The Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA.
BMC Emerg Med. 2009 Sep 28;9:19. doi: 10.1186/1471-227X-9-19.
More than one-third of US adults 65 and over fall every year. These falls may cause serious injury including substantial long-term morbidity (due declines in activities of daily living) and death. The emergency department (ED) visit represents an opportunity for identifying high risk elders and potentially instituting falls-related interventions. The unique characteristic of the ED environment and patient population necessitate that risk-assessment modalities be validated in this specific setting. In order to better identify elders at risk of falls, we examined the relationship between patient-provided history of falling and two testing modalities (a balance plate system and the timed up-and-go [TUG] test) in elder emergency department (ED) patients.
We conducted a cross-sectional observational study of patients > or = 60 years old being discharged from the ED. Patient history of falls in the past week, month, 6 months, and year was obtained. Balance plate center of pressure excursion (COP) measurements and TUG testing times were recorded. COP was recorded under four conditions: normal stability eyes open (NSEO) and closed (NSEC), and perturbed stability eyes open and closed. Correlation between TUG and COP scores was measured. Univariate logistic regression was used to identify the relationship between patient-provided falls history and the two testing modalities. Proportions, likelihood ratios, and receiver-operating-characteristic (ROC) curves for prediction of previous falls were reported.
Fifty-three subjects were enrolled, 11% had fallen in the previous week and 42% in the previous year. There was no correlation between TUG and any balance plate measurements. In logistic regression, neither testing modality was associated with prior history of falls (p > 0.05 for all time periods). Balance plate NSEO and NSEC testing cutoffs could be identified which were 83% sensitive and had a negative likelihood ratio (LR-) of 0.3 for falls in the past week. TUG testing was not useful for falls in the past week, but performed best for more distant falls in the past month, 6 months, or year. TUG cutoffs with sensitivity over 80% and LR(-) of 0.17-0.32 could be identified for these time periods.
Over 40% of community-dwelling elder ED patients report a fall within the past year. Balance plate and TUG testing were feasibly conducted in an ED setting. There is no relationship between scores on balance plate and TUG testing in these patients. In regression analysis, neither modality was significantly associated with patient provided history of falls. These modalities should not be adopted for screening purposes in elders in the ED setting without validation in future studies or as part of multi-factorial risk assessment.
超过三分之一的 65 岁及以上的美国成年人每年都会摔倒。这些跌倒可能会导致严重伤害，包括大量长期发病（由于日常生活活动能力下降）和死亡。急诊科（ED）就诊是识别高风险老年人并可能实施跌倒相关干预措施的机会。ED 环境和患者人群的独特特征需要在特定环境中验证风险评估模式。为了更好地识别有跌倒风险的老年人，我们研究了患者提供的跌倒史与两种测试模式（平衡板系统和计时起立行走测试[TUG]）在老年 ED 患者中的关系。
我们对从 ED 出院的年龄≥60 岁的患者进行了横断面观察性研究。获得了过去一周、一个月、六个月和一年的患者跌倒史。记录平衡板中心压力偏移（COP）测量值和 TUG 测试时间。在四种情况下记录 COP：正常稳定睁眼（NSEO）和闭眼（NSEC）以及受扰稳定睁眼和闭眼。测量 TUG 和 COP 评分之间的相关性。使用单变量逻辑回归来确定患者提供的跌倒史与两种测试模式之间的关系。报告了先前跌倒的预测比例、似然比和受试者工作特征（ROC）曲线。
共纳入 53 名受试者，11%的患者在过去一周内跌倒，42%的患者在过去一年内跌倒。TUG 与任何平衡板测量值均无相关性。在逻辑回归中，两种测试模式均与既往跌倒史无关（所有时间段的 p > 0.05）。可以确定平衡板 NSEO 和 NSEC 测试的截止值，这些截止值在过去一周内跌倒的敏感性为 83%，负似然比（LR-）为 0.3。TUG 测试对于过去一周的跌倒没有帮助，但对于过去一个月、六个月或一年的跌倒效果最佳。可以为这些时间段确定超过 80%的敏感性和 0.17-0.32 的 LR-的 TUG 截止值。
超过 40%的社区居住的 ED 老年患者在过去一年中报告跌倒。在 ED 环境中可行地进行了平衡板和 TUG 测试。这些患者的平衡板和 TUG 测试得分之间没有关系。在回归分析中，两种模式均与患者提供的跌倒史无显著关联。在没有未来研究验证或作为多因素风险评估的一部分的情况下，这些模式不应用于 ED 环境中老年人的筛查目的。
