External validation of a new predictive model for falls among inpatients using the official Japanese ADL scale, Bedriddenness ranks: a double-centered prospective cohort study

Abstract

Background Several reliable predictive models for falls have been reported, but are too complicated and time-consuming to evaluate. We recently developed a new predictive model using just eight easily-available parameters including the official Japanese activities of daily living scale, Bedriddenness ranks, from the Ministry of Health, Labour and Welfare. This model has not yet been prospectively validated. This study aims to prospectively validate our new predictive model for falls among inpatients admitted to two different hospitals. Methods A double-centered prospective cohort study was performed from October 1, 2018, to September 30, 2019 in an acute care hospital and a chronic care hospital. We analyzed data from all adult inpatients, for whom all data required by the predictive model were evaluated and recorded. The eight items required by the predictive model were age, gender, emergency admission, department of admission, use of hypnotic medications, previous falls, independence of eating, and Bedriddenness ranks. The main outcome is in-hospital falls among adult inpatients, and the model was assessed by area under the curve. Results A total of 3,551 adult participants were available, who experienced 125 falls (3.5%). The median age (interquartile range) was 78 (66–87) years, 1,701 (47.9%) were men, and the incidence of falls was 2.25 per 1,000 patient-days and 2.06 per 1,000 occupied bed days. The area under the curve of the model was 0.793 (95% confidence interval: 0.761–0.825). The cutoff value was set as − 2.18, making the specificity 90% with the positive predictive value and negative predictive value at 11.4% and 97%. Conclusions This double-centered prospective cohort external validation study showed that the new predictive model had excellent validity for falls among inpatients. This reliable and easy-to-use model is therefore recommended for prediction of falls among inpatients, to improve preventive interventions. Trial registration UMIN000040103 (2020/04/08)

History of Falls and Bedriddenness Ranks are Useful Predictive Factors for in-Hospital Falls: A Single-Center Retrospective Observational Study Using the Saga Fall Risk Model

“…14 Our previous studies revealed different results for the association between each factor and falls, which might be caused by different backgrounds of the study populations (ie, degree of cognitive impairment, age, primary illness on admission, and type of hypnotic medications prescribed) as well as different study periods. 14,18 Among those factors, our studies indicated the significance of BRs whereas other previous studies have also shown permanent residual damage from a previous stroke or a history of falls as factors associated with falls. 14,[18][19][20][21] Revealing the association between BRs and falls will highlight the usefulness of BRs in predicting falls, which may lead to developing a better and more accurate approach for predicting falls using BRs.…”

“…14,18 Among those factors, our studies indicated the significance of BRs whereas other previous studies have also shown permanent residual damage from a previous stroke or a history of falls as factors associated with falls. 14,[18][19][20][21] Revealing the association between BRs and falls will highlight the usefulness of BRs in predicting falls, which may lead to developing a better and more accurate approach for predicting falls using BRs. However, we performed stratified analyses on patients who had some items not used in the SFRM-2 in our former validation study.…”

“…14 Our second study, in which we had validated the prediction model for 8126 falls, revealed that three factors were significantly related to falls: admission to the department of neurosurgery, BRs, and a history of falls. 18 We conducted the present study to confirm the significance of the three above items in a different set of patients. Additionally, we conducted stratified analysis of items other than the eight items used in the model to identify suitable groups for use of the SFRM-2.…”

“…Because two of our previous studies showed differing results, in the present study, we aimed to clarify the association between inpatient falls and admission to the department of neurosurgery, BRs, and a history of falls in external validation. 18 Therefore, in the present study, we put forth the hypothesis that BRs, history of falls, or admission to the department of neurosurgery were associated with in-hospital falls. Additionally, we sought to identify those patients in whom use of the SFRM-2 was most suitable, using stratified analysis with some items that were not used in the model: patients with surgical operations, those without rehabilitation or visual impairment, patients with a length of hospital stay shorter than 10 days, and a CFS of M. previous studies.…”

Correction: External validation of a new predictive model for falls among inpatients using the official Japanese ADL scale, Bedriddenness ranks: a double-centered prospective cohort study

“…After publication of this article [ 1 ], the authors reported that there was a mistake in the formula of model 2 in Additional file 3. The correct formula of model 2 is as follows:…”