A High-yield Fall Risk and Adverse Events Screening Questions From the Stopping Elderly Accidents, Death, and Injuries (STEADI) Guideline for Older Emergency Department Fall Patients

Jiraporn Sri-On; Gregory Philip Tirrell; Anucha Kamsom; Keith A Marill; Kalpana Narayan Shankar; Shan W Liu

doi:10.1111/acem.13413

A High-yield Fall Risk and Adverse Events Screening Questions From the Stopping Elderly Accidents, Death, and Injuries (STEADI) Guideline for Older Emergency Department Fall Patients

Acad Emerg Med. 2018 Aug;25(8):927-938. doi: 10.1111/acem.13413. Epub 2018 May 30.

Authors

Jiraporn Sri-On¹, Gregory Philip Tirrell², Anucha Kamsom³, Keith A Marill², Kalpana Narayan Shankar⁴, Shan W Liu²

Affiliations

¹ Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
² Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
³ Department of Biostatistic, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
⁴ Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA.

PMID: 29575248
DOI: 10.1111/acem.13413

Abstract

Objectives: The objectives were to examine whether responses to the Stopping Elderly Accidents, Death, and Injuries (STEADI) questions responses predicted adverse events after an older adult emergency department (ED) fall visits and to identify factors associated with such recurrent fall.

Methods: We conducted a prospective study at two urban, teaching hospitals. We included patients aged ≥ 65 years who presented to the ED for an accidental fall. Data were gathered for fall-relevant comorbidities, high-risk medications for falls, and the responses to 12 questions from the STEADI guideline recommendation. Our outcomes were the number of 6-month adverse events that were defined as mortality, ED revisit, subsequent hospitalization, recurrent falls, and a composite outcome.

Results: There were 548 (86.3%) patients who completed follow-up and 243 (44.3%) patients experienced an adverse event after a fall within 6 months. In multivariate analysis, seven questions from the STEADI guideline predicted various outcomes. The question "Had previous fall" predicted recurrent falls (odds ratio [OR] = 2.45, 95% confidence interval [CI] = 1.52 to 3.97), the question "Feels unsteady when walking sometimes" (OR = 2.34, 95% CI = 1.44 to 3.81), and "Lost some feeling in their feet" predicted recurrent falls. In addition to recurrent falls risk, the supplemental questions "Use or have been advised to use a cane or walker," "Take medication that sometimes makes them feel light-headed or more tired than usual," "Take medication to help sleep or improve mood," and "Have to rush to a toilet" predicted other outcomes.

Conclusion: A STEADI score of ≥4 did not predict adverse outcomes although seven individual questions from the STEADI guidelines were associated with increased adverse outcomes within 6 months. These may be organized into three categories (previous falls, physical activity, and high-risk medications) and may assist emergency physicians to evaluate and refer high-risk fall patients for a comprehensive falls evaluation.

Abstract

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