Predictive Power of Dependence and Clinical-Social Fragility Index and Risk of Fall in Hospitalized Adult Patients: A Case-Control Study

ObjectivesAccidental falls are among the leading hospitals' adverse events, with incidence ranging from 2 to 20 events per 1.000 days/patients. The objective of this study is to assess the relationship between in-hospital falls and the score of 3 DEPendence and Clinical-Social Fragility indexes.MethodsA monocentric case-control study was conducted by retrieving data of in-hospital patients from the electronic health records.ResultsSignificant differences between the mean scores at the hospital admission and discharge were found. The BRASS scale mean (SD) values at the admission and at the discharge were also significantly higher in cases of in-hospital falls: at the admission 10.2 (+/- 7.7) in cases versus 7.0 (+/- 8.0) in controls (P = 0.003); at the discharge 10.0 (+/- 6.4) versus 6.7 (+/- 7.5) (P = 0.001). Barthel index mean (SD) scores also presented statistically significant differences: at the admission 60.3 (+/- 40.6) in cases versus 76.0 (+/- 34.8) in controls (P = 0.003); at discharge 51.3 (+/- 34.9) versus 73.3 (+/- 35.2) (P = 0.000).Odds ratios were as follows: for Barthel index 2.37 (95% CI, 1.28-4.39; P = 0.003); for Index of Caring Complexity 1.45 (95% CI, 0.72-2.91, P = 0. 255); for BRASS index 1.95 (95% CI, 1.03-3.70, P = 0.026). With BRASS index, the area under the curve was 0.667 (95% CI, 0.595-0.740), thus indicating a moderate predictive power of the scale.ResultsSignificant differences between the mean scores at the hospital admission and discharge were found. The BRASS scale mean (SD) values at the admission and at the discharge were also significantly higher in cases of in-hospital falls: at the admission 10.2 (+/- 7.7) in cases versus 7.0 (+/- 8.0) in controls (P = 0.003); at the discharge 10.0 (+/- 6.4) versus 6.7 (+/- 7.5) (P = 0.001). Barthel index mean (SD) scores also presented statistically significant differences: at the admission 60.3 (+/- 40.6) in cases versus 76.0 (+/- 34.8) in controls (P = 0.003); at discharge 51.3 (+/- 34.9) versus 73.3 (+/- 35.2) (P = 0.000).Odds ratios were as follows: for Barthel index 2.37 (95% CI, 1.28-4.39; P = 0.003); for Index of Caring Complexity 1.45 (95% CI, 0.72-2.91, P = 0. 255); for BRASS index 1.95 (95% CI, 1.03-3.70, P = 0.026). With BRASS index, the area under the curve was 0.667 (95% CI, 0.595-0.740), thus indicating a moderate predictive power of the scale.ConclusionsThe use of only Conley scale-despite its sensitivity and specificity-is not enough to fully address this need because of the multiple and heterogeneous factors that predispose to in-hospital falls. Therefore, the combination of multiple tools should be recommended.