title: In-hospital fall-risk screening in 4,735 geriatric patients from the LUCAS project.
abstract: OBJECTIVE
  In-hospital falls in older patients are frequent, but the identification of patients at risk of falling is challenging. Aim of this study was to improve the identification of high-risk patients. Therefore, a simplified screening-tool was developed, validated, and compared to the STRATIFY predictive accuracy.
  
  
  METHODS
  Retrospective analysis of 4,735 patients; evaluation of predictive accuracy of STRATIFY and its single risk factors, as well as age, gender and psychotropic medication; splitting the dataset into a learning and a validation sample for modelling fall-risk screening and independent, temporal validation.
  
  
  METHODS
  Geriatric clinic at an academic teaching hospital in Hamburg, Germany.
  
  
  METHODS
  4,735 hospitalised patients ≥65 years.
  
  
  METHODS
  Sensitivity, specificity, positive and negative predictive value, Odds Ratios, Youden-Index and the rates of falls and fallers were calculated.
  
  
  RESULTS
  There were 10.7% fallers, and the fall rate was 7.9/1,000 hospital days. In the learning sample, mental alteration (OR 2.9), fall history (OR 2.1), and insecure mobility (Barthel-Index items 'transfer' + 'walking' score = 5, 10 or 15) (OR 2.3) had the most strongest association to falls. The LUCAS Fall-Risk Screening uses these risk factors, and patients with ≥2 risk factors contributed to the high-risk group (30.9%). In the validation sample, STRATIFY SENS was 56.8, SPEC 59.6, PPV 13.5 and NPV 92.6 vs. LUCAS Fall-Risk Screening was SENS 46.0, SPEC 71.1, PPV 14.9 and NPV 92.3.
  
  
  CONCLUSIONS
  Both the STRATIFY and the LUCAS Fall-Risk Screening showed comparable results in defining a high-risk group. Impaired mobility and cognitive status were closely associated to falls. The results do underscore the importance of functional status as essential fall-risk factor in older hospitalised patients.
authors: Albertinen-Haus Geriatrics Centre, University of Hamburg, Hamburg, Germany.
authors: L
authors: L
authors: Neumann
authors: V S
authors: VS
authors: Hoffmann
authors: S
authors: S
authors: Golgert
authors: J
authors: J
authors: Hasford
authors: W
authors: W
authors: Von Renteln-Kruse
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D005858:Germany; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors