Are triage questions sufficient to assign fall risk precautions in the ED?
OBJECTIVE
The American College of Emergency Physicians Geriatric Emergency Department (ED) Guidelines and the Center for Disease Control recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance test endorsed by the Center for Disease Control Stop Elderly Accidents, Deaths, and Injuries Falls Prevention Guidelines, the 4-Stage Balance Test (4SBT), would improve the detection of patients at risk for falls.


METHODS
Prospective pilot study of a convenience sample of ambulatory adults 65 years and older in the ED. All participants received the standard nursing triage fall risk assessment. After patients were stabilized in their ED room, the 4SBT was administered.


RESULTS
The 58 participants had an average age of 74.1 years (range, 65-94), 40.0% were women, and 98% were community dwelling. Five (8.6%) presented to the ED for a fall-related chief complaint. The nursing triage screen identified 39.7% (n=23) as at risk for falls, whereas the 4SBT identified 43% (n=25). Combining triage questions with the 4SBT identified 60.3% (n=35) as at high risk for falls, as compared with 39.7% (n=23) with triage questions alone (P<.01). Ten (17%) of the patients at high risk by 4SBT and missed by triage questions were inpatients unaware that they were at risk for falls (new diagnoses).


CONCLUSIONS
Incorporating a quick functional test of balance into the ED assessment for fall risk is feasible and significantly increases the detection of older adults at risk for falls.
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: Lauren.Southerland@osumc.edu.
Lauren T
LT
Southerland
Ohio State University School of Health and Rehabilitation Sciences, Columbus, OH.
Lauren
L
Slattery
Department of Physical Medicine & Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH.
Joseph A
JA
Rosenthal
Department of Health and Rehabilitation Sciences, The Ohio State University Wexner Medical Center, Columbus, OH.
Deborah
D
Kegelmeyer
Department of Health and Rehabilitation Sciences, The Ohio State University Wexner Medical Center, Columbus, OH.
Anne
A
Kloos
D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D002487:Centers for Disease Control and Prevention, U.S.; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D004856:Postural Balance / Q000502:physiology*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012678:Sensation Disorders / Q000175:diagnosis*; D014218:Triage / Q000379:methods / Q000592:standards*; D014481:United States