Open Access, Peer-reviewed
eISSN 2288-338X
    Korean J Adult Nurs. 2015 Oct;27(5):559-571. Korean.
    Published online Oct 31, 2015.
    https://doi.org/10.7475/kjan.2015.27.5.559
    © 2015 Korean Society of Adult Nursing
    Original Article

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

    Seong-Hi Park,1 Yun-Kyoung Choi,2 and Jeong-Hae Hwang3
      • 1Department of Nursing, Soonchunhyang University, Cheonan, Korea.
      • 2Department of Nursing, Korea National Open University, Seoul, Korea.
      • 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, Email: jeonghae.hwang@gmail.com
    Received July 27, 2015; Revised October 05, 2015; Accepted October 06, 2015.

    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-∥ 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

    Figures

    Figure 1
    Flow diagram of article selection.

    Figure 2
    Diagnosis test accuracy of STRATIFY in total selected studies.

    Tables

    Table 1
    Characteristics of the Selected Studies

    Table 2
    Summary Results of Meta-analysis

    Notes

    This work was supported by the Soonchunhyang University Research Fund.

    Appendix

    • a1. Kim SR, Yoo SH, Shin YS, Jeon JY, Kim JY, Kang SJ, et al. Comparison of the reliability and validity of fall risk assessment tools in patients with acute neurological disorders. Korean Journal of Adult Nursing. 2013;25(1):24-32.

      http://dx.doi.org/10.7475/kjan.2013.25.1.24

    • a2. Barker A, Kamar J, Graco M, Lawlor V, Hill, K. Adding value to the STRATIFY falls risk assessment in acute hospitals. Journal of Advanced Nursing. 2011;67(2):450-7.

      http://dx.doi.org/10.1111/j.1365-2648.2010.05503.x

    • a3. Marschollek M, Rehwald A, Wolf KH, Gietzelt M, Nemitz G, ZuSchwabedissen HM, et al. Sensors vs. experts-A performance comparison of sensor-based fall risk assessment vs. conventional assessment in a sample of geriatric patients. BMC Medical Informatics & Decision Making. 2011;11:48.

      http://dx.doi.org/10.1186/1472-6947-11-48

    • a4. Vassallo M, Poynter L, Sharma JC, Kwan J, Allen SC, Vassallo M, et al. Fall risk-assessment tools compared with clinical judgment: an evaluation in a rehabilitation ward. Age and Ageing. 2008;37(3):277-81.

      http://dx.doi.org/10.1093/ageing/afn062

    • a5. Webster J, Courtney M, Marsh N, Gale C, Abbott B, Mackenzie-Ross A, et al. The STRATIFY tool and clinical judgment were poor predictors of falling in an acute hospital setting. Journal of Clinical Epidemiology. 2010;63(1):109-13.

      http://dx.doi.org/10.1016/j.jclinepi.2009.02.003

    • a6. Kim EA, Mordiffi SZ, Bee WH, Devi K, Evans D, Kim EAN, et al. Evaluation of three fall-risk assessment tools in an acute care setting. Journal of Advanced Nursing. 2007;60(4):427-35.

      http://dx.doi.org/10.1111/j.1365-2648.2007.04419.x

    • a7. Milisen K, Staelens N, Schwendimann R, De Paepe L, Verhaeghe J, Braes T, et al. Fall prediction in inpatients by bedside nurses using the St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) instrument: a multicenter study. Journal of the American Geriatrics Society. 2007;55(5):725-33.

      http://dx.doi.org/10.1111/j.1532-5415.2007.01151.x

    • a8. Haines TP, Bennell KL, Osborne RH, Hill KD. A new instrument for targeting falls prevention interventions was accurate and clinically applicable in a hospital setting. Journal of Clinical Epidemiology. 2006;59(2):168-75.

      http://dx.doi.org/10.1016/j.jclinepi.2005.07.017

    • a9. Smith J, Forster A. Young J. Use of the STRATIFY falls risk assessment tool was not useful in predicting falls in patients with acute stroke. Age and Ageing. 2006;35(2):138-43.

      http://dx.doi.org/10.1093/ageing/afj027

    • a10. Vassallo M, Stockdale R, Sharma JC, Briggs R, Allen S. A comparative study of the use of four fall risk assessment tools on acute medical wards. Journal of the American Geriatrics Society. 2005;53(6):1034-8.

      http://dx.doi.org/10.1111/j.1532-5415.2005.53316.x

    • a11. Jester R, Wade S, Henderson K. A pilot investigation of the efficacy of falls risk assessment tools and prevention strategies in an elderly hip fracture population. Journal of Orthopaedic Nursing. 2005;9(1):27-34.

      http://dx.doi.org/10.1016/j.joon.2004.10.002

    • a12. Papaioannou A, Parkinson W, Cook R, Ferko N, Coker E, Adachi JD. Prediction of falls using a risk assessment tool in the acute care setting. BMC Medicine. 2004;2:1.

      http://dx.doi.org/10.1186/1741-7015-2-1

    • a13. Coker E, Oliver D. Evaluation of the STRATIFY falls prediction tool on a geriatric unit. Outcomes Management. 2003;7(1):8-16.

    • a14. Oliver D, Britton M, Seed P, Martin FC, Hopper AH. Development and evaluation of an evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. British Medical Journal. 1997;315(7115):1049-53.

      http://dx.doi.org/10.1136/bmj.315.7115.1049

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    MeSH Terms
    Accidental Falls
    Aged
    Humans
    Inpatients
    Mass Screening*
    Population Characteristics
    Risk Assessment
    Sensitivity and Specificity
    Metrics
    Share
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