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Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies

BMJ 1997; 315 doi: (Published 25 October 1997) Cite this as: BMJ 1997;315:1049
  1. D Oliver, senior registrara,
  2. M Britton, senior registrara,
  3. P Seed, lecturerb,
  4. F C Martin, consultant physiciana,
  5. A H Hopper, consultant physiciana
  1. a Department of Elderly Care (Division of Medicine), United Medical and Dental Schools, St Thomas's Hospital, London SE1 7EH
  2. b Department of Statistics (Division of Public Health Sciences), United Medical and Dental Schools, St Thomas's Hospital
  1. Correspondence to: Dr Oliver
  • Accepted 18 September 1997


Objectives: To identify clinical characteristics of elderly inpatients that predict their chance of falling (phase 1) and to use these characteristics to derive a risk assessment tool and to evaluate its power in predicting falls (phases 2 and 3).

Design: Phase 1: a prospective case-control study. Phases 2 and 3: prospective evaluations of the derived risk assessment tool in predicting falls in two cohorts.

Setting: Elderly care units of St Thomas's Hospital (phase 1 and 2) and Kent and Canterbury Hospital (phase 3).

Subjects: Elderly hospital inpatients (aged 65 years): 116 cases and 116 controls in phase 1, 217 patients in phase 2, and 331 in phase 3.

Main outcome measures: 21 separate clinical characteristics were assessed in phase 1, including the abbreviated mental test score, modified Barthel index, a transfer and mobility score obtained by combining the transfer and mobility sections of the Barthel index, and several nursing judgments.

Results: In phase 1 five factors were independently associated with a higher risk of falls: fall as a presenting complaint (odds ratio 4.64 (95% confidence interval 2.59 to 8.33); a transfer and mobility score of 3 or 4 (2.10 (1.22 to 3.61)); and primary nurses' judgment that a patient was agitated (20.9 (9.62 to 45.62)), needed frequent toileting (2.48 (1.08 to 5.70)), and was visually impaired (3.56 (1.26 to 10.05)). A risk assessment score (range 0-5) was derived by scoring one point for each of these five factors. In phases 2 and 3 a risk assessment score >2 was used to define high risk: the sensitivity and specificity of the score to predict falls during the following week was 93% and 88% respectively in phase 2 and 92% and 68% respectively in phase 3.

Conclusion: This simple risk assessment tool predicted with clinically useful sensitivity and specificity a high percentage of falls among elderly hospital inpatients.


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