Comparison of fall risk assessment scales in the triage of an Italian emergency department

Background Falls in hospital are adverse events with serious consequences for the patient. Fall risk assessment requires easy tools that are suitable for the specific clinical context. This is important to quickly identify preventing measures. The aim of the study is to identify an appropriate scale for assessing fall risk in patients from an emergency department. Methods For the fall risk assessment in the emergency department, three scales were identified in literature: Kinder 1, MEDFRAT, and Morse. MEDFRAT and Morse classify the patient in high, moderate, and low risk; Kinder 1 split patients “at risk” (also when there is only one positive item) and “non-risk” (in which all items are negative). The study was carried out in July 2019 in an Italian emergency department. Patients who arrived in triage were assessed for the fall risk using the three scales. Results On a sample of 318 patients, the used scales show different levels of fall risk. For Kinder 1, 83.02% is at risk and 16.98% is not at risk; for MEDFRAT, 14.78% is at high risk, 15.09% moderate, and 70.13% low risk; for Morse, 8.81% is at high risk, 35.53% moderate, and 56.66% low risk. As Kinder 1 implies as “high risk” that all items of the questionnaire are positive, to compare Kinder 1 to the other scales with three measurements, we assumed only one positive response as “moderate risk”, all negative responses as “low risk”. Thus, Kinder 1 shows no cases at high risk, 83.02% moderate risk, and 16.98% low risk. All the scales show that the moderate-high risk increases with age. MEDFRAT and Morse have concordant percentages for young (13.6%), elderly (61.2%), and long-lived (66.6%) people. Kinder 1, 59%, 96.7%, and 100%, respectively. Conclusions The comparison between scales shows inhomogeneity in identifying the level of risk. MEDFRAT and Morse appear more reliable and consistent. Key messages An appropriate assessment scale is important to identify the fall risk level. Identifying accurate fall risk levels allows for implementing specific prevention actions.