Journal of Korean Academy of Fundamentals of Nursing (기본간호학회지)

Korean Academy of Fundamentals of Nursing (기본간호학회)
권호 표지
DOI QR코드

DOI QR Code

Predictive Effects of Previous Fall History on Accuracy of Fall Risk Assessment Tool in Acute Care Settings

기존 낙상위험 사정 도구의 낙상 과거력 변인 효과

  • Received : 2012.01.24
  • Accepted : 2012.11.25
  • Published : 2012.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To explore the usefulness of previous fall history as a triage variable for inpatients. Methods: Medical records of 21,382 patients, admitted to medical units of one tertiary hospital, were analyzed retrospectively. Inpatient falls were identified from the hospital's self-report system. Non-falls in 1,125 patients were selected by a stratified matching sampling with 125 patients with falls (0.59%). A comparative and predictive accuracy analysis was conducted to describe differences between the two groups with and without a history of falls. Logistic regression was used to measure the effect size of the fall history. Results: The fall history group showed higher prevalence by 9 fold than the non-fall history group. The relationships between falls and relevant variables which were significant in the non-fall history group, were not significant for the fall history group. Falls in the fall history group were 25 times more likely than in the non-fall group. Predictive accuracy of the risk assessment tool showed almost zero specificity in the fall history group. Conclusion: The presence of fall history, the fall prevalence, variables relevant to falls, and the accuracy of the risk tool were different, which support the usefulness of the fall history as a triage variable.

Keywords

References

  1. Brenner, H., & Gefeller, O. (1997). Variation of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence. Statistics in Medicine, 16, 981-991. https://doi.org/10.1002/(SICI)1097-0258(19970515)16:9<981::AID-SIM510>3.0.CO;2-N
  2. Capezuti, E., Zwicker, D., Mezey, M., Fulmer, T., Gray-Miceli, D., & Kluger, M. (2008). Evidence-based geriatric nursing protocols for best practice (3rd ed.). New York: Springer Publishing Company.
  3. Currie, L. M., Mellino, L. V., Cimino, J. J., & Bakken, S. (2004). Development and representation of a fall-injury risk assessment instrument in a clinical information system. Studies in Health Technology and Informatics, 107, 721-725.
  4. Dykes, P. C., Carroll, D. L., Hurley, A., Lipsitz, S., Bcomm, A. B., Chang, F., et al., (2010). Fall prevention in acute care hospitals: A randomized trial. Journal of the American Medical Association, 304, 1912-1918. https://doi.org/10.1001/jama.2010.1567
  5. Healey, F., Monro, A., Cockram, A., Adams, V., & Heseltine, D. (2004). Using targeted risk factor reduction to prevent falls in older in-patients: A randomized controlled trial. Age and Ageing, 33, 390-395. https://doi.org/10.1093/ageing/afh130
  6. Hendrich, A. L., Bender, P. S., & Nyhuis, A. (2003). Validation of the Hendrich II Fall Risk Model: a large concurrent case/control study of hospitalized patients. Applied Nursing Research, 16, 9-21. https://doi.org/10.1053/apnr.2003.016009
  7. Hitcho, E. B., Krauss, M. J., Birge, S., Claiborne Dunagan, W., Fisher, I., Johnson, S., et al. (2004). Characteristics and circumstances of falls in a hospital setting: A prospective analysis. Journal of General Internal Medicine, 19, 732-739. https://doi.org/10.1111/j.1525-1497.2004.30387.x
  8. Kim, C. G., & Seo, M. J. (2002). An analysis of fall incidence rate and its related factors of fall in hospital. Journal of Korean Society of Quality Assurance in Health Care, 9, 210-228.
  9. Kim, E. J., Lee, J. C., & Eom, M. R. (2008). Falls risk factors of inpatients. Journal of Korean Academy of Nursing, 38, 676-684. https://doi.org/10.4040/jkan.2008.38.5.676
  10. Kim, K. S., Kim, J. A., Kim, M. S., Kim, Y. J., Kim, E. S., Park, K. O., et al. (2009). Developement of performance measures based on the nursing process for prevention and management of pressure ulcers, falls and pain. Journal of Korean Clinical Nursing Research, 15, 133-147.
  11. Kwon, I. G., & Kim, K. H. (2007). A study on the variables forecasting elderly inpatients' fall experience. Journal of Korean Academy of Psychiatric and Mental Health Nursing, 16, 59-68.
  12. Lee, K. O., Shin, H. J., Park, H. A., Jeong, H. M., Lee, M. H., Choi, E. H., et al. (2000). Patient severity classification in a medical ICU using APACHE III and patient severity classification Tool. Journal of Korean Academy Nursing, 30, 1243-1253. https://doi.org/10.4040/jkan.2000.30.5.1243
  13. Mahoney, J. E. (1998). Immobility and falls. Clinics in Geriatric Medicine, 14, 699-726.
  14. McFarlane-Kolb, H. (2004). Falls risk assessment, multitargeted interventions and the impact on hospital falls. International Journal of Nursing Practice, 10, 199-206. https://doi.org/10.1111/j.1440-172X.2004.00482.x
  15. Milisen, K., Staelens, N., Schwendimann, R., De Paepe, L., Verhaeghe, J., Braes, T., et al. (2007). Fall prediction in inpatients by bedside nurses using the St. Thomas's Risk Assessment Tool in falling elderly inpatients (STRATIFY) instrument: A multicenter study. Journal of the American Geriatrics Society, 55, 725-733. https://doi.org/10.1111/j.1532-5415.2007.01151.x
  16. Morse, J. M., Prowse, M. D., Morrow, N., & Federspeil, G.(1985). A retrospective analysis of patient falls. Canadian Journal of Public Health, 76, 116-118.
  17. O'conell, B., & Myers, H. (2002). The sensitivity and specificity of the Morse Fall Scale in acute care setting. Journal of Clinical Nursing. 11, 134-135. https://doi.org/10.1046/j.1365-2702.2002.00578.x
  18. Oliver, D., Daly, F., Martin, F. C., & McMurdo, M. E. (2004). Risk factors and risk assessment tools for falls in hospital inpatients: A systematic review. Age and Ageing, 33, 122-130. https://doi.org/10.1093/ageing/afh017
  19. Park, I. S., Cho, I. S., Kim, E. M., & Kim, M. K. (2011). Evaluation of a fall risk assessment tool to establish a continuous quality improvement process for inpatients' falls. Journal of Korean Academy of Nursing Administration, 17, 484-492. https://doi.org/10.11111/jkana.2011.17.4.484
  20. Poe, S. S., Cvach, M. M., Gartrelu, D. G., Radzik, B. R., Joy, T. L. (2005). An evidence-based approach to fall risk assessment, prevention, and management: Lessons learned. Journal of Nursing Care Quality, 20, 107-116. https://doi.org/10.1097/00001786-200504000-00004
  21. Poses, R. M., Cebul, R. D., Collins, M., & Fager, S. S. (1986). The importance of disease prevalence in transporting clinical prediction rules: The case of streptococcal pharyngitis. Annals of Internal Medicine, 105, 586-591. https://doi.org/10.7326/0003-4819-105-4-586
  22. Reddy, M., Gill, S. S., Rochon, P. A. (2006). Preventing pressure ulcers: A systematic review, Journal of the American Medical Association, 296, 974-984. https://doi.org/10.1001/jama.296.8.974
  23. Rubenstein, L. Z., Powers, C. M., & MacLean, C. H. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine, 135, 686-693. https://doi.org/10.7326/0003-4819-135-8_Part_2-200110161-00007
  24. Ruchinskas, R. (2003). Clinical prediction of falls in the elderly. American Journal of Physical Medicine & Rehabilitation, 82, 273-278.
  25. Sohng, K. Y., & Choi, D. W. (2007). Instrumental activities of daily living, leg muscle strength, cognitive and visual function according to demographic variables and the experience of falling in community resident elderly Koreans. Journal of Korean Academy of Fundamentals of Nursing, 14, 221-229.
  26. Steinberg, D. M., Fine, J., & Chappell, R. (2009). Sample size for positive and negative predictive value in diagnostic research using case-control designs. Biostatistics, 10, 94-105.
  27. Sung, Y. H., Kwon, I. G., & Kim, K. H. (2006). Factors influencing falls in inpatients. Journal of Korean Academy of Fundamentals of Nursing, 13, 200-207.
  28. The Joint Commission. (2007). Improving America's Hospitals: A Report on Quality and Safety. Retrieved January 9, 2012, from Joint commission website: http://www.jointcommission.org/assets/1/6/2006_Annual_Report.pdf
  29. Vassallo, M., Vignaraja, R., Sharma, J. C., Hallam, H., Binns, K., Briggs, R., et al. (2004). The effect of changing practice on fall prevention in a rehabilitative hospital: The hospital injury prevention study. Journal of the American Geriatrics Society, 52, 335-339. https://doi.org/10.1111/j.1532-5415.2004.52102.x

Cited by

  1. Comparison of the predictive validity of three fall risk assessment tools and analysis of fall‐risk factors at a tertiary teaching hospital vol.29, pp.17, 2012, https://doi.org/10.1111/jocn.15387