Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER)
Objectives To develop (part I) and validate (part II) an electronic fall risk clinical rule (CR) to identify nursing home residents (NH-residents) at risk for a fall incident.Design Observational, retrospective case–control study.Setting Nursing homes.Participants A total of 1668 (824 in part I, 844...
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BMJ Publishing Group
2021-05-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/5/e042941.full |
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| author | Hugo M van der Kuy Dennis Wong Brigit P C van Oijen Kim P G M Hurkens Vanja Milosevic Aimee Linkens Carlota Mestres-Gonzalvo |
| author_facet | Hugo M van der Kuy Dennis Wong Brigit P C van Oijen Kim P G M Hurkens Vanja Milosevic Aimee Linkens Carlota Mestres-Gonzalvo |
| author_sort | Hugo M van der Kuy |
| collection | DOAJ |
| description | Objectives To develop (part I) and validate (part II) an electronic fall risk clinical rule (CR) to identify nursing home residents (NH-residents) at risk for a fall incident.Design Observational, retrospective case–control study.Setting Nursing homes.Participants A total of 1668 (824 in part I, 844 in part II) NH-residents from the Netherlands were included. Data of participants from part I were excluded in part II.Primary and secondary outcome measures Development and validation of a fall risk CR in NH-residents. Logistic regression analysis was conducted to identify the fall risk-variables in part I. With these, three CRs were developed (ie, at the day of the fall incident and 3 days and 5 days prior to the fall incident). The overall prediction quality of the CRs were assessed using the area under the receiver operating characteristics (AUROC), and a cut-off value was determined for the predicted risk ensuring a sensitivity ≥0.85. Finally, one CR was chosen and validated in part II using a new retrospective data set.Results Eleven fall risk-variables were identified in part I. The AUROCs of the three CRs form part I were similar: the AUROC for models I, II and III were 0.714 (95% CI: 0.679 to 0.748), 0.715 (95% CI: 0.680 to 0.750) and 0.709 (95% CI: 0.674 to 0.744), respectively. Model III (ie, 5 days prior to the fall incident) was chosen for validation in part II. The validated AUROC of the CR, obtained in part II, was 0.603 (95% CI: 0.565 to 0.641) with a sensitivity of 83.41% (95% CI: 79.44% to 86.76%) and a specificity of 27.25% (95% CI 23.11% to 31.81%).Conclusion Medication data and resident characteristics alone are not sufficient enough to develop a successful CR with a high sensitivity and specificity to predict fall risk in NH-residents.Trial registration number Not available. |
| format | Article |
| id | doaj-art-55cd182822af40ceb7e2c510c3054d8b |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-55cd182822af40ceb7e2c510c3054d8b2025-08-20T02:12:33ZengBMJ Publishing GroupBMJ Open2044-60552021-05-0111510.1136/bmjopen-2020-042941Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER)Hugo M van der Kuy0Dennis Wong1Brigit P C van Oijen2Kim P G M Hurkens3Vanja Milosevic4Aimee Linkens5Carlota Mestres-Gonzalvo6Department of Clinical Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The NetherlandsClinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen and Heerlen, Limburg, The NetherlandsClinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen and Heerlen, Limburg, The NetherlandsGeriatric Medicine, Department of Internal Medicine, Zuyderland Medisch Centrum, Heerlen, Limburg, The NetherlandsClinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen and Heerlen, Limburg, The NetherlandsInternal Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The NetherlandsClinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Limburg, The NetherlandsObjectives To develop (part I) and validate (part II) an electronic fall risk clinical rule (CR) to identify nursing home residents (NH-residents) at risk for a fall incident.Design Observational, retrospective case–control study.Setting Nursing homes.Participants A total of 1668 (824 in part I, 844 in part II) NH-residents from the Netherlands were included. Data of participants from part I were excluded in part II.Primary and secondary outcome measures Development and validation of a fall risk CR in NH-residents. Logistic regression analysis was conducted to identify the fall risk-variables in part I. With these, three CRs were developed (ie, at the day of the fall incident and 3 days and 5 days prior to the fall incident). The overall prediction quality of the CRs were assessed using the area under the receiver operating characteristics (AUROC), and a cut-off value was determined for the predicted risk ensuring a sensitivity ≥0.85. Finally, one CR was chosen and validated in part II using a new retrospective data set.Results Eleven fall risk-variables were identified in part I. The AUROCs of the three CRs form part I were similar: the AUROC for models I, II and III were 0.714 (95% CI: 0.679 to 0.748), 0.715 (95% CI: 0.680 to 0.750) and 0.709 (95% CI: 0.674 to 0.744), respectively. Model III (ie, 5 days prior to the fall incident) was chosen for validation in part II. The validated AUROC of the CR, obtained in part II, was 0.603 (95% CI: 0.565 to 0.641) with a sensitivity of 83.41% (95% CI: 79.44% to 86.76%) and a specificity of 27.25% (95% CI 23.11% to 31.81%).Conclusion Medication data and resident characteristics alone are not sufficient enough to develop a successful CR with a high sensitivity and specificity to predict fall risk in NH-residents.Trial registration number Not available.https://bmjopen.bmj.com/content/11/5/e042941.full |
| spellingShingle | Hugo M van der Kuy Dennis Wong Brigit P C van Oijen Kim P G M Hurkens Vanja Milosevic Aimee Linkens Carlota Mestres-Gonzalvo Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER) BMJ Open |
| title | Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER) |
| title_full | Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER) |
| title_fullStr | Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER) |
| title_full_unstemmed | Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER) |
| title_short | Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER) |
| title_sort | fall incidents in nursing home residents development of a predictive clinical rule finder |
| url | https://bmjopen.bmj.com/content/11/5/e042941.full |
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