2.1

Study design and setting

This investigation was a one-year prospective cohort descriptive study at two community teaching hospitals that were both level-one trauma centers that began on August 15, 2019. Both hospitals are in the same county in southeast Florida and are the only level-one trauma centers serving this county. The EDs have annual volumes of 50,000 and 69,000 patients. This project has been approved by the research committees of the participating hospitals and the university institutional review board. The primary outcome measure is the patient-reported PCP follow-up rate of patients who had presented to the ED with a head injury following a fall.

2.2

Selection of patients

ED patients’ age ≥65 who suffered head trauma associated with a ground-level fall were identified. Inclusion criteria included ED head CT or an ICD-10 code beginning with S00 to S09. Exclusion criteria were patients in which the injury occurred >24 h before presentation, penetrating injuries, open wounds due to a foreign object, and patients transferred to the hospital. Patients who we were unable to reach on Day 14 as well as those who did not consent to participate were also excluded.

2.3

Data collection and processing

Trained research assistants (RAs) performed structured chart reviews of hospital records on all enrolled study subjects. In addition, follow-up telephone interviews were conducted in English, Spanish or Haitian Creole. The initial telephone follow-up was made 14 days after discharge from the hospital. If no response was received on the first attempt, a voicemail was left and two subsequent attempts were made on different days and times.

Prior to the start of data collection, RAs were trained on the conduct of human research trials and structured telephone interviews. The project investigators provided regular feedback and answered questions. All telephone interviews were conducted from a hospital telephone number. The following demographic and clinical characteristics were collected from the hospital EMR.

2.4

Outcome measures

Primary outcomes were PCP follow-up, PCP performance of fall assessment and whether any fall intervention was initiated.

PCP follow-up: Participants were asked: “Have you followed up with your PCP since being discharged from the hospital?” Those that responded negatively or did not know were included in the no follow-up group.

Fall assessment: Participants were asked: “Did your PCP assess the reason that you fell?” Those that responded negatively or did not know were included in the no follow-up group.

Fall interventions: Participants were asked: “Have you or your PCP started any interventions since your original ED/hospital discharge?” If yes, recommendations for specific interventions were categorized into types based on: exercise activity, home modification, physical therapy/occupational therapy/rehabilitation, mobility aid, medication change, health aid, medical intervention, and footwear modification.

2.5

Primary data analysis

Statistical analyses were performed using the Statistical Package for the Social Sciences, version 27 (SPSS, IBM Corp, Armonk, NY, USA). Demographic and clinical characteristics were compared between groups based on patient-reported PCP follow-up. Pearson’s chi-square and t -test were used for categorical and continuous data respectively. P values <0.05 were considered statistically significant.