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Use of the 'STRATIFY' falls risk assessment in patients recovering from acute stroke
Jane Smith1, Anne Forster, John Young
1Stroke United Network Yorkshire (SUNY), Academic Unit of Elderly Care and Rehabilitation, St Luke's Hospital, University of Leeds. stroke.research@bradfordhospitals.nhs.uk
Objectives:
To investigate the predictive validity and reliability of the STRATIFY falls risk assessment tool as applied to patients recovering from acute stroke.
Design:
Prospective cohort study.
Setting:
Six stroke rehabilitation units in the North of England.
Subjects:
All patients with a diagnosis of acute stroke admitted to the participating stroke units during a 6-month study period.
Assessment:
on admission, falls risk (STRATIFY), disability (Barthel index), mobility (Rivermead mobility index), cognitive impairment (abbreviated mental test score) and visual neglect (Albert's test) were assessed. Then, STRATIFY was completed weekly and within 48 h of anticipated discharge. Consenting patients were contacted at 3 months after discharge to determine falls.
Outcome Measures:
Occurrence of a fall within 28 days of the baseline STRATIFY (in-patient study), falls in the first 3 months after discharge (post-discharge study) and falls during stroke unit stay (reliability study).
Results:
From 387 patients admitted to the participating units during the study period, 225 contributed to the 28 day in-patient study, and 234 were followed up at 3 months after discharge. STRATIFY performed poorly in predicting falls in the first 28 days (sensitivity 11.3% and specificity 89.5%) and after discharge (sensitivity 16.3% and specificity 86.4%). Agreement was 'fair' between baseline and discharge scores (kappa = 0.263) and 'good' between the pre-hospital discharge score and that obtained in the week preceding discharge (kappa = 0.639).
Conclusion:
STRATIFY performed poorly as a predictor of falls in a heterogeneous population of stroke patients. There is a need for a disease-specific rather than a generic falls risk assessment tool.