Can falls risk prediction tools correctly identify fall-prone elderly rehabilitation inpatients? A systematic review and meta-analysis

BACKGROUND: Falls of elderly people may cause permanent disability or death.Particularly susceptible are elderly patients in rehabilitation hospitals. Wesystematically reviewed the literature to identify falls prediction toolsavailable for assessing elderly inpatients in rehabilitation hospitals.METHODS AND FINDINGS: We searched six electronic databases using comprehensivesearch strategies developed for each database. Estimates of sensitivity andspecificity were plotted in ROC space graphs and pooled across studies. Oursearch identified three studies which assessed the prediction properties of fallsprediction tools in a total of 754 elderly inpatients in rehabilitationhospitals. Only the STRATIFY tool was assessed in all three studies; the otheridentified tools (PJC-FRAT and DOWNTON) were assessed by a single study. For aSTRATIFY cut-score of two, pooled sensitivity was 73% (95%CI 63 to 81%) andpooled specificity was 42% (95%CI 34 to 51%). An indirect comparison of the toolsacross studies indicated that the DOWNTON tool has the highest sensitivity (92%),while the PJC-FRAT offers the best balance between sensitivity and specificity(73% and 75%, respectively). All studies presented major methodologicallimitations.CONCLUSIONS: We did not identify any tool which had an optimal balance betweensensitivity and specificity, or which were clearly better than a simple clinical judgment of risk of falling. The limited number of identified studies with major methodological limitations impairs sound conclusions on the usefulness of fallsrisk prediction tools in geriatric rehabilitation hospitals.