Performance of the Hendrich Fall Risk Model II in Patients Discharged from Rehabilitation Wards. A Preliminary Study of Predictive Ability.

Isabella Campanini,Francesco Lombardi,Mirco Lusuardi,Stefano Tolomelli,Annalisa Bargellini,Stefano Mastrangelo,Andrea Merlo

doi:10.3390/ijerph18041444

Abstract

(1) Background: Falls are a dangerous adverse event in patients discharged from rehabilitation units, with the risk of falling being higher in the first weeks after discharge. In this study, we assessed the predictive performance of the Hendrich Fall Risk Model II tool (HIIFRM) when administered before discharging patients to their home from rehabilitative units in orthopedic (OR), neurologic (NR) and pulmonary (PR) rehabilitation wards. (2) Methods: Over a 6-month period, all adult patients who returned home after discharge were assessed by HIIFRM. At six months from discharge the occurrence of falls was obtained by performing a structured survey. The HIIFRM predictive performance was determined by the area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) for the whole sample and split by ward. (3) Results: 85 of 141 discharged patients were living at home and agreed to take part in the survey. Of these, 19 subjects fell, 6 suffered fractures or head traumas and 5 were hospitalized. The AUC was 0.809 (95% CI: 0.656–0.963), Se was 0.67 (0.30–0.93) and Sp was 0.79 (0.63–0.90) for OR patients. (4) Conclusions: Our preliminary results support the use of HIIFRM as a tool to be administered to OR patients at discharge and provides data for the design of a large study of predictive ability.

Highlights

Over 80% of all adverse events in hospitals are related to falls, with the fall rate being strongly dependent on the case mix and the settings [1]
The area under the curve was area under the Receiver operating operating curve curve (ROC) curve (AUC) = 0.712, p = 0.005, indicating a moderate predictive power, but with a very large confidence interval
It is worth noting that the idea of measuring the risk of falling at discharge with the aim of both planning preventive interventions and informing patients about their fall risk status is the novelty of this study

Summary

Introduction

Falls are the most common adverse event occurring in care facilities and hospitals. Over 80% of all adverse events in hospitals are related to falls, with the fall rate being strongly dependent on the case mix and the settings [1]. The two settings where falls are more frequent are geriatric units and rehabilitation wards. The fall rate can be as high as 20 falls per 1000 patient bed days [2,3,4,5,6,7]

Methods

Results

Discussion

Conclusion