Oliver David, Daly Fergus, Martin Finbarr C, McMurdo Marion E T
Department of Health and Social Care, University of Reading, Bulmershe Court, Earley, Reading RG6 1HY, UK.
Age Ageing. 2004 Mar;33(2):122-30. doi: 10.1093/ageing/afh017.
To identify all published papers on risk factors and risk assessment tools for falls in hospital inpatients. To identify clinical risk assessment tools or individual clinical risk factors predictive of falls, with the ultimate aim of informing the design of effective fall prevention strategies.
Systematic literature review (Cochrane methodology). Independent assessment of quality against agreed criteria. Calculation of odds ratios and 95% confidence intervals for risk factors and of sensitivity, specificity, negative and positive predictive value for risk assessment tools (with odds ratios and confidence intervals), where published data sufficient.
28 papers on risk factors were identified, with 15 excluded from further analysis. Despite the identification of 47 papers purporting to describe falls risk assessment tools, only six papers were identified where risk assessment tools had been subjected to prospective validation, and only two where validation had been performed in two or more patient cohorts.
A small number of significant falls risk factors emerged consistently, despite the heterogeneity of settings namely gait instability, agitated confusion, urinary incontinence/frequency, falls history and prescription of 'culprit' drugs (especially sedative/hypnotics). Simple risk assessment tools constructed of similar variables have been shown to predict falls with sensitivity and specificity in excess of 70%, although validation in a variety of settings and in routine clinical use is lacking. Effective falls interventions in this population may require the use of better-validated risk assessment tools, or alternatively, attention to common reversible falls risk factors in all patients.
识别所有已发表的关于医院住院患者跌倒风险因素及风险评估工具的论文。识别可预测跌倒的临床风险评估工具或个体临床风险因素，最终目的是为有效预防跌倒策略的设计提供依据。
系统文献综述（采用Cochrane方法）。根据既定标准独立评估质量。在有足够已发表数据的情况下，计算风险因素的比值比和95%置信区间，以及风险评估工具的敏感性、特异性、阴性和阳性预测值（包括比值比和置信区间）。
识别出28篇关于风险因素的论文，其中15篇被排除在进一步分析之外。尽管识别出47篇声称描述跌倒风险评估工具的论文，但仅找到6篇对风险评估工具进行了前瞻性验证的论文，仅有2篇在两个或更多患者队列中进行了验证。
尽管研究背景存在异质性，但仍一致出现了一些重要的跌倒风险因素，即步态不稳、意识错乱、尿失禁/尿频、跌倒史以及“可疑”药物（尤其是镇静/催眠药）的处方。由相似变量构成的简单风险评估工具已显示出能以超过70%的敏感性和特异性预测跌倒，不过缺乏在各种环境和常规临床应用中的验证。针对该人群的有效跌倒干预可能需要使用经过更好验证的风险评估工具，或者关注所有患者中常见的可逆转跌倒风险因素。
