Inpatient Fall Prediction Models: A Scoping Review

The digitization of hospital systems, including integrated electronic medical records, has provided opportunities to improve the prediction performance of inpatient fall risk models and their application to computerized clinical decision support systems. This review describes the data sources and scope of methods reported in studies that developed inpatient fall prediction models, including machine learning and more traditional approaches to inpatient fall risk prediction.

This scoping review used methods recommended by the Arksey and O'Malley framework and its recent advances. PubMed, CINAHL, IEEE Xplore, and EMBASE databases were systematically searched. Studies reporting the development of inpatient fall risk prediction approaches were included. There was no restriction on language or recency. Reference lists and manual searches were also completed. Reporting quality was assessed using adherence to Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis statement (TRIPOD), where appropriate.

Database searches identified 1,396 studies, 63 were included for scoping assessment and 45 for reporting quality assessment. There was considerable overlap in data sources and methods used for model development. Fall prediction models typically relied on features from patient assessments, including indicators of physical function or impairment, or cognitive function or impairment. All but two studies used patient information at or soon after admission and predicted fall risk over the entire admission, without consideration of post-admission interventions, acuity changes or length of stay. Overall, reporting quality was poor, but improved in the past decade.

There was substantial homogeneity in data sources and prediction model development methods. Use of artificial intelligence, including machine learning with high-dimensional data, remains underexplored in the context of hospital falls. Future research should consider approaches with the potential to utilize high-dimensional data from digital hospital systems, which may contribute to greater performance and clinical usefulness.