title: Use of the 'STRATIFY' falls risk assessment in patients recovering from acute stroke. Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. Further validation of the Elderly Mobility Scale for measurement of mobility of hospitalized elderly people A randomized trial of identification bracelets to prevent falls among patients in a rehabilitation hospital. Prediction of falls using a risk assessment tool in the acute care setting Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies Predicting which patient will fall again ... and again. Use of initial risk assessment and recording as the main nursing intervention in identifying risk of falls. Using targeted risk factor reduction to prevent falls in older in-patients: a randomised controlled trial. Falls prevention: the efficacy of a bed alarm system in an acute-care setting. A new instrument for targeting falls prevention interventions was accurate and clinically applicable in a hospital setting. Fall risk assessment: a prospective investigation of nurses' clinical judgement and risk assessment tools in predicting patient falls. Using the Downton index to predict those prone to falls in stroke rehabilitation. Hospital falls: development of a predictive model for clinical practice. Validation of the Hendrich II Fall Risk Model: a large concurrent case/control study of hospitalized patients. Evaluation of the STRATIFY falls prediction tool on a geriatric unit. Falls prevention revisited: a call for a new approach. A comparative study of the use of four fall risk assessment tools on acute medical wards. Factors associated with falling in elderly hospital patients.
abstract: OBJECTIVES To investigate the predictive validity and reliability of the STRATIFY falls risk assessment tool as applied to patients recovering from acute stroke . DESIGN Prospect i ve cohort study . SETTING Six stroke rehabilitation units in the North of Engl and . SUBJECTS All patients with a diagnosis of acute stroke admitted to the participating stroke units during a 6-month study period . ASSESSMENT on admission , falls risk ( STRATIFY ) , disability ( Barthel index ) , mobility ( Rivermead mobility index ) , cognitive impairment ( abbreviated mental test score ) and visual neglect ( Albert 's test ) were assessed . Then , STRATIFY was completed weekly and within 48 h of anticipated discharge . Consenting patients were contacted at 3 months after discharge to determine falls . OUTCOME MEASURES Occurrence of a fall within 28 days of the baseline STRATIFY ( in-patient study ) , falls in the first 3 months after discharge ( post-discharge study ) and falls during stroke unit stay ( reliability study ) . RESULTS From 387 patients admitted to the participating units during the study period , 225 contributed to the 28 day in-patient study , and 234 were followed up at 3 months after discharge . STRATIFY performed poorly in predicting falls in the first 28 days ( sensitivity 11.3 % and specificity 89.5 % ) and after discharge ( sensitivity 16.3 % and specificity 86.4 % ) . Agreement was ' fair ' between baseline and discharge scores ( kappa = 0.263 ) and ' good ' between the pre-hospital discharge score and that obtained in the week preceding discharge ( kappa = 0.639 ) . CONCLUSION STRATIFY performed poorly as a predictor of falls in a heterogeneous population of stroke patients . There is a need for a disease-specific rather than a generic falls risk assessment tool Abstract Objective To assess the effectiveness of a targeted , multiple intervention falls prevention programme in reducing falls and injuries related to falls in a subacute hospital . Design R and omised controlled trial of a targeted multiple intervention programme implemented in addition to usual care compared with usual care alone . Setting Three subacute wards in a metropolitan hospital specialising in rehabilitation and care of elderly patients . Participants 626 men and women aged 38 to 99 years ( average 80 years ) were recruited from consecutive admissions to subacute hospital wards . Intervention Falls risk alert card with information brochure , exercise programme , education programme , and hip protectors . Main outcome measures Incidence rate of falls , injuries related to falls , and proportion of participants who experienced one or more falls during their stay in hospital . Results Participants in the intervention group ( n = 310 ) experienced 30 % fewer falls than participants in the control group ( n = 316 ) . This difference was significant ( Peto log rank test P = 0.045 ) and was most obvious after 45 days of observation . In the intervention group there was a trend for a reduction in the proportion of participants who experienced falls ( relative risk 0.78 , 95 % confidence interval 0.56 to 1.06 ) and 28 % fewer falls result ed in injury ( log rank test P = 0.20 ) . Conclusions A targeted multiple intervention falls prevention programme reduces the incidence of falls in the subacute hospital setting The performance of a predictive model is overestimated when simply determined on the sample of subjects that was used to construct the model . Several internal validation methods are available that aim to provide a more accurate estimate of model performance in new subjects . We evaluated several variants of split- sample , cross-validation and bootstrapping methods with a logistic regression model that included eight predictors for  30-day mortality after an acute myocardial infa rct ion . R and om sample s with a size between n = 572 and n = 9165 were drawn from a large data set ( GUSTO-I ; n = 40,830 ; 2851 deaths ) to reflect modeling in data sets with between 5 and 80 events per variable . Independent performance was determined on the remaining subjects . Performance measures included discriminative ability , calibration and overall accuracy . We found that split- sample analyses gave overly pessimistic estimates of performance , with large variability . Cross-validation on 10 % of the sample had low bias and low variability , but was not suitable for all performance measures . Internal validity could best be estimated with bootstrapping , which provided stable estimates with low bias . We conclude that split- sample validation is inefficient , and recommend bootstrapping for estimation of internal validity of a predictive logistic regression model Objective : To further assess the validity and inter-rater reliability of the  Elderly Mobility Scale ( EMS ) . Also whether the scale reflects elderly people 's perceptions regarding their mobility , and whether it can predict discharge destination , or likelihood of falling . Design : Question naire-based study completed on admission and weekly after this on all patients referred to physiotherapy for mobility problems over the course of one month . Setting : Care of the elderly wards in the Bristol General Hospital . Subjects : Sixty-six patients ( ages 66 - 69 years , 66 % female ) were included in the validity study . Nineteen patients ( ages 71 - 95 years , 47 % female ) were included in the inter-rater reliability study . Interventions : EMS , Barthel and patients ' perceptions of mobility were tested with routine physiotherapy treatment carried out as necessary . Main outcome measures : Concurrent validity was assessed by correlating EMS scores with Barthel scores using Spearman 's test . Inter-rater reliability was also tested using a Spearman 's correlation . EMS scores of patients were also evaluated in conjunction with whether or not they fell and their destination on discharge . Results : A significant correlation between EMS and Barthel scores indicated concurrent validity . Inter-rater reliability was demonstrated on 19 patients with a significant correlation between scores . No predictive validity could be ascribed to  EMS  in terms of discharge destination or likelihood of falling . Results do indicate a possible predictive validity of the functional reach component of the  EMS  regarding the risk of future falls . Conclusions : The EMS was found to be a valid scale with good inter-rater reliability that could be readily applied during daily clinical work . However , it was found to have no predictive validity in terms of falling or discharge destination This purpose of this study was to determine whether an identification bracelet is effective in preventing falls among high-risk patients who are undergoing in-patient physical rehabilitation . A stratified , r and omized , balanced controlled clinical trial was conducted ; participants were blinded as to the outcome and the study hypothesis . All patients having one or more risk factors that predisposed them to falls were r and omized to receive either a blue identification bracelet or no bracelet . The identification bracelet was intended to increase patients ' vigilance about falling . Two risk strata were specified . The high risk stratum consisted of patients with stroke or ataxia , urinary incontinence , or a history of falls . The low risk stratum comprised patients older than 80 years and those on one or more medications that had been identified as contributing to an individual 's risk of falling . This report presents the effect of the identification bracelet only among persons in the high-risk stratum . Over 1 year , 65 high-risk subjects were r and omized to receive the blue identification bracelet  and 69 high-risk subjects were controls . In the intervention group , 27 persons ( 41 % ) fell at least once , whereas in the control group 21 persons ( 30 % ) fell at least once yielding a hazard ratio of 1.3 ( 95 % confidence interval : 0.8 to 2.4 ) . These results suggest that the identification system was of no benefit in preventing falls among high-risk persons Background The British STRATIFY tool was previously developed to predict falls in hospital . Although the tool has several strengths , certain limitations exist which may not allow generalizability to a Canadian setting . Thus , we tested the STRATIFY tool with some modification and re-weighting of items in Canadian hospitals . Methods This was a prospect i ve validation cohort study in four acute care medical units of two teaching hospitals in Hamilton , Ontario . In total , 620 patients over the age of 65 years admitted during a 6-month period . Five patient characteristics found to be risk factors for falls in the British STRATIFY study were tested for predictive validity . The characteristics included history of falls , mental impairment , visual impairment , toileting , and dependency in transfers and mobility . Multivariate logistic regression was used to obtain optimal weights for the construction of a risk score . A receiver-operating characteristic curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk . Results Inter-rater reliability for the weighted risk score indicated very good agreement ( inter-class correlation coefficient = 0.78 ) . History of falls , mental impairment , toileting difficulties , and dependency in transfer / mobility significantly predicted fallers . In the multivariate model , mental status was a significant predictor ( P < 0.001 ) while history of falls and transfer / mobility difficulties approached significance ( P = 0.089 and P = 0.077 respectively ) . The logistic regression model led to weights for a risk score on a 30-point scale . A risk score of 9 or more gave a sensitivity of 91 % and specificity of 60 % for predicting who would fall . Conclusion Good predictive validity for identifying fallers was achieved in a Canadian setting using a simple-to-obtain risk score that can easily be incorporated into practice Abstract Objectives : To identify clinical characteristics of elderly in patients that predict their chance of falling ( phase 1 ) and to use these characteristics to derive a risk assessment tool and to evaluate its power in predicting falls ( phases 2 and 3 ) . Design : Phase 1 : a prospect i ve case-control study . Phases 2 and 3 : prospect i ve evaluations of the derived risk assessment tool in predicting falls in two cohorts . Setting : Elderly care units of St Thomas 's Hospital ( phase 1 and 2 ) and Kent and Canterbury Hospital ( phase 3 ) . Subjects : Elderly hospital in patients ( aged 65 years ) : 116 cases and 116 controls in phase 1 , 217 patients in phase 2 , and 331 in phase 3 . Main outcome measures : 21 separate clinical characteristics were assessed in phase 1 , including the abbreviated mental test score , modified Barthel index , a transfer and mobility score obtained by combining the transfer and mobility sections of the Barthel index , and several nursing judgments . Results : In phase 1 five factors were independently associated with a higher risk of falls : fall as a presenting complaint ( odds ratio 4.64 ( 95 % confidence interval 2.59 to 8.33 ) ; a transfer and mobility score of 3 or 4 ( 2.10 ( 1.22 to 3.61 ) ) ; and primary nurses ' judgment that a patient was agitated ( 20.9 ( 9.62 to 45.62 ) ) , needed frequent toileting ( 2.48 ( 1.08 to 5.70 ) ) , and was visually impaired ( 3.56 ( 1.26 to 10.05 ) ) . A risk assessment score ( range 0 - 5 ) was derived by scoring one point for each of these five factors . In phases 2 and 3 a risk assessment score > 2 was used to define high risk : the sensitivity and specificity of the score to predict falls during the following week was 93 % and 88 % respectively in phase 2 and 92 % and 68 % respectively in phase 3 . Conclusion : This simple risk assessment tool predicted with clinical ly useful sensitivity and specificity a high percentage of falls among elderly hospital in patients In order to compare the characteristics , preventive interventions and outcomes of single and multiple fallers , a retrospective cross-sectional study was conducted in a 680-bed acute-care hospital in Western Australia . Fifty patients falling more than once ( multiple fallers ) were r and omly selected from all patients reported to have fallen between 1 July 1989 and 31 December 1989 , and age-sex matched with 50 patients falling once in the trial period ( single fallers ) . In total , 382 in- patients were reported to have sustained 578 falls in the 6-month trial period . Fifty-two per cent of these falls involved multiple fallers . An analysis of the 100 single and multiple fallers showed that single fallers were more likely to have fallen from their bed ; be discharged home from hospital ; and be clinical ly deteriorating at the time of the fall . Multiple fallers were more likely to be transferred to a long-term nursing facility after discharge from hospital ; suffer blindness/poor vision ; be se date d post fall ; be ordered to be restrained following a fall ; and be hospitalized for longer periods . There was also a tendency for multiple fallers to repeat the type and location of the fall on successive falls . Stepwise logistic regression showed that falling from the bed on the first fall predicted remaining a single faller . Being ordered to be restrained following the first fall and hospitalized for longer periods predicted the patient would fall repeatedly . Further analytical research incorporating an exp and ed number of independent variables is needed to allow confident assertions of causality . To test the effectiveness of preventive measures , a prospect i ve longitudinal study is required The consequences of falls among hospital patients are a great problem , for the patient , the family and society , and cost billions of dollars . In Sweden , almost one-third of all hip fractures occur in the hospital population . Despite this , very few prevention strategies have been developed and tested . In this study , a risk assessment and recording programme in relation to the risk of falling among patients in a geriatric department at a Swedish hospital was implemented . The records of all patients admitted to a geriatric unit during one year , and a stratified r and om sample of patient records , constituting the control group from the year before , were review ed . No recording of assessment s regarding the patients ' risk of falling , and no preventive nursing interventions , were found in the records of the control group . The study group , however , increased the recording of risk assessment to 96 % . Only implemented nursing interventions were found in the patients ' records , despite the fact that Swedish law makes it obligatory for the registered nurse to record both the planning and implementation of nursing care . In the study group there were explicit descriptions of problems of concern for nursing regarding the patients ' risk of falling in less than one-third of the records , the nursing care plans were rare , and the evaluations were not satisfactory . Nursing interventions consisted mostly of information or education , promotion of patient participation , and structuring of the environment . There was no agreement on any st and ard-care plan . Recording of falls was found more often in the study group than in the control group ( probably due to more careful recording ) , but the proportion of injuries in relation to falls was higher in the control group . The results of this study may be used as a baseline for developing a nursing strategy and documentation relating to falls BACKGROUND falls and related injuries are known to be a significant problem for older people . There is evidence that identifying and addressing individual risk factors can reduce the incidence of falls in the community but no evidence of the effectiveness of targeted risk factor reduction methods applied to hospital in- patients . OBJECTIVE to test the efficacy of a targeted risk factor reduction core care plan in reducing risk of falling while in hospital . DESIGN a group ( ward ) r and omised trial . SETTING elderly care wards and associated community units of a district general hospital in the North of Engl and . SUBJECTS all elderly patients who received care in eight wards and community units during a 12-month study period . METHODS matched pairs of wards were r and omly allocated to intervention or control groups . In the intervention wards , staff used a pre-printed care plan for patients identified as at risk of falling and introduced appropriate remedial measures . Numbers of falls in each group were then compared . RESULTS after introduction of the care plan there was a significant reduction in the relative risk of recorded falls on intervention wards ( relative risk 0.79 , 95 % CI 0.65 - 0.95 ) but not on control wards ( RR 1.12 , 95 % CI 0.96 - 1.31 ) . The difference in change between the intervention wards and control wards was highly significant ( RR 0.71 , 95 % CI 0.55 - 0.90 , P = 0.006 ) . There was no significant reduction in the incidence of falls-related injuries . CONCLUSION the use of a core care plan targeting risk factor reduction in older hospital in- patients was associated with a reduction in the relative risk of recorded falls The present study examined the clinical efficacy of a bed alarm system in reducing falls from bed on a geriatric evaluation and treatment unit . A nine-month case-controlled study was design ed , in which 70 patients ( 60 women , 10 men ; mean age 84 years , range 67 - 97 years ) at increased risk for bed falls were r and omly assigned to either an experimental or a control group . Subjects in the experimental group ( n = 35 ) received a bed alarm system and those in the control group ( n = 35 ) did not . Outcome measures included bed falls , performance of the bed alarm system , and staff attitudes toward the use of the system . Although results failed to demonstrate a statistical difference in bed falls between the experimental ( n = 1 ) and control ( n = 4 ) groups ( p = 1.00 ) , there was a clinical trend toward reduced falls in the experimental group . The system functioned properly , activating an alarm in all instances when patients were transferring from bed , and with the exception of one case , nurses could respond in a timely fashion to assist patients and prevent bed falls . The system did not produce any adverse effects in patients , nor did the device interfere with the rendering of medical care . The system was well accepted by patients , families , and nurses . These data suggest that bed alarm systems are beneficial in guarding against bed falls and are an acceptable method of preventing falls BACKGROUND AND OBJECTIVE To describe the diagnostic accuracy and practical application of the Peter James Centre Falls Risk Assessment Tool ( PJC-FRAT ) , a multidisciplinary falls risk screening and intervention deployment instrument . METHODS In phase 1 , the accuracy of the PJC-FRAT was prospect ively compared to a gold st and ard ( the STRATIFY ) on a cohort of subacute hospital patients ( n = 122 ) . In phase 2 , the PJC-FRAT was temporally reassessed using a subsequent cohort ( n = 316 ) , with results compared to those of phase 1 . Primary outcomes were falls ( events ) , fallers ( patients who fell ) , and hospital completion rates of the PJC-FRAT . RESULTS In phase 1 , PJC-FRAT accuracy of identifying fallers showed sensitivity of 73 % ( bootstrap 95 % confidence interval CI = 55 , 90 ) and specificity of 75 % ( 95 % CI = 66 , 83 ) , compared with the STRATIFY ( cutoff > or = 2/5 ) sensitivity of 77 % ( 95 % CI = 59 , 92 ) and specificity of 51 % ( 95 % CI = 41 , 61 ) . This difference was not significant . In phase 2 , accuracy of nursing staff using the PJC-FRAT was lower .  PJC-FRAT completion rates varied among disciplines over both phases : nurses and physiotherapists , > or = 90 % ; occupational therapists , > or = 82 % ; and medical officers , > or = 57 % . CONCLUSION The PJC-FRAT was practical and relatively accurate as a predictor of falls and a deployment instrument for falls prevention interventions , although continued staff education may be necessary to maintain its accuracy A prospect i ve cohort study was used to determine the reliability and validity of two fall risk assessment tools and  nurses ' clinical judgement in predicting patient falls .  The study wards comprised two aged care and rehabilitation wards within a 570 bed acute care tertiary teaching hospital in Western Australia . Instrument testing included test-retest reliability and calculations of sensitivity , specificity , positive predictive value , negative predictive value and accuracy . The test retest reliability of all methods was good . In this setting , the three methods of assessing fall risk showed good sensitivity but poor specificity . Also , all methods had limited accuracy , and overall , exhibited an inability to adequately discriminate between patient population s at risk of falling and those not at risk of falling . Consequently , neither nurses ' clinical judgement nor the fall risk assessment tools could be recommended for assessing fall risk in this clinical setting BACKGROUND AND PURPOSE Falls are a major complication in inpatient stroke rehabilitation . An important issue in preventive strategies is the early identification of those at risk . This study aim ed at assessing the fall-prediction accuracy of an easily administered fall risk index in stroke rehabilitation . METHODS A consecutive series of 135 patients admitted to a geriatric stroke rehabilitation unit was studied . A score on the Downton fall risk index was obtained from the admission assessment data and used as a predictive indicator of the risk of falls . The patients ' falls were prospect ively recorded during their rehabilitation stay . The correlation between falls and the predicted risk was assessed by means of survival analysis and a multiple regression analysis , adjusting for the time of observation . RESULTS The risk of falls as a function of the time observed was significantly greater among those predicted to be at high risk ( index score > or = 3 ) than among the others ( P = .009 , log-rank test ; odds ratio , 2.9 ) . Furthermore , the number of falls during rehabilitation stay was moderately correlated ( R = .57 ) with the fall risk index sum when adjusted as for the time of observation . The sensitivity of the fall prediction as to outcome was 91 % , whereas the specificity was limited to 27 % . CONCLUSIONS A moderately high correlation was found between the predicted and the observed risk of falls in stroke rehabilitation when the Downton fall risk index was used . However , a low specificity rate limits the accuracy of the prediction A retrospective case-control study related to falls was conducted at an 1,120-bed acute care tertiary hospital . The case ( fall ) sample consisted of 102 falls and 236 control ( nonfall ) charts during a 1-month period . An instrument developed by Hendrich ( 1988 ) was modified for use in the study . Demographic data and risk factors were recorded . Descriptive statistics included risk factor percentages for each sample and the corresponding univariate relative risks . Logistic regression was used to develop a multivariate risk factor model with seven risk factors . The significant risk factors were recent history of falls , depression , altered elimination patterns , dizziness or vertigo , primary cancer diagnosis , confusion , and altered mobility . The adjusted relative risks were converted to risk points to be used to assess a patient 's level of fall risk . Within the data set , a sensitivity of 77 % ( 79 of 102 ) and specificity of 72 % ( 169 of 236 ) were calculated . The model was cross-vali date d in a 1987 data set with a sensitivity of 83 % ( 59 of 71 ) and specificity of 66 % ( 106 of 161 ) This large case/control study of fall and non-fall patients , in an acute care tertiary facility , was design ed to concurrently test the Hendrich Fall Risk Model .  Cases and controls ( 355/780 ) were r and omly enrolled and assessed for more than 600 risk factors ( intrinsic/extrinsic ) . St and ardized instruments were used for key physical attributes as well as clinician assessment s. A risk factor model was developed through stepwise logistic regression . Two-way interactions among the risk factors were tested for significance . The best fitting model included 2 Log L chi square statistic as well as sensitivity and specificity values retrospectively . The result of the study is an easy to use vali date d  Hendrich Fall Risk Model  with eight assessment parameters for high-risk fall identification tested in acute care environments Accurate prediction of fall-prone hospitalized older adults may be integral to reducing falls . The STRATIFY , a simple 5-point falls prediction tool , was prospect ively vali date d on a Geriatric Assessment and Rehabilitation Unit as a one-time initial predictor of patients likely to fall . Sensitivity and specificity were lower than in the original British study . Introducing risk assessment s vali date d elsewhere on a patient care unit or on a hospital-wide scale requires caution BACKGROUND Patient falls  constitute a major threat to health services ' ability to provide care . Previous studies confirm that nurses can identify patients at risk and that a preventative programme can reduce the rate of falls but few studies have been evaluated over time . AIMS AND OBJECTIVES A study was undertaken to test a Falls Prevention Programme in an acute medical area that was re-evaluated 5 years later to determine if the effects were sustainable . DESIGN The design included two groups of patients admitted before and after the programme . Variables such as staffing , equipment , environment and routines were controlled . However , because of ethical approval constraints , some variables such as age , mental status , mobility and gender were not . METHODS The programme included a risk assessment tool , a choice of interventions , a graphic that alerted others to ' at risk patients ' and simple patient and staff education . Data were collected using incident forms and a formula was used to calculate a rate of falls . A non-paired t-test compared rates and anova examined the relationship of age , gender , mobility and mental status on the incidence of falls . Control graphs determined the stability of the process . RESULTS The falls rate was significantly reduced . Control graphs demonstrate that the process achieved greater control with less variation . In the next 5 years the falls rate increased to preprogramme levels and control graphs demonstrated that the process was no longer controlled . Compliance with the programme had deteriorated . CONCLUSIONS The practice review considered skill mix , patient activity and acuity but provided no definitive answers to explain non-compliance . The implication s to nursing are discussed . RELEVANCE TO CLINICAL PRACTICE Clinicians are called to conduct more rigorous research into falls prevention but it may be more useful to direct research towards examining nursing work and increasing nurse autonomy in falls prevention OBJECTIVES To compare the effectiveness of four falls risk assessment tools ( STRATIFY , Downton , Tullamore , and Tinetti ) by using them simultaneously in the same environment . DESIGN Prospect i ve , open , observational study . SETTING Two acute medical wards admitting predominantly older patients . PARTICIPANTS One hundred thirty-five patients , 86 female , mean age+/-st and ard deviation 83.8+/-8.01 ( range 56 - 100 ) . MEASUREMENTS A single clinician prospect ively completed the four falls risk assessment tools . The extent of completion and time to complete each tool was recorded . Patients were followed until discharge , noting the occurrence of falls . The sensitivity , specificity , negative predictive accuracy , positive predictive accuracy , and total predictive accuracy were calculated . RESULTS The number of patients that the STRATIFY correctly identified ( n=90 ) was significantly higher than the Downton ( n=46 ; P<.001 ) , Tullamore ( n=66 ; P=.005 ) , or Tinetti ( n=52 ; P<.001 ) tools , but the STRATIFY had the poorest sensitivity ( 68.2 % ) . The STRATIFY was also the only tool that could be fully completed in all patients ( n=135 ) , compared with the Downton ( n=130 ; P=.06 ) , Tullamore ( n=130 ; P=.06 ) , and Tinetti ( n=17 ; P<.001 ) . The time required to complete the STRATIFY tool ( average 3.85 minutes ) was significantly less than for the Downton ( 6.34 minutes ; P<.001 ) , Tinetti ( 7.4 minutes ; P<.001 ) , and Tullamore ( 6.25 minutes ; P<.001 ) . The Kaplan-Meier test showed that the STRATIFY ( log rank P=.001 ) and Tullamore tools ( log rank P<.001 ) were effective at predicting falls over the first week of admission . The Downton ( log rank P=.46 ) and Tinetti tools ( log rank P=.41 ) did not demonstrate this characteristic . CONCLUSION Significant differences were identified in the performance and complexity between the four risk assessment tools studied . The STRATIFY tool was the shortest and easiest to complete and had the highest predictive value but the lowest sensitivity Forty-four patients aged 65 years and over who fell whilst in an acute hospital and 44 patients who did not fall during their hospital stay underwent structured medical examinations to identify factors associated with falling . The control subjects were matched for age ( + /- 3 years ) , sex , patient type , and primary diagnosis . The examination was based on established assessment s of posture , balance and gait , the musculoskeletal system , vision , cardiovascular status , and neurological function . Bivariate analyses revealed seven assessment measures that were significantly associated with falls : cognitive impairment , particularly impaired orientation ; evidence of previous cerebrovascular accident ; incoordination as measured clinical ly ; inability to perform the ' Get-up- and -go ' test , especially an inability to turn around after a 5-metre walk , and the use of psycho-active medications . Of these variables , impaired orientation , psycho-active drug use , evidence of stroke , and impaired performance in the ' Get-up- and -go ' test were included in a stepwise logistic regression which correctly classified 80 % of the patients into faller and non-faller groups . Falling was also related to the number of these identified risk factors . These findings suggest that a simple screening protocol , taking about 5 min to complete , can assist in the identification of patients at risk of falls whilst in hospital
target: Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular setting s , but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment
background: INTRODUCTION Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals .
  Design -related bias in evaluations of tool predictive accuracy could lead to overoptimistic results , which would then contribute to program failure in practice .