Other Screening Tools
Screening tools in the ED
Tiedmann et al.
A score of 3 on the instrument of Tiedemann et al is the most accurate predictor of increased 6-month fall risk, which assesses vision, lower-limb sensation, lower-limb strength, reaction time, and standing balance.
Carpenter et al.
A score of <2 on the Carpenter et al instrument appears to identify a non–high-risk subset of patients, but this study lost 39% of patients to 6-month follow-up. This study entitled the identification of recurrent falls in ED patients. The objective was to determine fall risk at 6 months for community-dwelling older adults who used the ED for non–fall-related complaints. This cohort is important given that the proportion of ambulatory, community-dwelling elders who reported a fall in the preceding year was 39%, all of whom were in the ED for non–fall-related issues, highlighting how common falls are.
- 4 risk factors for future falls in this group included: nonhealing foot sores, self-reports of depression, falls in the preceding year, failure to cut one’s own toenails (due to mobility issues, unable to bend over)
- At 6-month follow-up, 14% of patients reported ≥1 fall, and of all patients enrolled, 22% of those that fell reported an injury.
No one tool proven most effective
A recent systematic review and meta-analysis of ED-based history, physical exam, and fall-risk stratification instruments was unable to provide a definitive fall screening strategy. However, it did give quantitative summary estimates of fall incidence and risk-factor accuracy and reliability to provide evidence on which clinicians, nursing leaders, administrators, educators, policy-makers, and researchers can build.
An ideal fall-risk screening instrument would be
- accurate and reliable
- sufficiently brief for routine ED use by clinicians, nurses, or ancillary screening staff
- not require space or equipment that is not routinely available in the average ED
Such a tool does not yet exist; no screening tool has proven to decrease future falls.
References
Carpenter CR. Ann Emerg Med. 2009;53(3):398–400.
Bueno-Cavanillas A et al. Eur J Epidemiol. 2000;16(9):849–859.
Tiedemann A et al. J Gerontol A Biol Sci Med Sci. 2010;65(8):896–903.
Abbreviations
ED, emergency department