Visual Impairment, Partially Dependent ADL and Extremely Old Age Could be Predictors for Severe Fall Injuries in Acute Care Settings

Aihara, Hidetoshi; Tago, Masaki; Oishi, Takao; Katsuki, Naoko E; Yamashita, Shizuya

doi:10.1016/j.ijge.2018.02.014

Cited by 13 publications

(40 citation statements)

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“…Conversely, our predictive model is extraordinarily convenient and easy to use even in extremely busy clinical situations because it requires only readily available variables such as age, sex, or circumstances of admission, all of which can be easily obtained from hospital charts, in addition to information routinely checked as risk factors on admission such as the use of hypnotic medications or history of previous falls. Of course the Japanese official scale of bedriddenness, the MHLW bedriddenness rank, is also easy to assess [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…As mentioned above, we used the official MHLW bedriddenness rank as one of the items of our predictive model [ 22 ]. Although there are no previous reports of the relationship between bedriddenness rank and incidence of falls, it promises to be a comprehensive evaluation tool integrating many possible risk factors of falls [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…MHLW bedriddenness rank and cognitive function scores are public assessment tools used in the Japanese long-term care insurance system, and are also used to help patients prepare their living conditions upon discharge from medical facilities in Japan [ 22 , 23 ]. Bedriddenness rank was easily assessed by the degree of confinement of daily life of a patient; at home, in a chair, or in a bed ( Fig 1A ).…”

Section: Methodsmentioning

confidence: 99%

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New predictive models for falls among inpatients using public ADL scale in Japan: A retrospective observational study of 7,858 patients in acute care setting

et al. 2020

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Aim Most predictive models for falls developed previously were awkward to use because of their complexity. We developed and validated a new easier-to-use predictive model for falls of adult inpatients using easily accessible information including the public ADL scale in Japan. Methods We retrospectively analyzed data from Japanese adult inpatients in an acute care hospital from 2012 to 2015. Two-thirds of cases were randomly extracted to the test set and one-third to the validation set. Data including age, sex, activity of daily living (ADL), public scales in Japan of ADL “bedriddenness rank,” and cognitive function in daily living, hypnotic medications, previous falls, and emergency admission were derived from hospital records. Falls during hospitalization were identified from incident reports. Two predictive models were created by multivariate analysis, each of which was assessed by area under the curve (AUC) from the validation set. Results A total of 7,858 adult participants were available. The AUC of model 1, using 13 factors—age, sex (male), emergency admission, use of ambulance, referral letter, admission to Neurosurgery, admission to Internal Medicine, use of hypnotic medication, permanent damage by stroke, history of falls, visual impairment, independence of eating, and bedriddenness rank—with low mutual collinearity and showing significant relationship by multivariate logistic regression analysis, was 0.789 in the validation set. The AUC of parsimonious model 2, using age and seven factors—sex (male), emergency admission, admission to Neurosurgery, use of hypnotic medication, history of falls, independence of eating, and bedriddenness rank—showing statistical significance by multivariate analysis in model 1, was 0.787 in the validation set. Conclusions We proposed new predictive models for inpatients’ fall using the public ADL scales in Japan, which had a higher degree of usability because of their use of simpler and fewer (8 or 13) predictors, especially parsimonious model 2.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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New predictive models for falls among inpatients using public ADL scale in Japan: A retrospective observational study of 7,858 patients in acute care setting

et al. 2020

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“…In the early 1990s, the Ministry of Health, Labour and Welfare (MHLW) released classifications for activities of daily living (ADLs), consisting of bedriddenness ranks and cognitive function scores [ 1 ]. These classifications have been widely used under the Japanese Health Insurance and Nursing-care Insurance systems, by attending physicians of elderly patients to assess them for nursing care insurance eligibility [ 2 ], by certified evaluators of long-term care to assess persistent disabilities of patients in their own home, or by attending nurses to determine the level of hospital care or discharge support required by elderly inpatients [ 3 – 5 ]. Bedriddenness ranks assess the degree of bedriddenness, which is classified into nine grades using four classification steps (S 1 , Fig.…”

Section: Introductionmentioning

confidence: 99%

High inter-rater reliability of Japanese bedriddenness ranks and cognitive function scores: a hospital-based prospective observational study

et al. 2021

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Background The statistical validities of the official Japanese classifications of activities of daily living (ADLs), including bedriddenness ranks (BR) and cognitive function scores (CFS), have yet to be assessed. To this aim, we evaluated the ability of BR and CFS to assess ADLs using inter-rater reliability and criterion-related validity. Methods New inpatients aged ≥75 years were enrolled in this hospital-based prospective observational study. BR and CFS were assessed once by an attending nurse, and then by a social worker/medical clerk. We evaluated inter-rater reliability between different professions by calculating the concordance rate, kappa coefficient, Cronbach’s α, and intraclass correlation coefficient. We also estimated the relationship of the Barthel Index and Katz Index with the BR and CFS using Spearman’s correlation coefficients. Results For the 271 patients enrolled, BR at the first assessment revealed 66 normal, 10 of J1, 15 of J2, 18 of A1, 31 of A2, 37 of B1, 35 of B2, 22 of C1, and 32 of C2. The concordance rate between the two BR assessments was 68.6%, with a kappa coefficient of 0.61, Cronbach’s α of 0.91, and an intraclass correlation coefficient of 0.83, thus showing good inter-rater reliability. BR was negatively correlated with the Barthel Index (r = − 0.848, p < 0.001) and Katz Index (r = − 0.820, p < 0.001), showing justifiable criterion-related validity. Meanwhile, CFS at the first assessment revealed 92 normal, 47 of 1, 19 of 2a, 30 of 2b, 60 of 3a, 8 of 3b, 8 of 4, and 0 of M. The concordance rate between the two CFS assessments was 70.1%, with a kappa coefficient of 0.62, Cronbach’s α of 0.87, and an intraclass correlation coefficient 0.78, thus also showing good inter-rater reliability. CFS was negatively correlated with the Barthel Index (r = − 0.667, p < 0.001) and Katz Index (r = − 0.661, p < 0.001), showing justifiable criterion-related validity. Conclusions BR and CFS could be reliable and easy-to-use grading scales of ADLs in acute clinical practice or large-scale screening, with high inter-rater reliabilities among different professions and significant correlations with well-established, though complicated to use, instruments to assess ADLs. Trial registration UMIN000041051 (2020/7/10).

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“…We treated extrathyroidal extension as an ordered categorical variable. The Cochran-Armitage trend test was used to examine associations with dichotomous parameters, and the Jonckheere-Terpstra test was used for continuous variables [15]. To explore possible associations with BMI, we used the Mann-Whitney U test for dichotomous parameters and the Spearman rank correlation coefficient for continuous variables.…”

Section: Methodsmentioning

confidence: 99%

Preoperative Factors Associated with Extrathyroidal Extension in Papillary Thyroid Cancer

Kuo¹,

Yang²,

Chien³

et al. 2020

Eur Thyroid J

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Objective: Extrathyroidal extension may not be accurately recognized during thyroidectomy and can increase the risk of positive margins and even recurrence. This study aimed to investigate the preoperative factors associated with extrathyroidal extension. Methods: We analyzed 887 patients with papillary thyroid cancer (PTC) who underwent surgery in the period of 2005-2017. Binary logistic regression analyses and generalized additive models were used to identify associations. Results: Minimal extrathyroidal extension was present in 233 (26%) patients and advanced extrathyroidal extension was found in 60 (7%) patients. Age, BMI, and tumor size were independent predictors of all or advanced extrathyroidal extension. Among the 493 patients whose BRAF mutation status was available, age (OR = 1.025), BMI (OR = 1.091), tumor size (OR = 1.544), and BRAF V600E mutation (OR = 2.311) were independently associated with extrathyroidal extension. Conclusions: Older age, a greater BMI, a larger tumor size, and presence of the BRAF mutation were predictive of extrathyroidal extension. These factors should be taken into consideration in decision-making before surgery is performed.

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Visual Impairment, Partially Dependent ADL and Extremely Old Age Could be Predictors for Severe Fall Injuries in Acute Care Settings

Cited by 13 publications

References 18 publications

New predictive models for falls among inpatients using public ADL scale in Japan: A retrospective observational study of 7,858 patients in acute care setting

New predictive models for falls among inpatients using public ADL scale in Japan: A retrospective observational study of 7,858 patients in acute care setting

High inter-rater reliability of Japanese bedriddenness ranks and cognitive function scores: a hospital-based prospective observational study

Preoperative Factors Associated with Extrathyroidal Extension in Papillary Thyroid Cancer

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