title: Post-hoc validation of the Conley Scale in predicting the risk of falling with older in-hospital medical patients: findings from a multicentre longitudinal study.
abstract: BACKGROUND
  The Conley Scale is one of the most widespread fall-risk screening tools in medical unit settings, despite the lack of data regarding its validity in patients currently admitted to these units.
  
  
  OBJECTIVE
  Establishing the validity of the Conley Scale in identifying patients at risk of falling in an acute medical setting.
  
  
  METHODS
  A 6-months longitudinal study in 12 acute medical units from September 2012 to March 2013, a total of 1464 patients with ≥65 years of age were consecutively enrolled and evaluated with the Conley Scale within 24 h of admission. A construct validity, internal consistency, and a priori and a posteriori predictive validity study was performed.
  
  
  RESULTS
  The explorative factor analysis showed a two-factor structure explaining a total variance of 48.3 %: previous history (30.41 %), and physical and cognitive impairment (17.9 %). The scale reported a poor internal consistency (Cronbach's α = 0.465) and the capability to correctly identify 18/649 patients as being at risk of falling, whereas the negative predictive value was 98.5 %. The sensitivity and specificity values were 60.0 and 55.9 %, respectively. No difference emerged between patients scored as at risk and those scored as not at risk in the time elapsed from admission to the first fall (HR = 0.600, 95 % CI 0.289-2.247 p = .166).
  
  
  CONCLUSIONS
  The Conley Scale is not able to predict falls in elderly acute medical patients, and has reported poor internal consistency and accuracy.
  
  
  CONCLUSIONS
  More studies are needed to develop appropriate tools to predict the risk of falling in elderly individuals admitted to an acute medical setting.
authors.affiliation: Udine University, Viale Ungheria 20, 33100, Udine, Italy. alvisa.palese@uniud.it.
authors.forename: Alvisa
authors.initials: A
authors.lastname: Palese
authors.affiliation: Verona University, Verona, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gonella
authors.affiliation: Udine University, Viale Ungheria 20, 33100, Udine, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Lant
authors.affiliation: Azienda per i Servizi Sanitari Provincia, Trento, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Guarnier
authors.affiliation: Azienda per i Servizi Sanitari Provincia, Trento, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Barelli
authors.affiliation: Azienda per i Servizi Sanitari Provincia, Trento, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Zambiasi
authors.affiliation: Azienda Ospedaliera Verona, Verona, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Allegrini
authors.affiliation: Fondazione Poliambulanza, Brescia, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Bazoli
authors.affiliation: Azienda Unità Sanitaria Locale n. 9 Treviso, Treviso, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Casson
authors.affiliation: Azienda per i Servizi Sanitari n. 2 "Isontina", Gorizia, Italy.
authors.forename: Meri
authors.initials: M
authors.lastname: Marin
authors.affiliation: Azienda Unità Sanitaria Locale n. 6 Vicenza, Vicenza, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: Padovan
authors.affiliation: Azienda per i Servizi Sanitari n. 4 "Medio Friuli", Udine, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Picogna
authors.affiliation: Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Taddia
authors.affiliation: Fondazione Zancan, Padua, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Salmaso
authors.affiliation: Bologna University, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiari
authors.affiliation: Azienda Ospedaliero-Universitaria, Padua, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Frison
authors.affiliation: Verona University, Verona, Italy.
authors.forename: Oliva
authors.initials: O
authors.lastname: Marognolli
authors.affiliation: Verona University, Verona, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Canzan
authors.affiliation: Verona University, Verona, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ambrosi
authors.affiliation: Verona University, Verona, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Saiani
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016743:Mental Competency; D011237:Predictive Value of Tests; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
keywords: Accidental falls; Acute medical inpatients; Conley Scale; Fall-risk assessment tools; Sensitivity; Specificity; Validation