Evaluation of three fall-risk assessment tools in an acute care setting.
OBJECTIVE
This paper is a report of a study to evaluate the validity of three fall-risk assessment tools to identify patients at high risk for falls.


BACKGROUND
Patient falls make up 38% of all adverse events occurring in hospital settings, and may result in physical injury and undesirable emotional and financial outcomes. No single fall-risk assessment tool has been conclusively validated.


METHODS
The Morse Fall Scale, St Thomas Risk Assessment Tool in Falling Elderly Inpatients, and Hendrich II Fall Risk Model were validated in inter-rater reliability and validity studies in 2003. This included assessment of the probability of disagreement, kappa-values, sensitivity, specificity, positive predictive values and negative predictive values of the assessment tools with the associated 95% CI.


RESULTS
One hundred and forty-four patients were recruited for the inter-rater reliability study. The probabilities of disagreement were between 2.8% and 9.7%, and 95% CI for all tools ranged from 1.1% to 15.7%. The kappa-values were all higher than 0.80. In the validity study, 5489 patients were recruited to observe 60 falls. The Morse Fall Scale at a cutoff score of 25 and Heindrich II Fall Risk Model at a cutoff score of 5 had strong sensitivity values of 88% and 70%, respectively. However, in comparison with the Morse Fall Scale (specificity = 48.3%), only the Heindrich II Fall Risk Model had a more acceptable level of specificity (61.5%).


CONCLUSIONS
The Heindrich II Fall Risk Model is potentially useful in identifying patients at high risk for falls in acute care facilities.
Kim
Emily Ang Neo
EA
University of Adelaide, South Australia, Australia. emily_nk_ang@nuh.com.sg
Mordiffi
Siti Zubaidah
SZ
Bee
Wong Hwee
WH
Devi
Kamala
K
Evans
David
D
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005163:Factor Analysis, Statistical; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012308:Risk Management / Q000379:methods*