Identifying Fall Risk of Patients Receiving Hematopoietic Cell Transplant

Abstract

Background and Purpose/Objective: Few studies have examined the efficacy of fall risk assessment tools for patients undergoing hematopoietic cell transplant (HCT). The purpose of this study was to determine whether the Hendrich II Fall Risk Model (HFRM II) can distinguish patients who fell from those who did not fall in the inpatient HCT population. Methods: Observational study. Design: Retrospective chart review. Setting: Academic medical center. Patients: Patients undergoing HCT who fell during the first 100 days posttransplant. Intervention: None. Measurements: Independent-sample t tests were performed to determine differences in HFRM II score, age, pulse, systolic and diastolic blood pressure, platelet count, hemoglobin concentration, and hematocrit for fallers compared with nonfallers. Chi-square tests of independence determined differences regarding sex, assistive device used on the day of fall, transplant type, and physical therapy. Logistic regression analysis detected odds of falling dependent on transplant type, pulse rate, and HFRM II score. Results: Forty-seven patients who fell within 100 days after HCT were control matched by transplant date with 2 nonfallers each. Significant differences included HFRM II mean score (5.36 for fallers vs 3.41 for nonfallers; t = 4.510, P < .001) and mean pulse rates (100.09 vs 88.70 bpm; t = 3.398, P = .001). Patients with allogeneic HCT were 3.46 times more likely to have fallen than those with autologous HCT (P = .007). Limitations: Potential selection bias of retrospective review. Conclusions: HCT patients with higher HFRM II scores, greater pulse rate, or allogeneic transplant were more likely to fall.

Fall risk factors in hospitalized bone marrow transplant patients: A systematic review

“…All six studies were conducted at a single hospital setting with four of the studies conducted in United States (U.S.) hospitals and two in Japan (see Table 2). Four studies took place at an academic medical center (Miwa et al., 2017; Rindflesch et al., 2018; Ueki et al., 2014; Vela et al., 2018), one study was conducted at a U.S. Veterans hospital (Dee et al., 2017), and another was at an urban U.S. hospital with a cancer center (Grady et al., 2020). All articles used retrospective chart reviews to examine the fall risk factor, with three of them including matched controls.…”

“…The identified risk factors include patient demographics (age of 65 and older), cancer diagnosis (transplant patients with a leukemia diagnosis), symptoms (days of diarrhea, incontinence of urine or stool, increased pulse rate, muscle weakness), medication (hypnotic and anxiolytic medication administration, and recent steroid use), and other factors related to medical treatment (allogenic transplant, post‐engraftment period). For example, patients with allogeneic transplantation have a high risk of fall when compared to patients with oncological conditions receiving other treatments (Miwa et al., 2017; Rindflesch et al., 2018); hypnotic or anxiolytic medications taken post‐transplantation period also increase the risk of fall for patients undergoing BMT (Miwa et al., 2017; Ueki et al., 2014). Ukei (2014) found that falls often occurred in the post‐engraftment period after transplant and were related to symptoms such as dizziness and loss of consciousness, while Vela et al.…”

“…Two studies also evaluated and validated the use of fall risk assessment tools to identify patients undergoing BMT at high risk for falls. Dee (2017) used the Morse Fall Scale to predict fall risk in autologous transplant patients, and Rindflesch (2018) applied Hendrich II Fall Risk Model in accurately predicting fall risk in patients undergoing BMT. The Morse Fall Scale is a valid and reliable tool to predict fall risk and has a reported a sensitivity of 74.5%, specificity of 65.8% and accuracy of 66.8% (Oliver et al., 2010; Schwendimann et al., 2006).…”

“…The types of bone marrow transplant the patients underwent varied in the articles, with one focusing on autologous transplant, two on allogeneic transplant, and three on both types of transplants. Rindflesch treatments (Miwa et al, 2017;Rindflesch et al, 2018); hypnotic or anxiolytic medications taken post-transplantation period also increase the risk of fall for patients undergoing BMT (Miwa et al, 2017;Ueki et al, 2014). Ukei (2014) found that falls often occurred in the postengraftment period after transplant and were related to symptoms such as dizziness and loss of consciousness, while Vela et al (2018) found the highest percentage of falls occurring in the post-transplant period.…”

“…and Rindflesch (2018) applied Hendrich II Fall Risk Model in accurately predicting fall risk in patients undergoing BMT.…”