Construction Of A Fall Risk Prediction Model For Inpatients With Strok

Objective:The present study aims to examine the status quo of falls among inpatients with stroke and analyze the factors of falls.We also look to establish a prediction model for falls among inpatients with stroke using logistic regression and to evaluate the performance of the model.Methods:A cross-sectional study was conducted.We analyzed the general information,clinical data,balance motor function,and activities of daily living of the inpatients with stroke hospitalized in a tertiary grade-A hospital in Changsha City between December 2020 to December 2022;the falls were confirmed using the adverse event reports in the nursing management system.The factors of falls were analyzed using univariate and multivariate analyses,and a prediction model for falls of inpatients with stroke was built on this basis.With the use of the receiver operating characteristic(ROC)curve,the area under curve(AUC),sensitivity,specificity,and Youden index were calculated,and the Hosmer-Lemeshow test was then performed to evaluate the fitness of the model.Decision Curve Analysis was conducted to evaluated the clinical efficiency.Internal validation was performed.Results:The present study examined a total of 560 inpatients with stroke.392 patients was in the model group,while 168 in the validation group.In the model group,incidence of falls was being21.9%(95%CI:0.18-0.26).Based on the multivariate analyses,we found that score of the Morse Fall Scale(OR:2.67,95%CI:1.16-6.15),hospital stay(OR:1.74,95%CI:0.66-4.59;OR:10.51,95%CI:2.90-38.12;OR:4.94,95%CI:1.07-22.88;OR:43.15,95%CI:9.31-199.97)were risk factors of inpatient falls,while coronary heart disease(OR:0.17,95%CI:0.06-0.51),syndrome of phlegm-stasis obstruction(OR:0.02,95%CI:0.01-0.05)were protective factors of inpatient falls.On this basis,the risk prediction model was established as logistic(P)=-1.796×coronary heart disease-4.114×syndrome of phlegm-stasis obstruction+0.982×Morse Fall Scale+0.556×8-14+2.352×hospital stay of 15-21 days+1.598×hospital stay of 22-28days+3.765×hospital stay of more than 29 days-1.296,and visualized using nomogram.It’s shown that the area under the ROC curve was 0.892(95%CI:0.86-0.93,P<0.001),the Youden index was 1.630,the sensitivity was 0.647,specificity was 0.781,and the accuracy was 0.796.The H-L test showedχ~2was 5.105 and P value was 0.796.The average AUC calculated by internal validation was 0.796(95%CI:0.72-0.87,P<0.001).Conclusion:The present study suggested that falls of inpatients with stroke in hospital were associated with a relatively high incidence.By including the length of hospital stay,score on the Morse Fall Scale,coronary heart disease,and syndrome of phlegm-stasis obstruction into the prediction model for the risk of falls among inpatients with stroke,we found that the length of hospital stay,and score on the Morse Fall Scale were risk factors of inpatient falls,while coronary heart disease,and syndrome of phlegm-stasis obstruction,were protective factors of such a risk.The model was of good quality after validation.