跌倒危險評估量表準確度之研究

Accuracy of an Acute Care Based Fall Risk Assessment Tool Applied in Adults in a Medical Center

林小玲(Shir-Ling Lin) ； 溫明寰(Ming-Huan Wen) ； 陳玉枝(Yu-Chih Chen)

《醫護科技期刊》 12卷1期 (2010/03) Pp. 47-59

https://doi.org/10.6563/TJHS.2010.12(1).5

摘要

正確評估跌倒高危險群，方可作爲執行預防跌倒措施與評值病人預防跌倒成效之依據。本研究係探討住院病人跌倒危險評估量表之敏感性及特異性，並檢定影響住院病人跌倒之高危險因子。採前瞻性調查型研究，自2007年8月至2008年10月，每日以評估表收集資料共9420份。研究工具以STRATIFY跌倒評估量表爲基礎，加入多重藥物項目及下肢肌力測試部分，完成「跌倒危險評估表」。統計方法採Diagnostic test與Logistic regression分析。主要結果：(1)有121位病人跌倒（佔1.28%），男性多於女性，年齡大於75歲者人數最多；(2)跌倒危險評估表準確度以評估表總分≥3分當篩選範圍，得敏感性爲7.93%，特異性爲77.7%，陽性預測值爲44%，陰性預測值爲99.7%，而相似比爲3.56；(3)檢定住院病人發生跌倒之高危險群，結果顯示六項病人跌倒危險因子評估總分≥3分時，發生跌倒是評估表總分≤2分者的8.902倍；而下肢肌力評估，無法單腳穩定站立＞5秒者，發生跌倒是能單腳穩定站立＞5秒者的4.780倍。藉由瞭解住院病人跌倒之高危險群，建立預防跌倒措施之標準作業流程，以強化病人安全。

關鍵字

跌倒危險評估量表 ； 急性照護機構 ； 敏感性 ； 特異性 ； 相似比

並列摘要

Understanding the accuracy of an ”acute care based fall risk assessment tool” is essential in nursing to prevent patient falls and to correctly predict the causes of falls under certain hospitalized circumstances. This prospective study tested the sensitivity, specificity, and likelihood ratio of this acute care based fall risk assessment tool. Daily data on 9420 inpatients from seven medical wards during August 2007 to October 2008 in a tertiary medical center were gathered for analysis. The assessment tool was based on the STRATIFY scoring system combined with consideration of use of multiple medications and the muscle power of the lower extremities. Diagnostic testing and logistic regression were implemented for data analysis using the SPSS 15.0 statistical package. The main findings were as follows: (1) The study recorded 121 patient falls, with numbers of male patients exceeding those of female patients, and patients aged over 75 years old accounting for the majority of the falls; (2) The sensitivity, specificity, and likelihood ratio were 79.3%, 77.7%, and 3.56, respectively, for detecting high risk of patients falling, based on the fall risk assessment score using 3 points as a cutoff value; (3) Fall risk assessment score of 3 points or higher and leg muscle power served as the valued risk factors for predicting patient fall, and the relative risk ratios were 8.902 and 4.780. The analytical results provide evidence that can assist in effectively using the fall risk assessment tool, as well as in developing a standard procedure that novice nurses can use to prevent patient falls, thus assisting their professional development.

並列關鍵字

Acute care based fall risk assessment tool ； acute care settings ； sensitivity ； specificity ； likelihood ratio

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