Developing a Scoring Model to Predict the Risk of Injurious Falls in Elderly Patients: A Retrospective Case-control Study in Multi-center Acute Hospitals
Abstract Background Injurious falls seriously threaten the safety of elderly patients. The identification of risk factors to predict the probability of injurious falls is an important issue still needed to be solved urgently. We aimed to identify predictors and develop a nomogram as an appropriate assessment tool for distinguishing high-risk populations of injurious falls from older adults in acute settings.Methods A retrospective case-control study was conducted in three acute care hospitals in Shanghai, China. We included elderly patients with injurious falls from 2014 to 2018, and the control patients without falls randomly identified from the electronic medical records. A new nomogram was established based on risk factors and its discrimination and calibration were verified to confirm the accuracy of the prediction. And the cut-off value of risk stratification was determined to help medical staff identify the high-risk groups.Results 115 elderly patients with injurious falls and 230 controls were identified in our study. The history of fractures, orthostatic hypotension, function status, sedative-hypnotics and the level of serum albumin were independent risk factors for injurious falls in elderly patients. And the scoring nomogram showed an acceptable predicting performance of injurious falls (C-index: 0.865, 95%CI: 0.789-0.941; corrected C-index: 0.868, 95%CI: 0.852-0.884). The threshold was 153 points to distinguish the high-risk groups from the aging patients, with acceptable sensitivity (72.2%) and specificity (86.1%).Conclusions The established nomogram will allow for identifying the high-risk populations among elderly patients, providing a new assessment tool to forecast the individual risk of injurious falls.