Department of Medicine, Telemark Hospital, Skien, Norway.
Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital Sogn Arena, Oslo, Norway.
Scand J Caring Sci. 2020 Jun;34(2):332-339. doi: 10.1111/scs.12733. Epub 2019 Jul 11.
Falls among inpatients are common. The method used by The Norwegian Patient Safety Campaign to measure the adverse events is the Global Trigger Tool, which does not look at the causation for falls. This study was aimed at investigating major risk factors for falls in the hospital setting.
This retrospective case-control study was conducted at Telemark Hospital in Norway, in the period from September 2012 to August 2014. A total of 842 patients from three wards were included, whereof 172 cases had experienced one or more fall(s) during hospitalisation and 670 random controls had not fallen. Data were analysed according to a pragmatic strategy.
Compared with patients who did not fall, patients who fell were 21 times more likely to have poor balance (OR = 21.50, 95% CI: 10.26-45.04) and 19 times more likely to have very poor balance (OR = 19.62, 95% CI: 9.55-40.27), twice as likely to be men (OR = 1.82, 95% CI: 1.24-2.68), and 50% increased probability of fall with every 10 year increase of age (OR = 1.51, 95% CI: 1.34-1.69). Furthermore, the patients who fell were more likely to use antidepressant drugs (OR = 3.85, 95% CI: 1.09-13.63), antipsychotic drugs (OR = 3.27, 95% CI: 1.94-5.51), anxiolytic/hypnotic drugs (OR = 1.80, 95% CI: 1.22-2.67) and antiepileptic drugs (OR = 1.13, 95% CI: 1.11-4.06) than patients who did not fall.
During hospital stay, patients who fell had a higher risk profile than patients who did not fall. Clinicians should work to improve patients' safety and reduce the risk of falls by accurately assessing balance and mobility as a form of primary prevention. We recommend that a review of the patient medications should be conducted upon falling, as a form of a secondary preventive strategy against falls.
住院患者中跌倒的情况很常见。挪威患者安全运动用于测量不良事件的方法是全球触发工具（Global Trigger Tool），该工具不关注跌倒的原因。本研究旨在调查医院环境中跌倒的主要危险因素。
这是一项在挪威特伦马克医院进行的回顾性病例对照研究，研究时间为 2012 年 9 月至 2014 年 8 月。共有来自三个病房的 842 名患者入组，其中 172 例在住院期间发生了一次或多次跌倒，670 名随机对照患者没有跌倒。数据按照实用策略进行分析。
与未跌倒的患者相比，跌倒的患者平衡能力较差的可能性高 21 倍（OR=21.50，95%CI：10.26-45.04），平衡能力极差的可能性高 19 倍（OR=19.62，95%CI：9.55-40.27），男性的可能性高 2 倍（OR=1.82，95%CI：1.24-2.68），年龄每增加 10 岁，跌倒的可能性增加 50%（OR=1.51，95%CI：1.34-1.69）。此外，跌倒的患者使用抗抑郁药（OR=3.85，95%CI：1.09-13.63）、抗精神病药（OR=3.27，95%CI：1.94-5.51）、抗焦虑/催眠药（OR=1.80，95%CI：1.22-2.67）和抗癫痫药（OR=1.13，95%CI：1.11-4.06）的可能性高于未跌倒的患者。
住院期间，跌倒的患者比未跌倒的患者具有更高的风险特征。临床医生应通过准确评估平衡和活动能力作为一级预防措施，努力提高患者的安全性并降低跌倒风险。我们建议在跌倒后对患者的药物进行审查，作为跌倒二级预防策略的一种形式。
