Objective: Falls in the elderly pose significant health risk with substantial effects on health resource utilization and cost; 95% of hip fractures are due to falls. Previous estimates of the costs of falls used administrative data which underestimate falls incidence. We aimed to estimate the direct health costs of injurious falls requiring Emergency Department (ED) care. Methods: Information was collected on patients >70 years who presented to the ED of Vancouver General Hospital. Fallers were identified though a search of ED census, ED presenting complaints, ED consultant records, and patient charts for reports of a fall. From hospital reports, data were collected on patient demographics, diagnoses, admission status, and hospital length of stay. Total costs were estimated for each fall from the third payer perspective. Unit cost estimates for ED visits, and hospitalizations were taken from a fully allocated hospital cost model. Results: Between December 1 2006 and March 31 2007, we identified 390 falls by 381 individuals costing $2,520,641. The mean age of fallers was 83.6 years (SD:7.4); 69% were women. Fallers sustained 183 (47%) fractures – these included 70 hip (39%) and 22 pelvic (12%) fractures. Other common diagnoses were contusions/lacerations (n=63, 16%), and syncope (n=31, 8%). 134 (34%) falls resulted in hospital admission with an average length of stay of 31.6 days (SD:41.59) and mean cost of $18,375 (SD:23601). Logistic regression analysis showed that compared to those <80 years, those >80 years were more likely to be hospitalized (OR:1.8, 95% CI:1.1-3.0). Women were more likely than men to be hospitalized (OR=1.5, 95% CI:0.9-2.4), however this association was not statistically significant. After adjusting for age and sex, a diagnosis of “fracture” was the strongest predictor of hospitalization (OR:15.5, 95% CI:8.2-27.2). Conclusion: Among seniors, the significant cost of fall related hospital admissions warrants increased fall prevention programs in this population.