IN-HOSPITAL FALL-RISK SCREENING IN 4,735 GERIATRIC PATIENTS FROM THE LUCAS PROJECT

Objectives: In-hospital falls in older patients are frequent, but the identification of patients at risk of falling is challenging. aim of this study was to improve the identification of high-risk patients. therefore, a simplified screening-tool was developed, validated, and compared to the StratIfY predictive accuracy. Design: retrospective analysis of 4,735 patients; evaluation of predictive accuracy of StratIfY and its single risk factors, as well as age, gender and psychotropic medication; splitting the dataset into a learning and a validation sample for modelling fall-risk screening and independent, temporal validation. Setting: Geriatric clinic at an academic teaching hospital in Hamburg, Germany. Participants: 4,735 hospitalised patients ≥65 years. Measurements: Sensitivity, specificity, positive and negative predictive value, odds ratios, Youden-Index and the rates of falls and fallers were calculated. Results: there were 10.7% fallers, and the fall rate was 7.9/1,000 hospital days. In the learning sample, mental alteration (or 2.9), fall history (or 2.1), and insecure mobility (Barthel-Index items ‘transfer’ + ‘walking’ score = 5, 10 or 15) (or 2.3) had the most strongest association to falls. the LuCaS fall-risk Screening uses these risk factors, and patients with ≥2 risk factors contributed to the high-risk group (30.9%). In the validation sample, StratIfY SeNS was 56.8, SPeC 59.6, PPV 13.5 and NPV 92.6 vs. LuCaS fall-risk Screening was SeNS 46.0, SPeC 71.1, PPV 14.9 and NPV 92.3. Conclusions: Both the StratIfY and the LuCaS fall-risk Screening showed comparable results in defining a high-risk group. Impaired mobility and cognitive status were closely associated to falls. the results do underscore the importance of functional status as essential fall-risk factor in older hospitalised patients