Can Falls Risk Prediction Tools Correctly Identify Fall- Prone Elderly Rehabilitation Inpatients? A Systematic Review and Meta-Analysis Bruno Roza da Costa 1 , Anne Wilhelmina Saskia Rutjes 1 , Angelico Mendy 2 , Rosalie Freund-Heritage 3 , Edgar Ramos Vieira 3,4 * 1 Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland, 2 Department of Epidemiology and Biostatistics, Robert Stempel School of Public Health, Florida International University, Miami, Florida, United States of America, 3 Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada, 4 Department of Physical Therapy, Florida International University, Miami, Florida, United States of America 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. Methods and Findings: 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. Citation: da Costa BR, Rutjes AWS, Mendy A, Freund-Heritage R, Vieira ER (2012) Can Falls Risk Prediction Tools Correctly Identify Fall-Prone Elderly Rehabilitation Inpatients? A Systematic Review and Meta-Analysis. PLoS ONE 7(7): e41061. doi:10.1371/journal.pone.0041061 Editor: Hamid Reza Baradaran, Tehran University of Medical Sciences, Islamic Republic of Iran Received April 11, 2012; Accepted June 16, 2012; Published July 17, 2012 Copyright: ß 2012 da Costa et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was supported by the Alberta Health Services. Funding for publishing this paper was provided by the College of Nursing and Health Sciences, Florida International University, Miami. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: evieira@fiu.edu Introduction Patient falls is a predominant patient safety issue in hospitals accounting for up to 32.3% of all reported patient safety incidents [1]. Fall-related complications lead to a prolonged rehabilitation period and increased health care costs [2,3]. It is estimated that just in the United Kingdom, patient falls in acute care hospitals cost approximately 92 million pounds per year [4]. The actual costs of inpatient falls may be even higher as falls are frequently underreported [1]. Other than the cost of falls to hospitals, patients incur additional costs as 35% of the patients who fall suffer physical harm or even death [1]. Falls may also cause fear of falling, which may lead to immobility and its complications such as muscle weakness, contracture, postural hypotension, and throm- bogenic events [5,6]. Falls are the first leading cause of unintentional injury-related death among the elderly (i.e. people 65 years and older) [7]. Falls cause more than 95% of all hip fractures in the elderly; 20% of the elderly people who suffer hip fractures die within a year [8]. The prevalence rate of falls in acute hospitals is around two to six percent, [9] in general rehabilitation settings is 12.5%, [3,10] and in geriatric rehabilitation hospitals is 24 to 30% [11,12]. The higher prevalence of falls in geriatric rehabilitation hospitals may be explained by the fact that elderly patients are generally frailer, are more exposed to risk factors for falling than younger patients, and are encouraged in rehabilitation settings to be physically active, independent, and involved in rehabilitation activities [3,13]. These circumstances challenge their physical abilities, and places them in situations where they are more likely to fall [3]. Thus, elderly patients in rehabilitation hospitals are particularly at risk for falls. Although there is a clear need to implement strategies to prevent elderly inpatient falls in rehabilitation hospitals, it is unclear which strategies are the most effective for fall prevention in this population [14]. A common strategy is the use of falls risk PLoS ONE | www.plosone.org 1 July 2012 | Volume 7 | Issue 7 | e41061 source: https://doi.org/10.7892/boris.14386 | downloaded: 15.6.2020