Should elderly patients be screened for their 'falls risk'? Validity of the STRATIFY falls screening tool and predictors of falls in a large acute hospital

SIR-Falls are not uncommon in hospitals settings at rates between 1.3 and 12.2% of all admissions [ 1-3] in acute facilities. Approximately 6% of falls result in serious injury such as bleeding or laceration, fracture and haematoma [ 4, 5]. Falls in hospital may lead to prolonged stay [ 6] or litigation [ 7]. Unfortunately, studies of interventions to prevent hospital-related falls are limited or of low quality [ 8] and provide no conclusive evidence that falls, in acute facilities, can be reduced through falls prevention programmes [ 9-11]. Despite this, screening to identify patients who may be at risk of falling is widespread. For example, recent Australian guidelines [ 12] recommend screening and assessment of all older people for risk of falling using the St Thomas' Risk Assessment Tool (STRATIFY tool) [ 13]. However, published studies about the ability of the STRATIFY tool to discriminate accurately between those with and without a high risk of falling [ 14-18] have been contradictory (Table 1 ). In addition, recent systematic reviews of fall screening tools have urged caution with their use because of their tendency to over-classify patients as high risk, leading to poorly targeted interventions [ 19-21]. The aim of the current study was to test the validity of the tool in our own setting, before introducing it as a standard practice.