hospital admission.19 25 26 28 Most often the definition referred to either the presence of symptoms or the use of medical care.13 19 25 26 28 In other cases, injurious falls meant simply any self reported physical consequence of a fall, without any details.20 21 24 29 30 Some definitions specifically required the use of medical care,21 23 25 28 31 32 by using non-specific terms such as “fall for which medical care was sought,” “falls requiring medical care/medical attention,” or “medical consultations/visits.” When serious injuries were distinguished or specifically reported, their definition was more homogeneous across studies. Such injuries usually included fractures, severe soft tissue injuries requiring suturing, or other injuries leading to hospital admission.22 24 25 27 31 Some studies reported only fractures.33 34
Based on our review of case definitions used in the 17 studies, we distinguished four categories of injurious falls: those resulting in any reported consequences, including specific symptoms (ranging from bruises and cuts to more serious injuries such as fractures) or medical care; those resulting in medical care; those resulting in serious injuries such as fractures, head trauma, soft tissue injury requiring suturing, or any other injury requiring admission to hospital; and those resulting in fractures.
These categories represent increasingly specific subgroups of all injurious falls, which can also be considered to correspond to increasing levels of severity (except for those resulting in fracture, which is simply a specific type of serious injury).
Depending on the available data, a given study could contribute data relevant to one or more categories of injurious falls. Table 2⇓ gives the definitions of injurious falls reported in each selected article (as a direct quotation), the category or categories of injurious falls in which it was classified for this review, and the rate ratio used in the corresponding analysis. For two studies, the rate ratio could not be calculated because the authors provided only the number of participants who had an injurious fall (rather than the number of such falls). In these cases, we used the ratio of the risk of at least one injurious fall in both groups instead. Of note, the outcomes of injurious fall in those studies were severe injuries26 and fractures,34 two outcomes that are relatively rare, so that the risk ratio was likely to be close to the rate ratio.