Heinzmann Jeannelle, Rossen Michael L, Efthimiou Orestis, Baumgartner Christine, Wertli Maria M, Rodondi Nicolas, Aubert Carole E, Liechti Fabian D
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern.
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern; Institute of Primary Health Care (BIHAM), University of Bern, Bern.
Arch Phys Med Rehabil. 2025 Feb;106(2):292-299. doi: 10.1016/j.apmr.2024.06.015. Epub 2024 Jul 6.
To identify and quantify risk factors for in-hospital falls in medical patients.
Six databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar) were systematically screened until April 11, 2023, to identify relevant articles.
All titles and abstracts of the retrieved articles were independently screened by 2 researchers who also read the full texts of the remaining articles. Quantitative studies that assessed risk factors for falls among adult patients acutely hospitalized were included in the review. Publications that did not capture internal medicine patients or focused on other specific populations were excluded.
Information on study characteristics and potential risk factors were systematically extracted. Risk of bias was assessed using the Quality in Prognosis Studies tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies in Epidemiology guidelines were followed for reporting.
The main outcome was any in-hospital falls. Using a random-effects meta-analysis model, association measures for each risk factor reported in 5 or more studies were pooled. Separate analyses according to effect measure and studies adjusted for sex and age at least were performed. Of 5067 records retrieved, 119 original publications from 25 countries were included. In conclusion, 23 potential risk factors were meta-analyzed. Strong evidence with large effect sizes was found for a history of falls (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.63-3.96; I, 91%), antidepressants (pooled OR, 2.25; 95% CI, 1.92-2.65; I, 0%), benzodiazepines (OR, 1.97; 95% CI, 1.68-2.31; I, 0%), hypnotics-sedatives (OR, 1.90; 95% CI, 1.53-2.36; I, 46%), and antipsychotics (OR, 1.61; 95% CI, 1.33-1.95; I, 0%). Furthermore, evidence of associations with male sex (OR, 1.22, 95% CI, 0.99-1.50; I, 65%) and age (OR, 1.17, 95% CI, 1.02-1.35; I, 72%) were found, but effect sizes were small.
The comprehensive list of risk factors, which specifies the strength of evidence and effect sizes, could assist in the prioritization of preventive measures and interventions.
识别并量化内科住院患者院内跌倒的风险因素。
系统检索了六个数据库（MEDLINE、Embase、Cochrane系统评价数据库、Cochrane对照试验中央注册库、护理学与健康领域数据库和谷歌学术），直至2023年4月11日，以识别相关文章。
由2名研究人员独立筛选检索到的文章的所有标题和摘要，他们还阅读了其余文章的全文。纳入本综述的是评估急性住院成年患者跌倒风险因素的定量研究。未纳入内科患者或关注其他特定人群的出版物被排除。
系统提取了关于研究特征和潜在风险因素的信息。使用预后研究质量工具评估偏倚风险。报告遵循系统评价和Meta分析的首选报告项目以及流行病学观察性研究Meta分析指南。
主要结局为任何院内跌倒。使用随机效应Meta分析模型，汇总了5项或更多研究报告的每个风险因素的关联度量。至少根据效应度量以及针对性别和年龄进行调整的研究进行了单独分析。在检索到的5067条记录中，纳入了来自25个国家的119篇原始出版物。总之，对23个潜在风险因素进行了Meta分析。发现跌倒史（优势比[OR]，2.54；95%置信区间[CI]，1.63 - 3.96；I²，91%）、抗抑郁药（汇总OR，2.25；95%CI，1.92 - 2.65；I²，0%）、苯二氮䓬类药物（OR，1.97；95%CI，1.68 - 2.31；I²，0%）、催眠镇静药（OR，1.90；95%CI，1.53 - 2.36；I²，46%）和抗精神病药物（OR，1.61；95%CI，1.33 - 1.95；I²，0%）有强有力的证据且效应量较大。此外，发现与男性（OR，1.22，95%CI，0.99 - 1.50；I²，65%）和年龄（OR，1.17，95%CI，1.02 - 1.35；I²，72%）存在关联的证据，但效应量较小。
这份详细列出证据强度和效应量的风险因素综合清单，有助于对预防措施和干预措施进行优先排序。
