A Case-control Study Examining the Characteristics of Patients who Fall in an Inpatient Traumatic Brain Injury Rehabilitation Setting

Abstract

A patient in the rehabilitation setting with a more severe TBI characterized by multisystem impairments is at an increased risk of falling, whereas some traditional fall risk factors were not associated with patients who fall. Rehabilitation settings should consider cohort-specific fall risk profiling. The Ontario STRATIFY Falls Risk Screening Tool is perhaps not the best tool to screen for falls in this inpatient population.

Development of the Sydney Falls Risk Screening Tool in brain injury rehabilitation: A multisite prospective cohort study

“…Many FRSTs developed in rehabilitation settings include risk factors that limit their clinical utility in the TBI rehabilitation population. For instance, tools [such as, the Fall Assessment Questionnaire (FAQ) (Rapport et al., ), Fall Prediction Index (FPI) (Nyberg & Gustafson, ) and Prediction of Falls in Rehabilitation Settings Tool (Predict_FIRST) (Sherrington et al., )] that include age and/or male sex as risk factors have limited value because patients admitted to inpatient TBI rehabilitation are generally younger males (McKechnie, Fisher, & Pryor, ; Tate, Cameron, Winstanley, Myles, & Harris, ). Similarly, the inclusion of antecedent falls as a risk factor (as in the Peninsula Health Falls Risk Assessment Tool [Stapleton et al., ;] and Predict_FIRST) has little relevance in the TBI patient population because (i) alcohol is often a contributor in patients who sustain their TBI from a fall (Ragnarsson et al., ), and (ii) multisystem sequelae often result from brain injury that can significantly change an individual's motor and/or cognitive function (Nyberg & Gustafson, ).…”

“…Similarly, the inclusion of antecedent falls as a risk factor (as in the Peninsula Health Falls Risk Assessment Tool [Stapleton et al., ;] and Predict_FIRST) has little relevance in the TBI patient population because (i) alcohol is often a contributor in patients who sustain their TBI from a fall (Ragnarsson et al., ), and (ii) multisystem sequelae often result from brain injury that can significantly change an individual's motor and/or cognitive function (Nyberg & Gustafson, ). Additionally, medications acting on the central nervous system (such as antipsychotics, sedatives or hypnotics) are included in FAQ, FPI, Predict_FIRST and Marianjoy Fall Risk Assessment Tool (Ruroede et al., ), but medications have been shown not to be associated with falls in the TBI rehabilitation population (McKechnie et al., ).…”

“…This study is the last study in a multiphase project that aimed to develop such a tool. Completed research includes (i) an integrative literature review (McKechnie, Pryor, & Fisher, ); (ii) a retrospective cohort study (McKechnie, Fisher, & Pryor, ); (iii) a retrospective nonequivalent case–control study (McKechnie et al., ); and (iv) a modified Delphi study (McKechnie, Pryor, & Fisher, ). The 21 falls risk variable data set examined in the current study was developed from this research.…”

Fall prevention: is the STRATIFY tool the right instrument in Italian Hospital inpatient? A retrospective observational study

“…This tool has been object of studies performed in several settings with deluding findings about its usefulness in screening faller than non-fallers, [ 3 , 12 ]. For instance, the STRATIFY has been considered as not the best tool for screening in traumatic brain injury rehabilitation as well its accuracy has been doubted in the acute geriatric inpatient population, [ 13 , 14 ]. Due to lack of demonstrable efficacy, limitations on the applicability of the instrument exist, [ 12 , 15 ].…”

Predicting falls: considerations for screening tool selection vs. screening tool development

“…The proportion of admitted patients who fall can also be an indicator of concern (McKechnie et al . ,b,c). Falls can result in an increase in mortality and morbidity (Vassallo et al .…”