Lee Vivian, Appiah-Kubi Linda, Vogrin Sara, Zanker Jesse, Mitropoulos Joanna
Department of Geriatric Medicine, Western Health, Melbourne, VIC 3011, Australia.
Australian Institute for Musculoskeletal Science, AIMSS, Melbourne, VIC 3011, Australia.
Muscles. 2023 Jul 7;2(3):250-270. doi: 10.3390/muscles2030019.
Falls risk assessment tools are used in hospital inpatient settings to identify patients at increased risk of falls to guide and target interventions for fall prevention. In 2022, Western Health, Melbourne, Australia, introduced a new falls risk assessment tool, the Western Health St. Thomas' Risk Assessment Tool (WH-STRATIFY), which adapted The Northern Hospital's risk tool (TNH-STRATIFY) by adding non-English speaking background and falls-risk medication domains to reflect patient demographics. WH-STRATIFY replaced Peninsula Health Risk Screening Tool (PH-FRAT) previously in use at Western Health. This study compared the predictive accuracy of the three falls risk assessment tools in an older inpatient high-risk population.
To determine the predictive accuracy of three falls risk assessment tools (PH-FRAT, TNH-STRATIFY, and WH-STRATIFY) on admission to Geriatric Evaluation Management (GEM) units (subacute inpatient wards where the most frail and older patients rehabilitate under a multi-disciplinary team).
A retrospective observational study was conducted on four GEM units. Data was collected on 54 consecutive patients who fell during admission and 62 randomly sampled patients who did not fall between December 2020 and June 2021. Participants were scored against three falls risk assessment tools. The event rate Youden (Youden Index) indices were calculated and compared using default and optimal cut points to determine which tool was most accurate for predicting falls.
Overall, all tools had low predictive accuracy for falls. Using default cut points to compare falls assessment tools, TNH-STRATIFY had the highest predictive accuracy (Youden Index = 0.20, 95% confidence interval CI = 0.07, 0.34). The PH-FRAT (Youden Index = 0.01 and 95% CI = -0.04, 0.05) and WH-STRATIFY (Youden Index = 0.00 and 95% CI = -0.04, 0.03) were statistically equivalent and not predictive of falls compared to TNH-STRATIFY. When calculated optimal cut points were applied, predictive accuracy improved for PH-FRAT (Cut point 17, Youden Index = 0.14 and 95% CI = 0.01, 0.29) and WH-STRATIFY (Cut point 7, Youden Index = 0.18 and 95% CI = 0.00, 0.35).
TNH-STRATIFY had the highest predictive accuracy for falls. The predictive accuracy of WH-STRATIFY improved and was significant when the calculated optimal cut point was applied. The optimal cut points of falls risk assessment tools should be determined and validated in different clinical settings to optimise local predictive accuracy, enabling targeted fall risk mitigation strategies and resource allocation.
跌倒风险评估工具用于医院住院环境，以识别跌倒风险增加的患者，从而指导和针对性地采取预防跌倒的干预措施。2022年，澳大利亚墨尔本的西部健康医疗集团引入了一种新的跌倒风险评估工具——西部健康圣托马斯风险评估工具（WH - STRATIFY），该工具通过增加非英语背景和跌倒风险药物领域来调整北部医院的风险工具（TNH - STRATIFY），以反映患者人口统计学特征。WH - STRATIFY取代了西部健康医疗集团之前使用的半岛健康风险筛查工具（PH - FRAT）。本研究比较了这三种跌倒风险评估工具在老年住院高危人群中的预测准确性。
确定三种跌倒风险评估工具（PH - FRAT、TNH - STRATIFY和WH - STRATIFY）在老年评估管理（GEM）病房（最虚弱和老年患者在多学科团队下进行康复的亚急性住院病房）入院时的预测准确性。
对四个GEM病房进行了一项回顾性观察研究。收集了2020年12月至2021年6月期间连续54例住院期间跌倒的患者和62例随机抽样未跌倒患者的数据。根据三种跌倒风险评估工具对参与者进行评分。计算并比较使用默认和最佳切点的尤登指数（Youden Index），以确定哪种工具在预测跌倒方面最准确。
总体而言，所有工具对跌倒的预测准确性都较低。使用默认切点比较跌倒评估工具时，TNH - STRATIFY的预测准确性最高（尤登指数 = 0.20，95%置信区间CI = 0.07，0.34）。与TNH - STRATIFY相比，PH - FRAT（尤登指数 = 0.01，95% CI = -0.04，0.05）和WH - STRATIFY（尤登指数 = 0.00，95% CI = -0.04，0.03）在统计学上等效，且不能预测跌倒。当应用计算出的最佳切点时，PH - FRAT（切点17，尤登指数 = 0.14，95% CI = 0.01，0.29）和WH - STRATIFY（切点7，尤登指数 = 0.18，95% CI = 0.00，0.35）的预测准确性有所提高。
TNH - STRATIFY对跌倒的预测准确性最高。应用计算出的最佳切点时，WH - STRATIFY的预测准确性有所提高且具有显著性。应在不同临床环境中确定并验证跌倒风险评估工具的最佳切点，以优化局部预测准确性，从而制定有针对性的跌倒风险缓解策略和资源分配方案。
