Identifying older people at high risk of future falls: development and validation of a screening tool for use in emergency departments
Identifying older people at high risk of future falls: development and validation of a screening tool for use in emergency departments
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DOI：
10.1136/emermed-2012-201783
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发表时间：
2013-11-01
影响因子：
3.1
通讯作者：
Close, Jacqueline C. T.
中科院分区：
文献类型：
--
作者：
Tiedemann, Anne;Sherrington, Catherine;Close, Jacqueline C. T.
背景 医院急诊科 (ED) 收治的老年人比例很高，其中许多人是跌倒的直接后果。 目的 开发并外部验证用于医院急诊科的跌倒风险筛查工具，并将该工具的预测能力与现有筛查工具进行比较。 方法 这项前瞻性队列研究涉及澳大利亚悉尼的两家医院急诊科。潜在参与者是 70 岁以上、跌倒后到急诊科就诊的人，或前一年有 2 次以上跌倒史并随后出院的人。 219 人参与了工具开发研究，178 人参与了外部验证研究。研究指标包括 6 个月随访期间跌倒的人数、身体状况、病史、跌倒史和社区服务使用情况。结果在开发样本和外部验证样本中分别有 31% 和 35% 的参与者跌倒。开发的两项筛查工具包括：过去一年跌倒 2 次以上（OR 4.18，95% CI 2.61 至 6.68）和服用 6 次以上药物（OR 1.89，CI 1.18 至 3.04）。受试者工作特征曲线下面积 (AUC) 为 0.70 (0.64-0.76)。这表明比单独 2 次以上跌倒的测量（AUC 0.67、0.62-0.72，p=0.02）具有显着更好的预测能力，并且与 FROP-Com（AUC 0.73、0.67-0.79，p=0.25）和 PROFET 屏幕（AUC 0.70、0.62-0.78，p=0.5）相似的预测能力。 结论 A简单的两项筛选工具表现出良好的外部效度，并能准确区分跌倒者和非跌倒者。该工具可以识别可能受益于急诊室出院后的转诊或干预的高风险个体。
Background Hospital emergency departments (EDs) treat a high proportion of older people, many as a direct consequence of falling.Objective To develop and externally validate a fall risk screening tool for use in hospital EDs and to compare the tool's predictive ability to existing screening tools.Methods This prospective cohort study involved two hospital EDs in Sydney, Australia. Potential participants were people aged 70+ years who presented to the ED after falling or with a history of 2+ falls in the previous year and were subsequently discharged. 219 people participated in the tool development study and 178 people participated in the external validation study. Study measures included number of fallers during the 6-month follow-up period, and physical status, medical history, fall history and community service use.Results 31% and 35% of participants fell in the development and external validation samples, respectively. The developed two-item screening tool included: 2+ falls in the past year (OR 4.18, 95% CI 2.61 to 6.68) and taking 6+ medications (OR 1.89, CI 1.18 to 3.04). The area under the receiver operating characteristic curve (AUC) was 0.70 (0.64-0.76). This represents significantly better predictive ability than the measure of 2+ previous falls alone (AUC 0.67, 0.62-0.72, p=0.02) and similar predictive ability to the FROP-Com (AUC 0.73, 0.67-0.79, p=0.25) and PROFET screens (AUC 0.70, 0.62-0.78, p=0.5).Conclusions A simple, two-item screening tool demonstrated good external validity and accurately discriminated between fallers and non-fallers. This tool could identify high risk individuals who may benefit from onward referral or intervention after ED discharge.