Open Access Highly Accessed Research article

Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis

Marta Aranda-Gallardo1*, Jose M Morales-Asencio2, Jose C Canca-Sanchez1, Silvia Barrero-Sojo1, Claudia Perez-Jimenez1, Angeles Morales-Fernandez1, Margarita Enriquez de Luna-Rodriguez1, Ana B Moya-Suarez1 and Ana M Mora-Banderas3

Author Affiliations

1 Department of Nursing, Agencia Sanitaria Costa del Sol, Autovia A7 km. 187, 29603, Marbella, Malaga, Spain

2 Faculty of Health Sciences, University of Malaga, Malaga, Spain

3 Quality of Health Care Unit, Agencia Sanitaria Costa del Sol, Autovia A7 km. 187, 29603, Marbella, Malaga, Spain

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BMC Health Services Research 2013, 13:122  doi:10.1186/1472-6963-13-122

Published: 2 April 2013



Falls are a serious problem for hospitalized patients, reducing the duration and quality of life. It is estimated that over 84% of all adverse events in hospitalized patients are related to falls. Some fall risk assessment tools have been developed and tested in environments other than those for which they were developed with serious validity discrepancies. The aim of this review is to determine the accuracy of instruments for detecting fall risk and predicting falls in acute hospitalized patients.


Systematic review and meta-analysis. Main databases, related websites and grey literature were searched. Two blinded reviewers evaluated title and abstracts of the selected articles and, if they met inclusion criteria, methodological quality was assessed in a new blinded process. Meta-analyses of diagnostic ORs (DOR) and likelihood (LH) coefficients were performed with the random effects method. Forest plots were calculated for sensitivity and specificity, DOR and LH. Additionally, summary ROC (SROC) curves were calculated for every analysis.


Fourteen studies were selected for the review. The meta-analysis was performed with the Morse (MFS), STRATIFY and Hendrich II Fall Risk Model scales. The STRATIFY tool provided greater diagnostic validity, with a DOR value of 7.64 (4.86 - 12.00). A meta-regression was performed to assess the effect of average patient age over 65 years and the performance or otherwise of risk reassessments during the patient’s stay. The reassessment showed a significant reduction in the DOR on the MFS (rDOR 0.75, 95% CI: 0.64 - 0.89, p = 0.017).


The STRATIFY scale was found to be the best tool for assessing the risk of falls by hospitalized acutely-ill adults. However, the behaviour of these instruments varies considerably depending on the population and the environment, and so their operation should be tested prior to implementation. Further studies are needed to investigate the effect of the reassessment of these instruments with respect to hospitalized adult patients, and to consider the real compliance by healthcare personnel with procedures related to patient safety, and in particular concerning the prevention of falls.

Accidental falls; Adverse events; Clinical safety; Risk assessment; Inpatients; Systematic review; Nursing assessment