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A pragmatic study of the predictive values of the Morse falls score
Frances Healey1, Terry P Haines
1NHS England, London, UK. frances.healey@nhs.net
Background:
inpatient falls are an important safety challenge, with around half causing physical injuries that compromise the recovery of older, frailer patients. Falls risk scores are in widespread use, but validation studies of their predictive values are few.
Objectives:
to assess the predictive values of the Morse falls score (MFS) in an acute general hospital.
Methods:
age, admitting speciality, MFS, and any falls in the subsequent 7 days were collected in April 2011 through case note review and incident reporting systems.
Results:
a total of 467 inpatients were included in the study; 51% were aged 75+ years; 56% had an MFS ≥25; 23% had an MFS ≥55; 28 fell. An MFS ≥25 was not significantly better than chance in the total sample or in any subgroups considered (YI: -0.01 to 0.15). An MFS ≥55 was significantly better than chance for the total sample (YI: 0.39), patients ≥75 years (YI: 0.31) and geriatrician-led wards (YI 0.37), although either sensitivity or specificity fell below 70% in each of these groups. Other subgroups did not demonstrate significantly better accuracy than chance, but may have been affected by type II error.
Conclusions:
using MFS ≥25 cannot be clinically justified, while using MFS ≥55 would be contingent on an effective intervention that was ethically acceptable to withhold from the patients with an MFS < 55, despite >40% of falls occurring in that group. Given similar limitations of alternative falls risk scores, hospitals should consider directly assessing and acting on individual patients' specific modifiable risk factors for falls.
Insights
The Morse falls score (MFS) has limited predictive value for inpatient falls. Hospitals should focus on individual fall risk factors rather than relying solely on scores like the MFS.
Area of Science:
- Geriatric Medicine
- Patient Safety
- Healthcare Quality Improvement
Background:
- Inpatient falls pose a significant safety risk, particularly for older adults, often leading to injuries that impede recovery.
- While falls risk scores are common, robust validation studies are scarce.
Purpose of the Study:
- To evaluate the predictive accuracy of the Morse falls score (MFS) in an acute general hospital setting.
Main Methods:
- Data on patient age, admitting specialty, MFS, and falls within seven days were collected.
- Methods included case note review and incident reporting systems in April 2011.
Main Results:
- Of 467 inpatients, 28% fell. An MFS of 25 or higher showed no significant predictive value.
- An MFS of 55 or higher was predictive for the total sample, older patients, and geriatric wards, but with suboptimal sensitivity or specificity.
Conclusions:
- The MFS at 25 is not clinically justifiable for predicting falls.
- An MFS of 55 requires effective, ethically sound interventions, yet over 40% of falls occur in patients with lower scores.
- Hospitals should prioritize assessing and addressing individual, modifiable fall risk factors.
