Head Impacts in Long-Term Care Falls Are Common but Often Underrecognized: A Video-Based Analysis of Injury and Transport

Falls are the leading cause of injury-related morbidity and mortality among older adults, particularly in long-term care (LTC) facilities. Although head impacts are common during falls, the relationship between impact occurrence, injury characteristics, and hospital transport remains inadequately defined. The objectives of this study were to (1) compare falls with and without head impact, (2) quantify unrecognized head impacts and their contexts, (3) examine factors associated with head injury occurrence, and (4) identify predictors of hospital transport following head impacts. This secondary analysis used an open-source video dataset from two LTC facilities. Three raters reviewed each of the 300 fall videos to determine the presence of head impact. Transport and injury data were extracted directly from the open-source, observational video dataset. Falls were characterized using the Fall Video Analysis Questionnaire. Generalized estimating equations evaluated predictors of head injury, and logistic regression modeled predictors of hospital transport. Head impacts were common yet often underrecognized when relying on reported or visible injuries. Many falls without documented head injury demonstrated clear head impact on video, indicating that visible injury is a poor proxy for impact. Hospital transport following head impact was uncommon and was primarily associated with visible injuries rather than patient characteristics or fall history. Most head impacts, including those without obvious injury, did not result in transport. These findings suggest that reliance on external injury may lead to underrecognition and potential under-triage of head trauma. Improved detection strategies beyond visible injury are needed to better identify clinically significant head impacts.