Using the Hendrich II Inpatient Fall Risk Screen to Predict Outpatient Falls after ED Visits

Abstract

Setting

Academic medical center ED.

Design

Retrospective electronic record review.

Participants

Individuals aged 65 and older seen from 1/1/2013– 9/30/2015

Measurements

We evaluated the utility of routinely collected Hendrich II fall risk scores in predicting ED visits for a fall within 6 months of an all-cause index ED visit.

Results

Among in-network patient visits resulting in discharge with a completed Hendrich II score (N = 4366), the return rate for fall within 6 months was 8.3%. The area under the ROC curve (AUC) when using the score to predict return visits for falls was 0.64. In a univariate model, the OR for returning with a fall in 6 months was 1.23 (95%CI 1.19–1.28) for a one point increase in Hendrich II score. When included in a model with other potential confounders or predictors of fall, the Hendrich II score remains a significant predictor of return visit for fall (aOR 1.15, 95%CI 1.10–1.20). The area under the ROC curve (AUC) for this model was 0.75.

Conclusion

Routinely collected Hendrich II scores demonstrated correlation with outpatient falls, but would likely have little utility as a stand-alone fall risk screen. When combined with easily extractable covariates, the screen performs much better. These results highlight the potential for secondary use of EHR data for risk stratification of ED patients. Using data already routinely collected, patients at high risk of falls after discharge could be identified for referral without requiring additional screening resources to be employed.