Predicting Falls in Rehabilitation: A Comparison of Three Instruments Including Hester Davis

Abstract

Purpose 

The aim of this study was to evaluate the ability of the Hester Davis Scale (HDS), Section GG, and facility fall risk assessment scores to predict patients who fall during inpatient rehabilitation.

Design 

This study was an observational quality improvement project.

Methods 

Nurses administered the HDS in parallel to the facility’s current fall risk assessment and Section GG of the Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility Patient Assessment Instrument. Receiver operating characteristic curves were compared in 1,645 patients. Relationships of individual scale items to falls were also assessed.

Results 

The HDS (area under the curve [AUC] = .680, 95% CI [.626, .734]), facility fall risk assessment (AUC = .688, 95% CI [.637, .740]), and Section GG scores (AUC = .687, 95% CI [.638, .735]) adequately identified patients who fell. AUCs did not significantly differ between assessments. HDS scores of ≥13, facility scores of ≥14, and Section GG scores of ≤51 resulted in the highest sensitivity/specificity balance.

Conclusions 

HDS, facility fall risk assessment, and Section GG scores adequately and similarly identified patients of mixed diagnoses at risk of falling in inpatient rehabilitation.

Clinical Relevance to the Practice of Rehabilitation Nursing 

Rehabilitation nurses have several options including the HDS and Section GG to identify patients at greatest risk of falling.