Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium.
J Am Geriatr Soc. 2012 Jun;60(6):1115-21. doi: 10.1111/j.1532-5415.2012.03957.x. Epub 2012 May 29.
To assess the value of nurses' clinical judgment (NCJ) in predicting hospital inpatient falls.
Prospective multicenter study.
Six Belgian hospitals.
Two thousand four hundred seventy participants (mean age 67.6 ± 18.3; female, 55.7%) on four surgical (n = 812, 32.9%), eight geriatric (n = 666, 27.0%), and four general medical wards (n = 992, 40.1%) were included upon admission. All participants were hospitalized for at least 48 hours.
Within 24 hours after admission, nurses gave their judgment on the question "Do you think your patient is at high risk for falling?" Nurses were not trained in assessing fall risk. Falls were documented on a standardized incident report form.
During hospitalization, 143 (5.8%) participants experienced one or more falls, accounting for 202 falls and corresponding to an overall rate of 7.9 falls per 1,000 patient days. NCJ of participant's risk of falling had high sensitivity (78-92%) with high negative predictive value (94-100%) but low positive predictive value (4-17%). Although false-negative rates were low (8-22%) for all departments and age groups, false-positive rates were high (55-74%), except on surgical and general medical wards and in participants younger than 75.
This analysis, based on multicenter data and a large sample size, suggests that NCJ can be recommended on surgical and general medical wards and in individuals younger than 75, but on geriatric wards and in participants aged 75 and older, NCJ overestimates risk of falling and is thus not recommended because expensive comprehensive fall-prevention measures would be implemented in a large number of individuals who do not need it.
评估护士临床判断（NCJ）在预测医院住院患者跌倒中的价值。
前瞻性多中心研究。
比利时六家医院。
共纳入 2477 名参与者（平均年龄 67.6±18.3 岁；女性占 55.7%），分别在 4 个外科病房（n=812，32.9%）、8 个老年病房（n=666，27.0%）和 4 个普通内科病房（n=992，40.1%）接受入院评估。所有参与者的住院时间均至少为 48 小时。
在入院后 24 小时内，护士对“您认为您的患者有跌倒高风险吗？”这一问题进行判断。护士未接受过评估跌倒风险的培训。使用标准化事件报告表记录跌倒情况。
住院期间，共有 143 名（5.8%）参与者发生 1 次或多次跌倒，共发生 202 次跌倒，总跌倒发生率为每 1000 患者天 7.9 次。NCJ 对参与者跌倒风险的判断具有较高的敏感性（78%-92%）和较高的阴性预测值（94%-100%），但阳性预测值较低（4%-17%）。尽管所有科室和年龄组的假阴性率均较低（8%-22%），但假阳性率较高（55%-74%），除了外科和普通内科病房以及 75 岁以下的参与者。
基于多中心数据和大样本量的分析表明，NCJ 可在外科和普通内科病房以及 75 岁以下的参与者中推荐使用，但在老年病房以及 75 岁及以上的参与者中，NCJ 高估了跌倒风险，因此不建议使用，因为需要实施昂贵的全面跌倒预防措施的人数众多，但这些人中许多人并不需要。
