使用NRS、PACD评分和FallRS预测住院期间跌倒：一项回顾性队列研究。
Prediction of In-Hospital Falls Using NRS, PACD Score and FallRS: A Retrospective Cohort Study.
作者信息
Siegwart Jennifer, Spennato Umberto, Lerjen Nathalie, Mueller Beat, Schuetz Philipp, Koch Daniel, Struja Tristan
机构信息
Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland.
Medical Faculty, University of Basel, 4001 Basel, Switzerland.
出版信息
Geriatrics (Basel). 2023 Jun 1;8(3):60. doi: 10.3390/geriatrics8030060.
BACKGROUND
Harmful in-hospital falls with subsequent injuries often cause longer stays and subsequently higher costs. Early identification of fall risk may help in establishing preventive strategies.
OBJECTIVE
To assess the predictive ability of different clinical scores including the Post-acute care discharge (PACD) score and nutritional risk screening score (NRS), and to develop a new fall risk score (FallRS).
METHODS
A retrospective cohort study of medical in-patients of a Swiss tertiary care hospital from January 2016 to March 2022. We tested the ability of the PACD score, NRS and FallRS to predict a fall by using the area under curve (AUC). Adult patients with a length of stay of ≥ 2 days were eligible.
RESULTS
We included 19,270 admissions (43% females; median age, 71) of which 528 admissions (2.74%) had at least one fall during the hospital stay. The AUC varied between 0.61 (95% confidence interval (CI), 0.55-0.66) for the NRS and 0.69 (95% CI, 0.64-0.75) for the PACD score. The combined FallRS score had a slightly better AUC of 0.70 (95% CI, 0.65-0.75) but was more laborious to compute than the two other scores. At a cutoff of 13 points, the FallRS had a specificity of 77% and a sensitivity of 49% in predicting falls.
CONCLUSIONS
We found that the scores focusing on different aspects of clinical care predicted the risk of falls with fair accuracy. A reliable score with which to predict falls could help in establishing preventive strategies for reducing in-hospital falls. Whether or not the scores presented have better predictive ability than more specific fall scores do will need to be validated in a prospective study.
背景
住院期间发生的有害跌倒及随后的损伤通常会导致住院时间延长，进而增加费用。早期识别跌倒风险可能有助于制定预防策略。
目的
评估包括急性后护理出院（PACD）评分和营养风险筛查评分（NRS）在内的不同临床评分的预测能力，并开发一种新的跌倒风险评分（FallRS）。
方法
对瑞士一家三级护理医院2016年1月至2022年3月的内科住院患者进行回顾性队列研究。我们使用曲线下面积（AUC）来测试PACD评分、NRS和FallRS预测跌倒的能力。住院时间≥2天的成年患者符合条件。
结果
我们纳入了19270例住院患者（43%为女性；中位年龄71岁），其中528例住院患者（2.74%）在住院期间至少发生了一次跌倒。NRS的AUC在0.61（95%置信区间（CI），0.55 - 0.66）之间，PACD评分的AUC为0.69（95%CI，0.64 - 0.75）。综合FallRS评分的AUC略好，为0.70（95%CI，0.65 - 0.75），但计算起来比其他两个评分更费力。在截断值为13分时，FallRS在预测跌倒方面的特异性为77%，敏感性为49%。
结论
我们发现，关注临床护理不同方面的评分对跌倒风险的预测具有一定准确性。一个可靠的跌倒预测评分有助于制定减少住院期间跌倒的预防策略。所呈现的评分是否比更具体的跌倒评分具有更好的预测能力，需要在前瞻性研究中进行验证。
Zotero 插件