Predicting geriatric falls following an episode of emergency department care: a systematic review.
Predicting geriatric falls following an episode of emergency department care: a systematic review.
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在急诊科护理的一集之后，预测老年跌倒：系统评价。
DOI：
10.1111/acem.12488
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Lo AX
中科院分区：
文献类型：
--
作者：
Carpenter CR;Avidan MS;Wildes T;Stark S;Fowler SA;Lo AX
跌倒是老年人创伤性死亡的主要原因。尽管最近多专业指南建议提倡在急诊室 (ED) 采取主动跌倒预防方案，但风险因素或风险分层工具识别短期跌倒风险增加的老年患者子集的能力在很大程度上尚未得到探索。这是对基于 ED 的病史、体检和跌倒风险分层工具的系统回顾和荟萃分析，主要目的是为每个风险因素的准确性提供定量估计，以预测未来跌倒。次要目标是使用敏感性和特异性的派生估计来量化 ED 跌倒风险评估测试和治疗阈值。一名医学图书馆员和两名急诊医生 (EP) 对 PUBMED、EMBASE、CINAHL、CENTRAL、DARE、Cochrane 注册中心和临床试验进行了医学文献检索。未发表的研究是通过手工检索全国会议的急诊医学 (EM) 研究摘要来找到的。原始研究的纳入标准包括基于 ED 对 65 岁及以上患者的 ED 前或 ED 后跌倒风险进行评估，并提供足够的细节来重现列联表以进行荟萃分析。必要时会联系原始研究作者以获取更多详细信息。诊断准确性研究质量评估工具 (QUADAS-2) 用于评估符合纳入标准的研究的个别研究质量。当不止一项定性相似的研究在 ED 评估后的相同时间间隔内评估相同的跌倒危险因素时，则使用 Meta-DiSc 软件进行荟萃分析。主要结果是跌倒风险因素或风险分层工具的敏感性、特异性和似然比。次要结果包括使用 Pauker 方法根据准确性、筛查风险以及急诊科跌倒预防干预措施的预计益处或危害来估计测试和治疗阈值。总共确定了 608 项独特且可能相关的研究，但只有三项符合我们的纳入标准。两项纳入 660 名患者的研究评估了 ED 评估后 6 个月内老年患者跌倒的 29 个危险因素和两种风险分层工具，而一项纳入 107 名患者的研究评估了前 12 个月内的跌倒风险。自我报告抑郁症的最高阳性似然比 (LR) 为 6.55（95% 置信区间 [CI] = 1.41 至 30.48）。在不止一项研究中确定了六种跌倒预测因素（过去跌倒、独居、使用助行器、抑郁、认知缺陷和六种以上药物），并对这些风险因素进行了荟萃分析。一种筛查仪器足够准确，可以识别出跌倒风险较低的老年 ED 患者子集，其阴性 LR 为 0.11（95% CI = 0.06 至 0.20）。测试阈值是6.6%，治疗阈值是27.5%。这项研究表明，文献中缺乏关于基于 ED 的老年人未来跌倒风险筛查的证据。本研究中确定的筛查工具和个人特征为制定急诊科成人老年病筛查方案以降低跌倒风险提供了证据基础
Falls are the leading cause of traumatic mortality in geriatric adults. Despite recent multispecialty guideline recommendations that advocate for proactive fall prevention protocols in the emergency department (ED), the ability of risk factors or risk stratification instruments to identify subsets of geriatric patients at increased risk for short-term falls is largely unexplored. This was a systematic review and meta-analysis of ED-based history, physical examination, and fall risk stratification instruments with the primary objective of providing a quantitative estimate for each risk factor’s accuracy to predict future falls. A secondary objective was to quantify ED fall risk assessment test and treatment thresholds using derived estimates of sensitivity and specificity. A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED, EMBASE, CINAHL, CENTRAL, DARE, the Cochrane Registry, and Clinical Trials. Unpublished research was located by a hand search of emergency medicine (EM) research abstracts from national meetings. Inclusion criteria for original studies included ED-based assessment of pre-ED or post-ED fall risk in patients 65 years and older with sufficient detail to reproduce contingency tables for meta-analysis. Original study authors were contacted for additional details when necessary. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality for those studies that met inclusion criteria. When more than one qualitatively similar study assessed the same risk factor for falls at the same interval following an ED evaluation, then meta-analysis was performed using Meta-DiSc software. The primary outcomes were sensitivity, specificity, and likelihood ratios for fall risk factors or risk stratification instruments. Secondary outcomes included estimates of test and treatment thresholds using the Pauker method based on accuracy, screening risk, and the projected benefits or harms of fall prevention interventions in the ED. A total of 608 unique and potentially relevant studies were identified, but only three met our inclusion criteria. Two studies that included 660 patients assessed 29 risk factors and two risk stratification instruments for falls in geriatric patients in the 6 months following an ED evaluation, while one study of 107 patients assessed the risk of falls in the preceding 12 months. A self-report of depression was associated with the highest positive likelihood ratio (LR) of 6.55 (95% confidence interval [CI] = 1.41 to 30.48). Six fall predictors were identified in more than one study (past falls, living alone, use of walking aid, depression, cognitive deficit, and more than six medications) and meta-analysis was performed for these risk factors. One screening instrument was sufficiently accurate to identify a subset of geriatric ED patients at low risk for falls with a negative LR of 0.11 (95% CI = 0.06 to 0.20). The test threshold was 6.6% and the treatment threshold was 27.5%. This study demonstrates the paucity of evidence in the literature regarding ED-based screening for risk of future falls among older adults. The screening tools and individual characteristics identified in this study provide an evidentiary basis on which to develop screening protocols for geriatrics adults in the ED to reduce fall risk
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影响因子：
5.5
作者：
Chapman, Joanne;Bachand, Deborah;Hyrkaes, Kristiina
通讯作者：
Hyrkaes, Kristiina
影响因子：
2.8
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
通讯作者：
Mora-Banderas AM
影响因子：
4.4
作者：
Carpenter, Christopher R.;Heard, Kennon;Miller, Douglas K.
通讯作者：
Miller, Douglas K.
影响因子：
6.2
作者：
Chase, Maureen;Robey, Jennifer L.;Hollander, Judd E.
通讯作者：
Hollander, Judd E.
影响因子：
7.2
作者：
Bongue, Bienvenu;Dupre, Caroline;Colvez, Alain
通讯作者：
Colvez, Alain