Risk stratification for early and late falls in acute care settings.
Masae Satoh, Takeshi Miura, Tomoko Shimada and 1 others
PMID 35224808WHAT IT FOUND
In Japanese acute wards, admission fall-risk assessments by nurses separated early from late fall risk: early factors included fall history, impaired understanding, psychotropic medicines, muscle weakness, and doing everything alone; late factors included age over 65, impaired limbs, muscle weakness, and unstable gait.
Key findings
01Registered nurses performed fall-risk assessments at admission using a modified Japanese Nursing Association tool containing 26 items.
02Early falls (87) and late falls (90) were modelled separately, and both models included muscle weakness as a shared risk factor.
03Early fall models included significant predictors of fall history, impaired understanding, psychotropic medication, muscle weakness, and doing everything on one's own; late fall models included age over 65, impaired extremities, muscle weakness, and unstable gait.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective and used records from one acute university hospital in Japan between 1 October 2018 and 30 September 2019. Only 177 first falls were analysed, with 87 early and 90 late falls, and the authors state the number of fall cases was inadequate for department- or disease-specific analysis. The models were internally validated only, using a 70/30 split and bootstrap resampling, and the authors state validation in different cohorts in Japan and other countries is necessary. ICU, psychiatric, paediatric and infectious disease wards were excluded, and patients with missing admission values were excluded, so findings apply to general acute inpatients with complete admission records.
The easy way to misread this
Do not conclude that these risk factors prove a fall-prevention programme works. This was a retrospective record study of associations at one hospital, and the authors state the concept should be verified in future studies.