title: Can falls risk prediction tools correctly identify fall-prone elderly rehabilitation inpatients? A systematic review and meta-analysis.
abstract: BACKGROUND
  Falls of elderly people may cause permanent disability or death. Particularly susceptible are elderly patients in rehabilitation hospitals. We systematically reviewed the literature to identify falls prediction tools available for assessing elderly inpatients in rehabilitation hospitals.
  
  
  RESULTS
  We searched six electronic databases using comprehensive search strategies developed for each database. Estimates of sensitivity and specificity were plotted in ROC space graphs and pooled across studies. Our search identified three studies which assessed the prediction properties of falls prediction tools in a total of 754 elderly inpatients in rehabilitation hospitals. Only the STRATIFY tool was assessed in all three studies; the other identified tools (PJC-FRAT and DOWNTON) were assessed by a single study. For a STRATIFY cut-score of two, pooled sensitivity was 73% (95%CI 63 to 81%) and pooled specificity was 42% (95%CI 34 to 51%). An indirect comparison of the tools across studies indicated that the DOWNTON tool has the highest sensitivity (92%), while the PJC-FRAT offers the best balance between sensitivity and specificity (73% and 75%, respectively). All studies presented major methodological limitations.
  
  
  CONCLUSIONS
  We did not identify any tool which had an optimal balance between sensitivity and specificity, or which were clearly better than a simple clinical judgment of risk of falling. The limited number of identified studies with major methodological limitations impairs sound conclusions on the usefulness of falls risk prediction tools in geriatric rehabilitation hospitals.
authors: Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors: Bruno Roza
authors: BR
authors: da Costa
authors: Anne Wilhelmina Saskia
authors: AW
authors: Rutjes
authors: Angelico
authors: A
authors: Mendy
authors: Rosalie
authors: R
authors: Freund-Heritage
authors: Edgar Ramos
authors: ER
authors: Vieira
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D007297:Inpatients; D008297:Male; D017063:Outcome Assessment, Health Care; D012372:ROC Curve; D012046:Rehabilitation / Q000458:organization & administration*; D012306:Risk; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity