Comparison of fall risk assessment scales in the triage of an Italian emergency department

Background:
Falls in hospital are adverse events with serious consequences
for the patient. Fall risk assessment requires easy tools that are
suitable for the specific clinical context. This is important to
quickly identify preventing measures. The aim of the study is
to identify an appropriate scale for assessing fall risk in patients
from an emergency department.
Methods:
For the fall risk assessment in the emergency department, three
scales were identified in literature: Kinder 1, MEDFRAT, and
Morse. MEDFRAT and Morse classify the patient in high,
moderate, and low risk; Kinder 1 split patients ‘‘at risk’’ (also
when there is only one positive item) and ‘‘non-risk’’ (in which
all items are negative). The study was carried out in July 2019
in an Italian emergency department. Patients who arrived in
triage were assessed for the fall risk using the three scales.
Results:
On a sample of 318 patients, the used scales show different
levels of fall risk. For Kinder 1, 83.02% is at risk and 16.98% is
not at risk; for MEDFRAT, 14.78% is at high risk, 15.09%
moderate, and 70.13% low risk; for Morse, 8.81% is at high
risk, 35.53% moderate, and 56.66% low risk. As Kinder 1
implies as ‘‘high risk’’ that all items of the questionnaire are
positive, to compare Kinder 1 to the other scales with three
measurements, we assumed only one positive response as
‘‘moderate risk’’, all negative responses as ‘‘low risk’’. Thus,
Kinder 1 shows no cases at high risk, 83.02% moderate risk,
and 16.98% low risk. All the scales show that the moderatehigh
risk increases with age. MEDFRAT and Morse have
concordant percentages for young (13.6%), elderly (61.2%),
and long-lived (66.6%) people. Kinder 1, 59%, 96.7%, and
100%, respectively.
Conclusions:
The comparison between scales shows inhomogeneity in
identifying the level of risk. MEDFRAT and Morse appear
more reliable and consistent.
Key messages:
An appropriate assessment scale is important to identify the
fall risk level.
Identifying accurate fall risk levels allows for implementing
specific prevention actions.