Predictive Validity of the STRATIFY for Fall Screening Assessment in Acute Hospital Setting: A meta-analysis

Seong-Hi Park; Yun-Kyoung Choi; Jeong-Hae Hwang

doi:10.7469/kjan.2015.27.5.559

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Park, Choi, and Hwang: Predictive Validity of the STRATIFY for Fall Screening Assessment in Acute Hospital Setting: A meta-analysis

Original Article

Korean J Adult Nurs 2015;27(5):559-571.

Published online: October 2015

DOI: https://doi.org/10.7469/kjan.2015.27.5.559

Predictive Validity of the STRATIFY for Fall Screening Assessment in Acute Hospital Setting: A meta-analysis

Seong-Hi Park¹, Yun-Kyoung Choi², Jeong-Hae Hwang^3,

^¹Department of Nursing, Soonchunhyang University, Cheonan

^²Department of Nursing, Korea National Open University, Seoul

^³Department of Health Administration, Hanyang Cyber University, Seoul, Korea

Corresponding author: Hwang, Jeong-Hae Department of Health Administration. Hanyang Cyber University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea. Tel: +82-2-2290-0811, Fax: +82-2-2290-0603, E-mail: jeonghae.hwang@gmail.com

Received 27 July 20155 October 2015 Accepted 6 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study is to determine the predictive validity of the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) for inpatients' fall risk.

Methods

A literature search was performed to identify all studies published between 1946 and 2014 from periodicals indexed in Ovid Medline, Embase, CINAHL, KoreaMed, NDSL and other databases, using the following key words; ‘fall’, 'fall risk assessment', 'fall screening', 'mobility scale', and 'risk assessment tool'. The QUADAS-Ⅱ was applied to assess the internal validity of the diagnostic studies. Fourteen studies were analyzed using meta-analysis with MetaDisc 1.4.

Results

The predictive validity of STRATIFY was as follows; pooled sensitivity .75 (95% CI: 0.72~0.78), pooled specificity .69 (95% CI: 0.69~0.70) respectively. In addition, the pooled sensitivity in the study that targets only the over 65 years of age was .89 (95% CI: 0.85~0.93).

Conclusion

The STRATIFY's predictive validity for fall risk is at a moderate level. Although there is a limit to interpret the results for heterogeneity between the literature, STRATIFY is an appropriate tool to apply to hospitalized patients of the elderly at a potential risk of accidental fall in a hospital.

Keywords: Accidental falls, Sensitivity, Specificity, Meta-analysis

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Figure 1.

Flow diagram of article selection.

Figure 2.

Diagnosis test accuracy of STRATIFY in total selected studies.

Table 1.

Characteristics of the Selected Studies

YP	Authors	Location	Participants					As	FC	COP	Follow up	2×2Table				Value (95% Confidence interval)
YP	Authors	Location	Setting	Total (n)	M:F (n)	M±SD (year)	Aged criteria	As	FC	COP	Follow up	TP	FP	FN	TN	SN	SP	DOR
2013	Kim et al.^a1)	Korea	Neurology and rehabilitation wards	1,026	484:542	56.4±14.9	＞20	N	≥1	≥2	Until discharge	27	263	5	731	0.84 (0.67~0.94)	0.74 (0.73~0.74)	15.0 (5.43~44.9)
2011	Barker et al.^a2)	Australia	Medical and surgical wards	263	137:126	61.3±20.6		S	≥1	UR	Until discharge	8	17	15	223	0.35 (0.18~0.54)	0.93 (0.91~0.96)	7.00 (2.33~20.9)
2011	Marschollek et al.^a3)	Germany	Geriatric inpatients	50 (46)	13:37	81.3		S	≥1	≥2	Until discharge	15	20	4	7	0.79 (0.62~0.92)	0.26 (0.14~0.35)	1.31 (0.27~6.65)
2008	Vassallo et al.^a4)	UK	Rehabilitation ward	200	77:123	80.9		C	≥1	≥2	Until discharge	42	98	9	51	0.82 (0.71~0.91)	0.34 (0.30~0.37)	2.43 (1.04~5.84)
2008	Webster et al.^a5)	Australia	Medical and Surgical wards	788	260:528	77.7±7.9	＞65	N	≥1	≥2	Until discharge	59	272	13	444	0.82 (0.71~0.90)	0.62 (0.61~0.63)	7.41 (3.86~14.47)
2007	Kim et al.^a6)	Singapore	Medical and Surgical wards	5,489	2,842:2,647	55.0±19.0	＞18	N	≥1	≥2	Until first fall	33	1,341	27	4,088	0.55 (0.42~0.68)	0.75 (0.75~0.75)	3.73 (2.17~6.41)
2007	Milisen et al.^a7)	Belgium	Medical and Surgical wards	2,568	1,148:1,420	67.2±18.4		N	≥1	≥2	Until discharge	122	997	14	1,435	0.90 (0.83~0.94)	0.59 (0.59~0.59)	12.54 (7.00~22.90)
2006	Haines et al.^a8)	Australia	Rehabilitation and aged care	122	38:84	79.0±9.0		S	≥1	≥2	Until discharge	20	47	6	49	0.77 (0.58~0.90)	0.51 (0.46~0.55)	3.48 (1.18~10.68)
2006	Smith et al.^a9)	UK	Stroke rehabilitation units	359 (225)	176:183	78.0 (34~100)		S	≥1	≥2	12 weeks after discharge	6	18	47	154	0.11 (0.05~0.21)	0.90 (0.88~0.92)	1.09 (0.36~3.14)
2005	Vassallo et al.^a10)	UK	Medical wards	135	49:86	83.8±8.0		C	≥1	≥2	Until discharge	15	38	7	75	0.68 (0.47~0.85)	0.66 (0.62~0.70)	4.23 (1.46~12.65)
2005	Jester et al.^a11)	UK	Hip fracture pts. in orthopaedic unit	90 (60)	20:70	60~81		N	≥1	≥2	Unrepor ted	1	14	1	44	0.50 (0.03~0.97)	0.76 (0.74~0.78) (	3.14 (0.08~125.08)
2004	Papaioannou et al.^a12)	Canada	General medical units	620	282:338	78.0±7.7	＞65	N	≥1	≥2	Unrepor ted	31	234	3	352	0.91 (0.75~0.98)	0.60 (0.59~0.60)	15.54 (4.48~64.53)
2003	Coker & Oliver^a13)	Canada	Geriatric unit with Parkinson's dz. etc.	432	134:298	81.0		N	≥1	≥2	Until discharge	73	171	38	150	0.66 (0.57~0.74)	0.47 (0.44~0.49)	1.69 (1.05~2.71)
1997	Oliver et al.^a14)	UK	Elderly care and rehabilitation units	837	-	80~83	＞65	N	≥1	≥2	8 weeks	139	155	11	532	0.93 (0.87~0.96)	0.77 (0.76~0.78) (	43.37 (22.17~87.00)

YP=year of publication; M:F=male:female; As=assesser; FC=falls criteria; COP=cut off point; TP=true positive; FP=false positive; FN=false negative; TN=true negative; SN=sensitivity; SP=specificity; DOR=diagnosis odds ratio; N=nurses; S=staff members; C=clinicians; UR=unreported.

Table 2.

Summary Results of Meta-analysis

Categories		Studies (n)	Results of pooled diagnostic test accuracy (95% Confidence interval)								Results of sROC curve
			Sensitivity			Specificity			Positive likelihood ratio	Negative likelihood ratio	Diagnostic odds ratio	AUC	SE (AUC)	Q	SE (Q)
				I₂ (%)	x²		I₂ (%)	x²	Positive likelihood ratio	Negative likelihood ratio	Diagnostic odds ratio	AUC	SE (AUC)	Q	SE (Q)
Total		14	0.75 (0.72~0.78)	93.2	191.81	0.69 (0.69~0.70)	97.8	587.43	2.02 (1.63~2.50)	0.40 (0.23~0.71)	5.23 (2.84~9.64)	0.75	0.04	0.69	0.03
≥65 elderly with G & RW		3	0.80 (0.71~0.88)	0.0	0.34	0.39 (0.33~0.45)	78.2	9.19	1.28 (1.07~1.54)	0.53 (0.34~0.82)	2.47 (1.40~4.35)	0.78	0.13	0.72	0.11
Setting	G & RW	5	0.87 (0.83~0.91)	55.0	8.89	0.70 (0.68~0.71)	97.2	143.39	1.96 (0.12~3.40)	0.32 (0.13~0.75)	6.20 (1.58~24.41)	0.94	0.06	0.88	0.08
	General wards	6	0.77 (0.72~0.82)	90.7	54.01	0.70 (0.69~0.70)	98.5	331.48	2.21 (2.08~2.35)	0.36 (0.21~0.63)	7.09 (4.31~11.68)	0.78	0.02	0.72	0.02
	Specific disease pts.	3	0.48 (0.40~0.56)	95.7	47.05	0.63 (0.59~0.67)	98.0	102.20	1.24 (1.05~1.46)	0.85 (0.58~1.25)	1.59 (1.06~2.37)	0.58	0.03	0.56	0.03
Sex ratio	M＜F (1＜1.5)	7	0.74 (0.69~0.79)	36.9	9.50	0.55 (0.53~0.58)	92.1	76.06	1.51 (1.18~1.93)	0.52 (0.37~0.72)	3.01 (1.73~5.26)	0.71	0.06	0.66	0.05
Sex ratio	M≒F	6	0.67 (0.62~0.72)	96.4	140.00	0.71 (0.70~0.72)	98.6	351.32	2.44 (2.05~2.91)	0.38 (0.15~0.95)	6.52 (3.00~14.17)	0.80	0.03	0.73	0.02
Age (Average years)	＞65 only	3	0.89 (0.85~0.93)	64.0	5.56	0.67 (0.65~0.69)	96.5	56.35	2.72 (1.78~4.17)	0.16 (0.07~0.37) 1	17.18 (5.02~58.75)	0.81	0.30	0.75	0.27
	≤60	4	0.76 (0.70~0.81)	93.8	48.18	0.71 (0.70~0.72)	98.9	284.46	2.65 (2.05~3.42)	0.37 (0.17~0.78)	8.10 (3.85~17.03)	0.81	0.04	0.74	0.03
	70~79	4	0.63 (0.55~0.70)	96.7	90.57	0.64 (0.61~0.66)	95.8	70.66	1.98 (1.62~2.43)	0.38 (0.07~2.08)	4.52 (1.62~12.65)	0.74	0.03	0.68	0.03
	≥80	5	0.80 (0.76~0.84)	87.8	32.89	0.63 (0.60~0.65)	97.6	67.63	1.69 (0.93~306)	0.42 (0.16~1.08)	4.08 (0.96~17.38)	0.77	0.16	0.71	0.14
Assessor	Nurses	8	0.81 (0.78~0.84)	89.0	63.53	0.69 (0.68~0.70)	98.0	353.14	2.34 (1.83~2.98)	0.29 (0.15~0.54)	8.47 (3.55~20.20)	0.76	0.06	0.70	0.05
Assessor	Staff members	4	0.40 (0.32~0.50)	93.8	48.54	0.81 (0.77~0.84)	97.5	119.24	1.66 (0.97~2.82)	0.75 (0.48~1.16)	2.53 (1.04~6.14)	0.64	0.09	0.61	0.07
Age (≥65) & assesser	Nurses assessed	4	0.90 (0.86~0.92)	46.1	5.57	0.62 (0.61~0.64)	96.5	84.59	2.57 (1.91~3.47)	0.17 (0.10~0.28) 1	15.77 (7.02~35.43)	0.85	0.19	0.78	0.17
Age (≥65) & assesser	Staff members assesse	d 3	0.42 (0.32~0.52)	95.8	48.15	0.71 (0.66~0.76)	97.3	75.03	1.28 (0.95~1.72)	0.74 (0.34~1.57)	1.77 (0.83~3.79)	0.60	0.07	0.58	0.05
Research Scale	≥500	6	0.85 (0.81~0.88)	88.4	43.14	0.70 (0.69~0.71)	98.2	279.69	2.61 (2.09~3.26)	0.22 (0.10~0.45) 1	12.03 (5.55~26.10)	0.79	0.05	0.73	0.04
Research Scale	＜500	8	0.59 (0.53~0.64)	91.4	81.11	0.64 (0.61~0.67)	97.6	290.88	1.48 (1.19~1.84)	0.67 (0.49~0.93)	2.46 (1.59~3.80)	0.65	0.04	0.61	0.03

ROC curve=receiver operating characteristic curve; AUC=area under the curve; SE=standard error; G & RW=Geriatric and rehabilitation wards; M=male; F=female; p＜.01; p＜.001.

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