Vanderbilt University Medical Center, Department of Neurology, United States.
Vanderbilt Heart and Vascular Institute, Department of Clinical Administration, United States.
Epilepsy Behav. 2023 Mar;140:109080. doi: 10.1016/j.yebeh.2022.109080. Epub 2023 Jan 28.
Inpatient falls within the Epilepsy Monitoring Unit (EMU) are a common, and potentially preventable adverse event contributing to morbidity for patients living with epilepsy. Accurate fall risk screening is important to identify and efficiently allocate proper safety measures to high-risk patients, especially in EMUs with limited resources. We sought to compare existing screening tools for the ability to predict falls in the EMU.
This is a retrospective, single-center, case-controlled, comparative analysis of 7 nurse-administered fall risk assessment tools (NAFRAT) of patients admitted to the Vanderbilt University Medical Center (VUMC) EMU. Analysis of categorical data was compared using chi-square analysis while quantitative distributions were compared using student's t-test.
A total of 56 patient records (28 falls and 28 controls) were included in the analysis. Epilepsy Monitoring Unit falls were most common within the first 3 days of admission (p = .0094). Pre-admission documentation of falls was a strong predictor of falls within the EMU (p < .0001). Epilepsy Monitoring Unit falls were associated with documented falls after EMU discharge (p = .011). The John Hopkins fall risk assessment tool (JHFRAT) accurately stratified fall risk in the fall group compared to the control (p = .008), however, none of the 7 NAFRATs demonstrated significant categorical differences among the epilepsy subgroups. There was a significant difference in the distribution of quantitative scores, higher in the fall group according to the Morse Fall Scale (MFS) (p = 0.012), JHFRAT (p = 0.003), Schmid Fall Risk Assessment Scale (p = 0.029) and Hester-Davis Scale (p = 0.049). The modified Conley (p = 0.03) and Morse scale (p = 0.025) demonstrated differences in the distribution of quantitative scores in the epilepsy subgroups.
The findings of this study demonstrate variable accuracy of NAFRATs in assessing fall risk among patients admitted to the EMU, particularly among patients with epilepsy. The findings underscore the need for a validated, EMU-specific, fall assessment tool that accurately stratifies fall risk and inform efficient use of patient-specific fall prevention resources and protocols.
住院患者在癫痫监测单元（EMU）内跌倒，是导致癫痫患者发病和致残的常见、可预防的不良事件。准确的跌倒风险筛查对于识别和有效地为高风险患者分配适当的安全措施非常重要，尤其是在资源有限的 EMU 中。我们旨在比较现有的筛查工具在预测 EMU 内跌倒的能力。
这是一项回顾性、单中心、病例对照、比较分析，纳入了在范德比尔特大学医学中心（VUMC）EMU 住院的 7 种护士管理的跌倒风险评估工具（NAFRAT）的患者。使用卡方分析比较分类数据，使用学生 t 检验比较定量分布。
共纳入 56 例患者记录（28 例跌倒和 28 例对照）进行分析。EMU 内跌倒最常见于入院的前 3 天（p=0.0094）。EMU 前有跌倒病史是预测 EMU 内跌倒的有力指标（p<0.0001）。EMU 出院后有记录的跌倒与 EMU 内跌倒相关（p=0.011）。与对照组相比，约翰霍普金斯跌倒风险评估工具（JHFRAT）在跌倒组中准确地分层了跌倒风险（p=0.008），然而，7 种 NAFRAT 均未在癫痫亚组中表现出显著的分类差异。根据 Morse 跌倒量表（MFS）（p=0.012）、JHFRAT（p=0.003）、Schmid 跌倒风险评估量表（p=0.029）和 Hester-Davis 量表（p=0.049），跌倒组的定量评分分布存在显著差异，评分更高。改良 Conley（p=0.03）和 Morse 量表（p=0.025）在癫痫亚组的定量评分分布中存在差异。
本研究结果表明，NAFRAT 在评估 EMU 住院患者跌倒风险方面的准确性存在差异，尤其是在癫痫患者中。研究结果强调需要一种经过验证的、专门针对 EMU 的跌倒评估工具，该工具能够准确分层跌倒风险，并为患者特定的跌倒预防资源和方案的有效利用提供信息。
