四种跌倒风险评估量表在老年患者中的应用研究

Application of four fall risk assessment scales in elderly patients

目的:研究比较四种跌倒风险评估量表对康复科老年住院患者跌倒的预测价值及意义。方法:选择2018年1月-2019年10月于广州市中西医结合医院康复科住院的患者为研究对象。住院期间对患者分别进行Morse评分、Hendrich评分、Barthel评分和Berg评分,评分3个月后以电话随访的形式询问患者在此期间的跌倒情况。比较跌倒组和非跌倒组Morse评分、Hendrich评分、Barthel评分和Berg评分的差异,并用ROC曲线评估不同跌倒评估量表对跌倒的预测效果。结果:本研究对入选的154名住院患者进行问卷调查及随访。随访结果显示发生跌倒的患者为30例,没发生跌倒的患者为124例。跌倒组患者的年龄更大,Morse评分和HendrichⅡ评分更高,而Barthel评分和Berg评分更低,差异具有统计学意义(P<0.05)。ROC曲线分析结果显示Morse评分、HendrichⅡ评分、Barthel评分和Berg评分的AUC值分别为0.806[95%CI(0.715~0.897)]、0.617[95%CI(0.521~0.714)]、0.736[95%CI(0.633~0.840)]和0.750[95%CI(0.660~0.839)],其中Morse评分的AUC值最大。结论:四种跌倒评估量表对我科住院患者的跌倒都有一定预测价值,其中Morse评估量表的预测价值最好。当然,在康复科住院的老年患者,尤其是脑血管病变患者,其跌倒高危因素较多,如肢体无力、偏瘫、步态不稳、视物不清等,把他们纳入更多高危因素评估的量表对预测老年患者跌倒的价值更高,这可能是Morse评估量表预测价值优于HendrichⅡ评估量表的原因。

Objective:This study compared the predictive value and significance of four fall risk assessment scales for elderly inpatients in rehabilitation department.Methods:Patients admitted to the Rehabilitation Department of Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to October 2019 were selected as study subjects.During hospitalization,patients were assessed with Morse score,Hendrich score,Barthel score and Berg score respectively.The patients were then asked about their falls during this period in the form of telephone follow-up 3 months later.The differences of Morse score,Hendrich score,Barthel score and Berg score between the fall group and the non-fall group were compared,and the prediction effect of different fall assessment scales on falls was evaluated by ROC curve.Results:A total of 154 inpatients were included in this study for questionnaire survey and follow-up.The follow-up results showed that 30 patients had fallen and 124 patients had not.Patients in the fall group were older and had higher Morse and Hendrich Ⅱ scores,while the Barthel and Berg scores were lower,and the difference was statistically significant(P<0.05).ROC curve analysis showed Morse score,Hendrich Ⅱ score,Barthel grade and Berg AUC values were 0.806(95%CI 0.7150.897),0.617(95%CI 0.5210.714),0.736(95%CI 0.6330.840)and 0.750(95%CI,0.660 to 0.839),Morse score the AUC value was the largest.Conclusion:All the four fall assessment scales have certain predictive value for the fall of inpatients in our department,among which Morse scale has the best predictive value.Elderly patients hospitalized in the rehabilitation department,especially patients with cerebrovascular diseases,have more risk factors for falls,such as limb weakness,hemiplegia,gait instability,blurred vision,etc.Including them into the more risk factors assessment scale for predicting the value of a fall in the elderly patients is higher,which may be where Morse assessment scale prediction value is superior to the Hendrich II assessment scale.