All Title Author
Keywords Abstract

PLOS ONE  2012 

Can Falls Risk Prediction Tools Correctly Identify Fall-Prone Elderly Rehabilitation Inpatients? A Systematic Review and Meta-Analysis

DOI: 10.1371/journal.pone.0041061

Full-Text   Cite this paper   Add to My Lib


Background Falls of elderly people may cause permanent disability or death. Particularly susceptible are elderly patients in rehabilitation hospitals. We systematically reviewed the literature to identify falls prediction tools available for assessing elderly inpatients in rehabilitation hospitals. Methods and Findings We searched six electronic databases using comprehensive search strategies developed for each database. Estimates of sensitivity and specificity were plotted in ROC space graphs and pooled across studies. Our search identified three studies which assessed the prediction properties of falls prediction tools in a total of 754 elderly inpatients in rehabilitation hospitals. Only the STRATIFY tool was assessed in all three studies; the other identified tools (PJC-FRAT and DOWNTON) were assessed by a single study. For a STRATIFY cut-score of two, pooled sensitivity was 73% (95%CI 63 to 81%) and pooled specificity was 42% (95%CI 34 to 51%). An indirect comparison of the tools across studies indicated that the DOWNTON tool has the highest sensitivity (92%), while the PJC-FRAT offers the best balance between sensitivity and specificity (73% and 75%, respectively). All studies presented major methodological limitations. Conclusions We did not identify any tool which had an optimal balance between sensitivity and specificity, or which were clearly better than a simple clinical judgment of risk of falling. The limited number of identified studies with major methodological limitations impairs sound conclusions on the usefulness of falls risk prediction tools in geriatric rehabilitation hospitals.


[1]  Healey F, Scobie S, Oliver D, Pryce A, Thomson R, et al. (2008) Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports. Qual Saf Health Care 17: 424–430.
[2]  Bates DW, Pruess K, Souney P, Platt R (1995) Serious falls in hospitalized patients: correlates and resource utilization. Am J Med 99: 137–143.
[3]  Saverino A, Benevolo E, Ottonello M, Zsirai E, Sessarego P (2006) Falls in a rehabilitation setting: functional independence and fall risk. Eura Medicophys 42: 179–184.
[4]  National Patient Safety Agency (2007) Slips, trips and falls in hospital. Accessed 2011 Nov 5.
[5]  Rousseau P (1993) Immobility in the aged. Arch Fam Med 2: 169–177; discussion 178.
[6]  Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ (1997) Fear of falling and restriction of mobility in elderly fallers. Age Ageing 26: 189–193.
[7]  Centers for Disease Control and Prevention (2007) Preventing falls among older adults. Accessed 2011 Mar 21.
[8]  PHAC - Public Health Agency of Canada. Division of Aging and Seniors (2005) Report on Seniors’ falls in Canada. Accessed 2011 Nov 5.
[9]  Evans D, Hodgkinson B, Lambert L, Wood J, Kowanko I (1998) Falls in acute hospitals: a systematic review. The Joanna Briggs Institute for Evidence Based Nursing and Midwifery.
[10]  Vlahov D, Myers AH, al-Ibrahim MS (1990) Epidemiology of falls among patients in a rehabilitation hospital. Arch Phys Med Rehabil 71: 8–12.
[11]  Uden G (1985) Inpatient accidents in hospitals. J Am Geriatr Soc 33: 833–841.
[12]  Vassallo M, Sharma JC, Briggs RS, Allen SC (2003) Characteristics of early fallers on elderly patient rehabilitation wards. Age Ageing 32: 338–342.
[13]  Vieira ER, Freund-Heritage R, da Costa BR (2011) Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review. Clin Rehabil 25: 788–799.
[14]  Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, et al. (2003) Interventions for preventing falls in elderly people. Cochrane Database Syst Rev. CD000340 p.
[15]  Oliver D (2006) Assessing the risk of falls in hospitals: time for a rethink? Can J Nurs Res 38: 89–94; discussion 95–86.
[16]  Morse JM (2006) The safety of safety research: the case of patient fall research. Can J Nurs Res 38: 73–88.
[17]  Oliver D, Papaioannou A, Giangregorio L, Thabane L, Reizgys K, et al. (2008) A systematic review and meta-analysis of studies using the STRATIFY tool for prediction of falls in hospital patients: how well does it work? Age Ageing 37: 621–627.
[18]  Hayden JA, Cote P, Bombardier C (2006) Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 144: 427–437.
[19]  Oliver D, Britton M, Seed P, Martin FC, Hopper AH (1997) Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. BMJ 315: 1049–1053.
[20]  Coker E, Oliver D (2003) Evaluation of the STRATIFY falls prediction tool on a geriatric unit. Outcomes Manag 7: 8–14; quiz 15–16.
[21]  Harbord RM, Whiting P (2009) Metandi: Meta–analysis of diagnostic accuracy using hierarchical logistic regression. Stata Journal 9: 211–229.
[22]  Haines TP, Bennell KL, Osborne RH, Hill KD (2006) A new instrument for targeting falls prevention interventions was accurate and clinically applicable in a hospital setting. J Clin Epidemiol 59: 168–175.
[23]  Vassallo M, Poynter L, Sharma JC, Kwan J, Allen SC (2008) Fall risk-assessment tools compared with clinical judgment: an evaluation in a rehabilitation ward. Age Ageing 37: 277–281.
[24]  Haines TP, Hill K, Walsh W, Osborne R (2007) Design-related bias in hospital fall risk screening tool predictive accuracy evaluations: systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci 62: 664–672.
[25]  Higgins JP, (editors) GS (2009) Meta-analyses with continuous outcomes. In: Collaboration TC, editor. Cochrane Handbook for Systematic Reviews of Interventions.
[26]  Macaskill P, Gatsonis C, Deeks J, Harbord R, Takwoingi Y (2010) Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Chapter 10 Analysing and Presenting Results. In: Deeks JJ, Bossuyt PM, Gatsonis C, editors: The Cochrane Collaboration.


comments powered by Disqus