The George Institute for Global Health, University of Sydney, PO Box M201, Missenden Road, Sydney NSW 2050, Australia.
J Clin Epidemiol. 2011 Jul;64(7):779-86. doi: 10.1016/j.jclinepi.2010.09.015. Epub 2011 Jan 19.
To develop and internally validate a falls prediction tool for people being discharged from inpatient aged care rehabilitation.
Prospective cohort study. Possible predictors of falls were collected for 442 aged care rehabilitation inpatients at two hospitals.
One hundred fifty participants fell in the 3 months after discharge from rehabilitation (34% of 438 with follow-up data). Predictors of falls were male gender (odds ratio [OR] 2.32, 95% confidence interval [CI]=1.00-4.03), central nervous system medication prescription (OR 2.04, 95% CI=1.00-3.30), and increased postural sway (OR 1.93, 95% CI=1.00-3.26). This three-variable model was adapted for clinical use by unit weighting (i.e., a score of 1 for each predictor present). The area under the receiver operating characteristic curve (AUC) for this tool was 0.69 (95% CI=0.64-0.74, bootstrap-corrected AUC=0.69). There was no evidence of lack of fit between prediction and observation (Hosmer-Lemeshow P=0.158).
After external validation, this simple tool could be used to quantify the probability with which an individual will fall in the 3 months after an aged care rehabilitation stay. It may assist in the discharge process by identifying high-risk individuals who may benefit from ongoing assistance or intervention.
为从住院老年康复护理出院的患者开发并内部验证一种跌倒预测工具。
前瞻性队列研究。在两家医院的 442 名老年康复护理住院患者中收集了跌倒的可能预测因素。
在从康复治疗出院后的 3 个月内，有 150 名参与者跌倒（438 名有随访数据的参与者中有 34%）。跌倒的预测因素为男性（优势比 [OR] 2.32，95%置信区间 [CI]=1.00-4.03）、中枢神经系统药物处方（OR 2.04，95% CI=1.00-3.30）和姿势摆动增加（OR 1.93，95% CI=1.00-3.26）。该三变量模型通过单位加权（即每个存在预测因子的评分 1）进行了临床应用的改编。该工具的受试者工作特征曲线下面积（AUC）为 0.69（95% CI=0.64-0.74， bootstrap 校正 AUC=0.69）。预测与观察之间没有证据表明拟合不足（Hosmer-Lemeshow P=0.158）。
经过外部验证后，这种简单的工具可用于量化个体在老年康复护理后 3 个月内跌倒的概率。它可以通过识别可能受益于持续帮助或干预的高风险个体，协助出院过程。
