[Comparison of Clinical Diagnostic Effectiveness Between Psychiatric Inpatient and Wilson-Sims Fall Risk Assessment...

The incidence of falls is very high among psychiatric inpatients. However, the lack of an effective, validated psychiatric inpatient fall risk assessment tool inhibits the ability of medical staffs to make correct judgments.

The purposes of this study were to compare the sensitivity, specificity, and accuracy of the psychiatric inpatient fall risk assessment tool (PIFRAT) and the Wilson-Sims fall risk assessment tool (WSFRAT) and to predict the fall risk factors in PIFRAT and WSFRAT for psychiatric inpatients.

Study data were collected from 2016/10/01 to 2017/03/10. Fall assessment data were collected from new patients during their 1st through 7th days after admission to a psychiatry unit in northern Taiwan. Data were analyzed using descriptive analysis, logistic regression analysis, reliability and validity testing, tool effective testing, and receiver operating characteristic (ROC) curve analysis.

Both of the fall risk assessment tools exhibited low sensitivity (WSFRAT 57.1%, PIFRAT 50%), the specificity of WSFRAT (79.6%) was higher than that of PIFRAT (70.4%), and the accuracy of WSFRAT (76.9%) was higher than that of PIFRAT (67.9%). The ROC curve analysis revealed that the AUC of PIFRAT was .602 (95% CI [0.48, 0.73]). According to the Youden index, the best cutoff level is 7.5 points, in which the specificity is 88.8% and the sensitivity is 39.3%. To increase the sensitivity to 96.4%, the cutoff level must be set to 1.5 points. Moreover, the AUC of WSFRAT was .625 and the highest sensitivity was 82.1% when the cutoff point was set to 3.5 points. Further, multivariate logistic regression analysis revealed that fall risk was significantly higher among patients who had previously fallen than among those had not. Male gender (OR = 2.57, 95% CI [1.11, 5.94]), physical activity difficulties (OR = 3.43; 95% CI [1.40, 8.41]), and weakness (OR = 3.03; 95% CI [1.08, 8.49]) were each significantly associated with fall risk.

This study identified four critical risk factors for falls. In the future, clinical healthcare professionals should be more aware of these factors and develop related fall-prevention interventions. The findings may serve as references for the future development of psychiatric fall assessment tools.