Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular setting s , but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment
INTRODUCTION Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals .
Design -related bias in evaluations of tool predictive accuracy could lead to overoptimistic results , which would then contribute to program failure in practice .
A comparative study of the use of four fall risk assessment tools on acute medical wards.
OBJECTIVES To compare the effectiveness of four falls risk assessment tools ( STRATIFY , Downton , Tullamore , and Tinetti ) by using them simultaneously in the same environment . DESIGN Prospect i ve , open , observational study . SETTING Two acute medical wards admitting predominantly older patients . PARTICIPANTS One hundred thirty-five patients , 86 female , mean age+/-st and ard deviation 83.8+/-8.01 ( range 56 - 100 ) . MEASUREMENTS A single clinician prospect ively completed the four falls risk assessment tools . The extent of completion and time to complete each tool was recorded . Patients were followed until discharge , noting the occurrence of falls . The sensitivity , specificity , negative predictive accuracy , positive predictive accuracy , and total predictive accuracy were calculated . RESULTS The number of patients that the STRATIFY correctly identified ( n=90 ) was significantly higher than the Downton ( n=46 ; P<.001 ) , Tullamore ( n=66 ; P=.005 ) , or Tinetti ( n=52 ; P<.001 ) tools , but the STRATIFY had the poorest sensitivity ( 68.2 % ) . The STRATIFY was also the only tool that could be fully completed in all patients ( n=135 ) , compared with the Downton ( n=130 ; P=.06 ) , Tullamore ( n=130 ; P=.06 ) , and Tinetti ( n=17 ; P<.001 ) . The time required to complete the STRATIFY tool ( average 3.85 minutes ) was significantly less than for the Downton ( 6.34 minutes ; P<.001 ) , Tinetti ( 7.4 minutes ; P<.001 ) , and Tullamore ( 6.25 minutes ; P<.001 ) . The Kaplan-Meier test showed that the STRATIFY ( log rank P=.001 ) and Tullamore tools ( log rank P<.001 ) were effective at predicting falls over the first week of admission . The Downton ( log rank P=.46 ) and Tinetti tools ( log rank P=.41 ) did not demonstrate this characteristic . CONCLUSION Significant differences were identified in the performance and complexity between the four risk assessment tools studied . The STRATIFY tool was the shortest and easiest to complete and had the highest predictive value but the lowest sensitivity
Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular setting s , but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment
INTRODUCTION Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals .
Design -related bias in evaluations of tool predictive accuracy could lead to overoptimistic results , which would then contribute to program failure in practice .