• acute care;
  • falls;
  • fall-risk assessment tool;
  • instrument validation;
  • nursing;
  • reliability;
  • validity


Title. Evaluation of three fall-risk assessment tools in an acute care setting

Aim.  This paper is a report of a study to evaluate the validity of three fall-risk assessment tools to identify patients at high risk for falls.

Background.  Patient falls make up 38% of all adverse events occurring in hospital settings, and may result in physical injury and undesirable emotional and financial outcomes. No single fall-risk assessment tool has been conclusively validated.

Method.  The Morse Fall Scale, St Thomas Risk Assessment Tool in Falling Elderly Inpatients, and Hendrich II Fall Risk Model were validated in inter-rater reliability and validity studies in 2003. This included assessment of the probability of disagreement, κ-values, sensitivity, specificity, positive predictive values and negative predictive values of the assessment tools with the associated 95% CI.

Findings.  One hundred and forty-four patients were recruited for the inter-rater reliability study. The probabilities of disagreement were between 2·8% and 9·7%, and 95% CI for all tools ranged from 1·1% to 15·7%. The κ-values were all higher than 0·80. In the validity study, 5489 patients were recruited to observe 60 falls. The Morse Fall Scale at a cutoff score of 25 and Heindrich II Fall Risk Model at a cutoff score of 5 had strong sensitivity values of 88% and 70%, respectively. However, in comparison with the Morse Fall Scale (specificity = 48·3%), only the Heindrich II Fall Risk Model had a more acceptable level of specificity (61·5%).

Conclusion.  The Heindrich II Fall Risk Model is potentially useful in identifying patients at high risk for falls in acute care facilities.