Background: STRATIFY is a prediction tool developed for use in for hospital inpatients. It has been widely used as part of hospital fall prevention plans, but it is not clear how effective its operational utility is in a variety of settings.
Objectives: (i) to describe the predictive validity of STRATIFY for identifying hospital in-patients who will fall via systematic review and descriptive analysis, based on its use in several prospective cohort studies of hospital inpatients; (ii) to describe the predictive validity of STRATIFY among inpatients in geriatric rehabilitation via meta-analysis and (iii) in turn, to help practitioners and institutions wishing to implement interventions to prevent in-hospital falls.
Methods: a systematic literature review of prospective validation studies of STRATIFY for falls prediction in hospital inpatients. studies included reported sufficient data for calculation of sensitivity (SENS), specificity (SPEC), negative and positive predictive value (NPV and PPV), total predictive accuracy (TPA) and 95% confidence intervals (CI). meta-analysis was performed using precision-weighted fixed- and random-effects models using studies that evaluated STRATIFY among geriatric rehabilitation inpatients.
Results: forty-one papers were identified by the search, with eight ultimately eligible for inclusion in the systematic review and four for inclusion in the meta-analysis.
Conclusion: the current study reveals a relatively high NPV and low PPV and TPA for the STRATIFY instrument, suggesting that it may not be optimal for identifying high-risk individuals for fall prevention. Further, the study demonstrates that population and setting affect STRATIFY performance.
The paper can be downloaded here: Oliver et al. 2008
