Query purpose:
The Outdoor Falls query is designed to capture falls that occur outdoors within approximately 48 hours of the encounter and excludes activities more likely to result in a fall or intentionally caused the fall (e.g., hockey or assault). It is inclusive for all age groups and while it can be used year-round, it may be most beneficial during or after extreme weather or after human-caused events (e.g., stage collapse and panic results in falls).
How it works:
The Chief Complaint Discharge Diagnosis Parsed Free Text field (also applied to Chief Complaint History, Triage Notes, and Clinical Impression) is used to query discharge diagnosis codes and free text with exclusions (as necessary), to develop the syndrome definition.
Visits are included if they have either of the following:
- One or more of the inclusion diagnosis codes listed in Table 1
- Text terms or abbreviations that refer to falls and an outdoor-related term
Visits are excluded if they have Chief Complaint Discharge Diagnosis Parsed Free Text, Chief Complaint History, Triage Notes, or Clinical Impression text terms that:
- One or more of the exclusion diagnosis codes listed in Table 1
- Refer to an outside force that may have caused the fall
- Refer a possible medical cause for the fall
- Mention a week or a month period passing
- Mention a recreational activity more like to have falls (e.g., ice skating)
- Mention entering or exiting a vehicle
- Mention not being in an upright or standing position
- Indicate a subsequent visit
- Indicate a garage being the possible location
- Indicate was a possible suicide attempt
Plain language description:
The Outdoor Falls query is designed to capture potential accidental falls that may have occurred outdoors within the past 48 hours. This is done by looking for diagnosis codes from initial falls resulting from ice or snow and free text combinations of different ways to phrase ‘fall’ plus an outdoor indicator such as ‘sidewalk’ or ‘driveway’. It also has some measure in place to remove falls that occurred an extended period of time before the encounter (e.g., weeks or months), falls that may have been caused by an outside force (e.g, assault or hit by a car), potentially had a non-mobility related medical cause (e.g., stroke), or happened during a common activity or location where falls may be more likely to occur (e.g., gymnastics or at water park).
For consideration:
This query was only validated for Emergency visits, so use with other patient classes should be evaluated if a jurisdiction intends to monitor trends with other patient classes. Triage Notes and Clinical Impressions were included since they can greatly contribute to identifying where the fall occurred. If your jurisdiction does not include those elements, you may not be able to identify as many outdoor falls. This query was validated by states that experience snowfall. While warm weather months were reviewed as well, warmer states may want to validate their results before tracking trends. Finally, SNOMED CT codes are not included.
Core syntax: Chief Complaint Discharge Diagnosis Parsed Free Text; also apply to Chief Complaint History, Clinical Impression and TriageNote
Additional exclusion syntax: Clinical Impression and TriageNote (Separately)
Core ESSENCE Syntax
(,(,(,^F[ea]ll^,ANDNOT,(,^fallopian^,or,^falling out ^,or,^no fall^,or,^not f[ae]ll^,or,^denies any fall^,or,^deny any fall^,or,^denies recent fall^,or,^deny recent fall^,or,^denies any recent fall^,or,^deny any recent fall^,or,^denies fall^,or,^deny fall^,or,^without fall^,or,^w/o fall^,or,^wo fall^,or,^catheter fell^,or,^tube fell^,OR,^Past medical History^f[ae]ll^,OR,^fall at home^,or,^f[ae]ll off^,or,^F[ea]ll unconscious^,or,^fall of chest^,or,^falling back asleep^,or,^falling because of GSW^,or,!crib!,or,^swing^,or,^off ladder^,),or,^Slip^,ANDNOT,(,^dyslipidemia^,or,^pink slip^,or,^slipped dis^,or,^slip dis^,or,^disc slip^,or,^slipper^,or,^work slip^,OR,^past medical history^slip^,),or,(,Trip^,or,^ trip^,),ANDNOT,(,^trip to^,or,^tripod^,or,^bus trip^,or,^triple^,OR,^past medical history^ trip^,),),AND,(,^outside^,andnot,(,^outside room^,or,^outside of room^,or,^outside living room^,or,^outside bathroom^,or,^trauma activated outside of the hospital^,or,^Sign placed on door outside of room^,or,^the outside^,or,^go outside^,or,^outside UC^,or,^outside facility^,or,^outside medical^,or,^outside clinic^,or,^past medical history^outside^,or,^not outside^,or,^outside of the room^,or,^outside of her normal^,or,^outside of his normal^,or,^arrives from outside^,),or,^outdoor^,or,^sidewalk^,or,^Side walk^,or,^driveway^,or,^drive way^,or,^ cement^,andnot,(,^cement floor^,or,^past medical history^ cement^,),or,^parking lot^,or,^snow^,andnot,(,^snow board^,or,^snowmobile^,or,^snowboard^,),OR,^in the mud^,or,^in mud^,or,^some mud^,or,^on the farm^,or,^manure^,or,^gravel^,or,^curb^,or,^lawn^,or,^yard^,OR,^;Y93H2^,or,^;Y92007^,or,^;Y92480^,or,^;Y92828^,),or,^;W00^,ANDNOT,(,^;W00____[DS]^,or,^;W00___[DS]^,),or,(,^F[ae]ll^ on ice^,or,^slip^ on^ ice^,or,^fell on the ice^,or,^GLF on ice^,),andnot,^past medical history^ ice^,),),ANDNOT,(,^;Y932[23]^,or,^;V00321A^,or,^;V19^,or,^;V9322^,or,^;V86^,or,^;V00841A^,or,^;W0[4-9]^,OR,^;W1[1-6]^,OR,^asleep^,or,^assault^,andnot,^denies^assault^,or,^assult^,or,^altercation^,or,^fight^,or,^suicid^,ANDNOT,^Past Medical History^suicid^,or,^seizure^,ANDNOT,^Past Medical History^seizure^,or,^heart attack^,ANDNOT,^Past Medical History^heart attack^,or,^;I6[0-9]^,or,^stroke^,ANDNOT,^Past Medical History^stroke^,or,^ischemic attack^,ANDNOT,^Past Medical History^ischemic attack^,or,^cardiac arrest^,ANDNOT,^Past Medical History^cardiac arrest^,or,^collision^,and,^vehicle^,or,^week ago^,or,^weeks^,andnot,^past medical history^weeks^,or,^month ago^,or,^months^,andnot,^past medical history^months^,or,^denies new injury^,or,^deny new injury^,or,^ice skat^,or,^iceskat^,or,^getting into^,OR,^syncopal^,ANDNOT,^Past Medical History^syncopal^,OR,^garage^,OR,^pull^,OR,^mo ago^,OR,^bike^,or,^bicycl^,OR,^passed out^,ANDNOT,^past medical history^passed out^,OR,^golf cart^,OR,^scooter^,OR,^gym^,or,^getting out^,or,play^,or,^ play^,andnot,^past medical history^ play^,or,^pushed^,andnot,^past medical history^pushed^,or,^days^,andnot,(,^two days^,or,^2 days^,OR,^Past Medical History^days^,),OR,^standing in^,OR,^Crash^,or,^s[ck]ateboard^,or,^waterpark^,or,^monkey bar^,)
Additional Exclusion ESSENCE Syntax
ISNULL,OR,^,ANDNOT,(,^asleep^,or,^assault^,andnot, ^denies^assault^,or,^assult^,or,^altercation^,or,^fight^,or,^suicid^,ANDNOT,^Past Medical History^suicid^,or,^seizure^,ANDNOT,^Past Medical History^seizure^,or,^heart attack^,ANDNOT,^Past Medical History^heart attack^,or,^stroke^,ANDNOT,^Past Medical History^stroke^,or,^ischemic attack^,ANDNOT,^Past Medical History^ischemic attack^,or,^cardiac arrest^,ANDNOT,^Past Medical History^cardiac arrest^,or,^collision^,and,^vehicle^,or,^week ago^,or,^weeks^,andnot,^past medical history^weeks^,or,^month ago^,or,^months^,andnot,^past medical history^months^,or,^denies new injury^,or,^deny new injury^,or,^ice skat^,or,^iceskat^,or,^getting into^,OR,^syncopal^,ANDNOT,^Past Medical History^syncopal^,OR,^garage^,OR,^pull^,OR,^mo ago^,OR,^bike^,OR,^passed out^,ANDNOT,^past medical history^passed out^,OR,^golf cart^,OR,^scooter^,OR,^gym^,or,^getting out^,or,play^,or,^ play^,andnot,^past medical history^ play^,or,^pushed^,andnot,^past medical history^pushed^,or,^days^,andnot,(,^two days^,or,^2 days^,OR,^Past Medical History^days^,),OR,^standing in^,OR,^Crash^,or,^s[ck]ateboard^,or,^waterpark^,or,^monkey bar^,)