Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis.
Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis.
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DOI：
10.1186/1472-6963-13-122
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发表时间：
2013-04-02
影响因子：
2.8
通讯作者：
Mora-Banderas AM
中科院分区：
文献类型：
--
作者：
Aranda-Gallardo M;Morales-Asencio JM;Canca-Sanchez JC;Barrero-Sojo S;Perez-Jimenez C;Morales-Fernandez A;de Luna-Rodriguez ME;Moya-Suarez AB;Mora-Banderas AM
跌倒对住院患者来说是一个严重的问题，缩短了病程和生活质量。据估计，住院患者所有不良事件中超过84%与跌倒有关。有些跌倒风险评估工具的开发和测试环境不同于为其开发工具的环境，存在严重的有效性差异。本综述的目的是确定在急性住院患者中检测跌倒风险和预测跌倒的仪器的准确性。系统综述和荟萃分析。检索主要数据库、相关网站和灰色文献。两位盲评人评估了选定文章的标题和摘要，如果它们符合纳入标准，则在新的盲法过程中评估方法质量。用随机效应法对诊断OR(DOR)和似然(LH)系数进行Meta分析。计算林地的敏感度和特异度、DOR和LH值。此外，每次分析都计算汇总ROC(SROC)曲线。14项研究被选为综述的对象。采用Morse(MFS)、Strayfy和Hendrich II跌倒风险模型量表进行Meta分析。分层工具提供了更好的诊断有效性，DOR值为7.64(4.86-12.00)。进行Meta回归分析，以评估患者平均年龄超过65岁的影响，以及患者住院期间是否进行风险重新评估。再评估显示MFS的DOR显著降低(rDOR0.75，95%CI：0.64~0.89，p = 0.017)。分层量表被发现是评估住院的危重成人跌倒风险的最佳工具。然而，这些工具的行为因人口和环境的不同而有很大不同，因此在实施之前应对其操作进行测试。需要进行进一步的研究，以调查重新评估这些仪器对住院成年患者的影响，并考虑医护人员对与患者安全相关的程序的真正遵守情况，特别是关于预防跌倒的程序。
Falls are a serious problem for hospitalized patients, reducing the duration and quality of life. It is estimated that over 84% of all adverse events in hospitalized patients are related to falls. Some fall risk assessment tools have been developed and tested in environments other than those for which they were developed with serious validity discrepancies. The aim of this review is to determine the accuracy of instruments for detecting fall risk and predicting falls in acute hospitalized patients. Systematic review and meta-analysis. Main databases, related websites and grey literature were searched. Two blinded reviewers evaluated title and abstracts of the selected articles and, if they met inclusion criteria, methodological quality was assessed in a new blinded process. Meta-analyses of diagnostic ORs (DOR) and likelihood (LH) coefficients were performed with the random effects method. Forest plots were calculated for sensitivity and specificity, DOR and LH. Additionally, summary ROC (SROC) curves were calculated for every analysis. Fourteen studies were selected for the review. The meta-analysis was performed with the Morse (MFS), STRATIFY and Hendrich II Fall Risk Model scales. The STRATIFY tool provided greater diagnostic validity, with a DOR value of 7.64 (4.86 - 12.00). A meta-regression was performed to assess the effect of average patient age over 65 years and the performance or otherwise of risk reassessments during the patient’s stay. The reassessment showed a significant reduction in the DOR on the MFS (rDOR 0.75, 95% CI: 0.64 - 0.89, p = 0.017). The STRATIFY scale was found to be the best tool for assessing the risk of falls by hospitalized acutely-ill adults. However, the behaviour of these instruments varies considerably depending on the population and the environment, and so their operation should be tested prior to implementation. Further studies are needed to investigate the effect of the reassessment of these instruments with respect to hospitalized adult patients, and to consider the real compliance by healthcare personnel with procedures related to patient safety, and in particular concerning the prevention of falls.
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影响因子：
5.5
作者：
Chapman, Joanne;Bachand, Deborah;Hyrkaes, Kristiina
通讯作者：
Hyrkaes, Kristiina
DOI：
10.1111/j.1532-5415.2010.02816.x
发表时间：
2010-05-01
影响因子：
6.3
作者：
Bohl, Alex A.;Fishman, Paul A.;Phelan, Elizabeth A.
通讯作者：
Phelan, Elizabeth A.
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
1.2
作者：
Browne, JA;Covington, BG;Davila, Y
通讯作者：
Davila, Y
影响因子：
3.8
作者：
Barker, Anna;Kamar, Jeannette;Hill, Keith
通讯作者：
Hill, Keith