Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

The STRATIFY rule is limited at identifying adults at risk of falling

20 November 2012
A study carried out by the HRB Centre for Primary Care Research, based in the Royal College of Surgeons in Ireland (RCSI) has completed a review of 18 validation studies of the STRATIFY score, a clinical prediction rule widely used in clinical practice to identify individuals at high risk of falling.

The STRATIFY rule (St. Thomas Risk Assessment Tool In Falling elderly inpatients) consists of five items that address risk factors for falling including past history of falling, patient agitation, visual impairment affecting everyday function, need for frequent toileting, and limited transfer ability and mobility. The STRATIFY rule yields a possible score between 0 and 5 with each item scoring 1 if present or 0 if absent.

The research found the rule is not useful for distinguishing between people at low and high risk of falling. Additional analysis which examined the performance of the rule in different settings of care including nursing homes, and in different patient subgroups, showed that the rule performed in a limited manner across a variety of different clinical settings.

Commenting on the review, Dr Rose Galvin, a research physiotherapist at the Centre, said that ‘falls risk screening tools are commonly used in clinical practice to identify patients at high risk of falling who would benefit from a falls prevention programme. Using screening tools such as the STRATIFY rule to identify patients at risk can lead to inappropriate distribution of resources, contributing to varying degrees of success and failure of falls prevention strategies.'

‘From a total of 18 studies incorporating 11,378 patients, our research found the predictive value of the STRATIFY rule is limited and should not be used in isolation for identifying individuals at high risk of falls in clinical practice,' Dr Galvin continued.

A number of other screening tools have been proposed to identify people at risk of falling, including the value of the clinician's judgement or patient self judgement. However, these tools need to be investigated further prior to mainstream clinical use. In the meantime, clinicians should continue to complete a multi-factorial falls assessment and apply caution when screening for falls risk using these methods until more robust evidence is available.
The research was led by Dr Rose Galvin and Professor Tom Fahey from the HRB Centre for Primary Care Research. The HRB Centre is a 5-year programme funded by the Health Research Board (HRB) in Ireland.