Two people in the same hospital may differ in many ways that affect their chance of falling. Comparing a patient’s medication exposure at different points in the same stay can address some of those differences while raising new questions about what changed over time.
How the two analyses worked
Ishibashi and colleagues compared 325 patients who had a first inpatient fall with 1,295 age- and sex-matched patients who did not fall. In a separate case-crossover analysis, the investigators compared patients’ medication exposure at the fall with exposure at earlier points in their own stay. Suvorexant was associated with falls in both analyses. The reported odds ratios were 2.61 in the matched analysis and 1.78 in the within-person analysis.
What the comparison adds to a case review
The within-person design reduces the influence of characteristics that stay constant during the admission. It can still be affected by changes in health, mobility or care between the comparison times. The two estimates support a study-level association. To evaluate a specific fall, compare the medication administration record with the documented changes in the patient’s condition and activity.
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