The predictive validity of a modified Japanese Nursing Association fall risk assessment tool: A retrospective cohort study

Higaonna, Miki

doi:10.1016/j.ijnurstu.2015.05.009

Cited by 12 publications

(12 citation statements)

References 46 publications

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“…These modified factors are not included in the three common risk assessment tools mentioned above. Higaonna ( 2015 ) showed that the modified Japanese Nursing Association Fall Risk Assessment Tool demonstrated good predictive validity in a Japanese university hospital.…”

Section: Introductionmentioning

confidence: 99%

“…It is necessary to recognise that falls, especially injurious falls, occur during the relatively early period of hospital stay. Cho et al ( 2020 ) reported that 52% of falls occurred within 10 days of admission, and Higaonna ( 2015 ) reported that 40.3% occurred during the first week of the 28 days of observation. Recently, Francis‐Coad et al ( 2020 ) reported that for injurious falls in acute medical and surgical units, the peak occurrence time was between day 1 and day 4 with 46.8% having occurred by the third day of admission.…”

Section: Introductionmentioning

confidence: 99%

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Risk stratification for early and late falls in acute care settings

Satoh

Miura

Shimada

et al. 2022

Journal of Clinical Nursing

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Background and Aims Falling generally injures patients, lengthens hospital stays and leads to the wastage of financial and medical resources. Although falls can occur at any stage after hospital admission, there are no studies that characterise falls with length of hospital stay in acute care settings. This study aims to clarify risk stratification of early and late falls in acute care settings. Methods A retrospective cohort study was conducted for participants who were admitted to a teaching hospital in Japan. Patients’ falls were divided into two groups based on the median of the fall date (day 10). Considering a 70/30 split, the logistic regression model was used to extract independent predictors for early and late falls for nine risk variables based on exploratory analysis among 26 items selected from the modified Japanese Nursing Association Fall Risk Assessment Tool, and risk models were validated. This study was conducted according to the STROBE guideline. Results Of the 10,975 patients admitted, 87 and 90 with early and late falls, respectively, were identified. The five significant risk factors extracted for early falls were fall history, muscle weakness, impaired understanding, use of psychotropics and the personality trait of ‘doing everything on one's own’; risk factors identified for late falls were being older than 65 years, impaired extremities and unstable gait, in addition to muscle weakness. Using these variables for early and late falls in the validation cohort, the concordance indices of the risk models were both over 0.80. Conclusions By separately extracting risk factors for early and late falls in an acute care hospital setting, this study shed light on the characteristics of the respective types of falls. Relevant to clinical practice As the risk factors of falls vary according to the length of hospitalisation, specific preventive care can be implemented to avoid fall incidents.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk stratification for early and late falls in acute care settings

Satoh

Miura

Shimada

et al. 2022

Journal of Clinical Nursing

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“…Fall rates vary according to health practices, the patients’ environment and the measurement method used, and so statistics for the incidence of falls in hospitals worldwide present great variability: 14.9% of a hospital in Switzerland [5], 8.7% in an acute-care hospital in Australia [6], or 1.6% in a Japanese hospital [7]. In Spain in recent years have reported rates of falls in hospitals ranging between 1.8% [8] or 0.6% in a recent study [9].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic validity of the STRATIFY and Downton instruments for evaluating the risk of falls by hospitalised acute-care patients: a multicentre longitudinal study

Aranda-Gallardo

Luna-Rodríguez

Vazquez-Blanco

et al. 2017

BMC Health Serv Res

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BackgroundFalls are major adverse events in hospitals. The appropriateness of using risk assessment instruments for falls in hospitals has recently been questioned, although the research performed in this respect presents some methodological shortcomings. The purpose of the present study is to evaluate the accuracy of the Downton and STRATIFY instruments to determine the risk of falls and to predict their incidence in acute care hospitals in the public health system in Andalusia (Spain).MethodsA longitudinal, multicentre prospective study was made of a cohort of patients recruited between May 2014 and March 2016. The risk of falls was assessed using each of the above instruments during the first 24 h after hospital admittance, with later re-evaluations every 72 h until discharge. Descriptive statistics were obtained, bivariate and multivariate analysis were performed. The diagnostic validity of the process was assessed by calculations of sensitivity, specificity, positive and negative predictive values and ratios of positive and negative likelihood. ROC curve analysis was performed for both instruments.ResultsFor this study, 1247 patients were recruited, of whom 977 completed all the follow-up assessments. Twenty-three of these patients (2.35%) suffered 24 falls. ROC curve analysis showed that the optimal cut-off point for each assessment instrument was below that described by the authors: AUC STRATIFY = 0.69 (95% CI: 0.57–0.8); AUC Downton = 0.6 (95% CI: 0.48–0.72). With a cut-off point of 1, the sensitivity of STRATIFY was 47.6% and its specificity, 85%. With a cut-off point of 2, Downton presented a sensitivity of 66.7% and a specificity of 55.3%.ConclusionsThe Downton and STRATIFY falls risk assessment instruments presented little utility as means of detecting the risk of falls among a sample of adult patients admitted to acute care hospitals. Fall prevention in hospitals should be based on the study of individual risk factors.

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“…Studies investigating hospital inpatients in a single clinical specialty were excluded. In addition, a previous study that had been conducted at the authors’ university hospital was included in the review (Higaonna, ).…”

Section: Methodsmentioning

confidence: 99%

“…The university hospital where the present study was conducted has adopted the modified Japanese Nursing Association's (JNA's) fall risk assessment tool. This tool has good predictive validity (sensitivity 0.82, specificity 0.71), but only 21 out of the 35 included items show significant differences among the fallers, compared with the non‐fallers (Higaonna, ). This modified JNA tool comprises a higher number of items, compared with the STRATIFY (five items; Oliver et al , ), the Morse Fall Scale (six items; Morse et al , ), and the Hendrich II Fall Risk Model (eight items; Hendrich et al , ).…”

Section: Introductionmentioning

confidence: 99%