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A High‐yield Fall Risk and Adverse Events Screening Questions From the Stopping Elderly Accidents, Death, and Injuries ( STEADI ) Guideline for Older Emergency Department Fall Patients
Author(s) -
Srion Jiraporn,
Tirrell Gregory Philip,
Kamsom Anucha,
Marill Keith A.,
Shankar Kalparayan,
Liu Shan W.
Publication year - 2018
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13413
Subject(s) - medicine , emergency department , guideline , adverse effect , poison control , injury prevention , odds ratio , emergency medicine , fall prevention , accidental fall , confidence interval , prospective cohort study , physical therapy , surgery , psychiatry , pathology
Objectives The objectives were to examine whether responses to the Stopping Elderly Accidents, Death, and Injuries ( STEADI ) questions responses predicted adverse events after an older adult emergency department ( ED ) fall visits and to identify factors associated with such recurrent fall. Methods We conducted a prospective study at two urban, teaching hospitals. We included patients aged ≥ 65 years who presented to the ED for an accidental fall. Data were gathered for fall‐relevant comorbidities, high‐risk medications for falls, and the responses to 12 questions from the STEADI guideline recommendation. Our outcomes were the number of 6‐month adverse events that were defined as mortality, ED revisit, subsequent hospitalization, recurrent falls, and a composite outcome. Results There were 548 (86.3%) patients who completed follow‐up and 243 (44.3%) patients experienced an adverse event after a fall within 6 months. In multivariate analysis, seven questions from the STEADI guideline predicted various outcomes. The question “Had previous fall” predicted recurrent falls (odds ratio [ OR ] = 2.45, 95% confidence interval [ CI ] = 1.52 to 3.97), the question “Feels unsteady when walking sometimes” ( OR = 2.34, 95% CI = 1.44 to 3.81), and “Lost some feeling in their feet” predicted recurrent falls. In addition to recurrent falls risk, the supplemental questions “Use or have been advised to use a cane or walker,” “Take medication that sometimes makes them feel light‐headed or more tired than usual,” “Take medication to help sleep or improve mood,” and “Have to rush to a toilet” predicted other outcomes. Conclusion A STEADI score of ≥4 did not predict adverse outcomes although seven individual questions from the STEADI guidelines were associated with increased adverse outcomes within 6 months. These may be organized into three categories (previous falls, physical activity, and high‐risk medications) and may assist emergency physicians to evaluate and refer high‐risk fall patients for a comprehensive falls evaluation.