Risk Factors for Falls Among Hospitalized Medical Patients – A Systematic Review and Meta-analysis

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation Pub Date : 2025-02-01 DOI:10.1016/j.apmr.2024.06.015

Jeannelle Heinzmann MB , Michael L. Rossen MMed , Orestis Efthimiou PhD , Christine Baumgartner MD, MSc , Maria M. Wertli MD, PhD , Nicolas Rodondi MD, MAS , Carole E. Aubert MD, MSc , Fabian D. Liechti MD, PhD

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引用次数: 0

Abstract

Objective

To identify and quantify risk factors for in-hospital falls in medical patients.

Data Sources

Six databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar) were systematically screened until April 11, 2023, to identify relevant articles.

Study Selection

All titles and abstracts of the retrieved articles were independently screened by 2 researchers who also read the full texts of the remaining articles. Quantitative studies that assessed risk factors for falls among adult patients acutely hospitalized were included in the review. Publications that did not capture internal medicine patients or focused on other specific populations were excluded.

Data Extraction

Information on study characteristics and potential risk factors were systematically extracted. Risk of bias was assessed using the Quality in Prognosis Studies tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies in Epidemiology guidelines were followed for reporting.

Data Synthesis

The main outcome was any in-hospital falls. Using a random-effects meta-analysis model, association measures for each risk factor reported in 5 or more studies were pooled. Separate analyses according to effect measure and studies adjusted for sex and age at least were performed. Of 5067 records retrieved, 119 original publications from 25 countries were included. In conclusion, 23 potential risk factors were meta-analyzed. Strong evidence with large effect sizes was found for a history of falls (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.63-3.96; I², 91%), antidepressants (pooled OR, 2.25; 95% CI, 1.92-2.65; I², 0%), benzodiazepines (OR, 1.97; 95% CI, 1.68-2.31; I², 0%), hypnotics–sedatives (OR, 1.90; 95% CI, 1.53-2.36; I², 46%), and antipsychotics (OR, 1.61; 95% CI, 1.33-1.95; I², 0%). Furthermore, evidence of associations with male sex (OR, 1.22, 95% CI, 0.99-1.50; I², 65%) and age (OR, 1.17, 95% CI, 1.02-1.35; I², 72%) were found, but effect sizes were small.

Conclusions

The comprehensive list of risk factors, which specifies the strength of evidence and effect sizes, could assist in the prioritization of preventive measures and interventions.

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住院病人跌倒的风险因素--系统回顾与荟萃分析。

目的：确定并量化内科病人院内跌倒的风险因素：识别并量化内科病人院内跌倒的风险因素：截至 2023 年 4 月 11 日，对六个数据库（MEDLINE、Embase、Cochrane 系统综述数据库、Cochrane 对照试验中央注册库、CINAHL 和 Google Scholar）进行了系统筛选，以确定相关文章：所有检索文章的标题和摘要均由两名研究人员独立筛选，他们还阅读了其余文章的全文。综述包括评估急性住院成年患者跌倒风险因素的定量研究。数据提取：数据提取：系统地提取研究特征和潜在风险因素的相关信息。使用预后研究质量（QUIPS）工具评估偏倚风险。报告遵循 PRISMA 和 MOOSE 指南：主要结果为院内跌倒。采用随机效应荟萃分析模型，对五项或五项以上研究中报告的每个风险因素的关联测量值进行汇总。根据效应指标和至少对性别和年龄进行调整的研究分别进行分析。在检索到的 5,067 条记录中，纳入了来自 25 个国家的 119 篇原始出版物。最后，对 23 个潜在风险因素进行了元分析。研究发现，有跌倒史（OR 2.54；95% 置信区间 [95% CI] 1.63-3.96；I2 91%）、抗抑郁药（汇总 OR 2.25；95% 置信区间 [95% CI] 1.92-2.65；I2 0%）、苯二氮卓类（OR 1.97；95% CI 1.68-2.31；I2 0%）、催眠药-镇静剂（OR 1.90；95% CI 1.53-2.36；I2 46%）和抗精神病药（OR 1.61；95% CI 1.33-1.95；I2 0%）。此外，还发现了与男性性别（OR 1.22，95% CI 0.99-1.50，I2 65%）和年龄（OR 1.17，95% CI 1.02-1.35，I2 72%）相关的证据，但效应大小很小：综合风险因素清单明确了证据强度和效应大小，有助于确定预防措施和干预措施的优先次序。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of physical medicine and rehabilitation 医学-康复医学

CiteScore

6.20

自引率

4.70%

发文量

495

审稿时长

38 days

期刊介绍： The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.