Características de la escala Downton en la valoración del riesgo de caídas en pacientes hospitalizados

  1. María Jesús Bueno-García 1
  2. María Teresa Roldán-Chicano 2
  3. Javier Rodríguez-Tello 2
  4. María Dolores Meroño-Rivera 2
  5. Rut Dávila-Martínez 1
  6. Noelia Berenguer-García 1
  1. 1 Servicio Murciano de salud
  2. 2 HGU de Santa Lucía de Cartagena
Revista:
Enfermería clínica

ISSN: 1130-8621

Año de publicación: 2017

Volumen: 27

Número: 4

Páginas: 227-234

Tipo: Artículo

DOI: 10.1016/J.ENFCLI.2017.02.008 DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Enfermería clínica

Objetivos de desarrollo sostenible

Resumen

Objective To describe the risk of falls assessments properties and profiles of the patients who fell in a public hospital of the National Health System, and to determine the relationship between the “presence of a fall” and the previous score using the Downton scale, in order to calculate some of the features of this tool: Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio, and odss ratio. Materials and methods A study with a descriptive retrospective design was conducted on the incidence of falls recorded in Cartagena Hospital. An analysis was made of possible causes and effects of falls during the period from March 2010 to March 2015. A total of 576 patients fell during the period of the study, of whom 107 were recorded in the no “fall risk” registry, leaving a sample of 469 patients in the study. Data analysis was performed using the SPSSv.19 Statistics Package. Results In the context in which the assessment was made, the Downton scale had a sensitivity of 0.58, specificity 0.62, a positive likelihood ratio of 1.55, and negative likelihood ratio of 0.67. The odds ratio calculated was 2.31. Conclusions The data on the incidence of falls (0.51%) are similar to those found in other studies. Poor scores obtained on the Downton Index should serve as a wakeup call for the healthcare institutions. An assessment tool that classifies the at-risk patient should be included in patient safety profiles, provided it is of relevant validity to cover any changes in the patient's situation, and acts as a better yardstick than the nurses’ own assessment.

Referencias bibliográficas

  • Organización Mundial de la Salud. Caídas.[portal en internet]2016 [consultado sep 2016]. Disponible en: http://www.who.int/med(1)iacentre/factsheets/fs344/es/.
  • Iturrioz I, Gurruchaga A, Elicegui M, Olaizola A, Genua MI, Prego E, et al. Caídas en personas mayores institucionalizadas: Factores implicados y estudio de prevención. [en línea] 2012 [consultado 8 Mar 2015]. Disponible en: http://www.gizartelan.ejgv.euskadi.eus/contenidos/informacion/estadisticas_ss/es_estadist/adjuntos/proyecto_caidas_memoria_final%20%282%29.pdf.
  • Gama ZA da S, Conesa AG, Ferreira MS. Epidemiología de caídas de ancianos en España. Una revisión sistemática. Revista Española de Salud Pública [serie en Internet] 2008 ene-feb [consultado 5 Nov 2015]. Disponible en: http://www.redalyc.org/articulo.oa?id=17082104.
  • Laguna-Parras, J.M., Arrabal-Orpez, M.A.J., Zafra-López, F., García-Fernández, F.P., Carrascosa-Corral, R.R., Carrascosa-García, M.A.I., et al. Incidencia de caídas en un hospital de nivel 1: factores relacionados. Gerokomos [serie en Internet] 22 (2011), 167–173 [consultado 5 Mar 2016]. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2011000400004.
  • Huang, H.-T., Chang, C.-M., Liu, L.-F., Lin, H.-S., Chen, C.-H., Trajectories and predictors of functional decline of hospitalised older patients. J Clin Nurs. [serie en Internet] 22:9–10 (2013), 1322–1331 [consultado 5 Abr 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/23279450.
  • Hitcho, E.B., Krauss, M.J., Birge, S., Dunagan, W.C., Fischer, I., Johnson, S., et al. Characteristics and circumstances of falls in a hospital setting. J Gen Intern Med. [serie en Internet] 19 (2004), 732–739 [consultado 6 May 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1492485/.
  • Passaro, A., Volpato, S., Romagnoni, F., Manzoli, N., Zuliani, G., Fellin, R., Benzodiazepines with different half-life and falling in a hospitalized population: The GIFA study. Gruppo Italiano di Farmacovigilanza nell'Anziano. J Clin Epidemiol. [serie en Internet] 53 (2000), 1222–1229 [consultado 20 Feb 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/11146268.
  • Everhart, D., Schumacher, J.R., Duncan, R.P., Hall, A.G., Neff, D.F., Shorr, R.I., Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics. Health Care Manage Rev. [serie en internet] 39 (2014), 352–360 [consultado 3 Nov 2015]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277236/.
  • Coussement, J., de Paepe, L., Schwendimann, R., Denhaerynck, K., Dejaeger, E., Milisen, K., Interventions for preventing falls in acute- and chronic-care hospitals: a systematic review and meta-analysis. J Am Geriatr Soc. [serie en Internet] 56 (2008), 29–36 [consultado 30 Jun 2015]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2007.01508.x/abstract;jsessionid=52EC8D9F83F22367F40F4615BBAB24AE.f04t01.
  • Aranda-Gallardo, M., Morales-Asencio, J.M., Canca-Sánchez, J.C., Morales-Fernández, Á., Enríquez de Luna-Rodríguez, M., Moya-Suarez, A.B., et al. Consecuencias de los errores en la traducción de cuestionarios: versión española del índice Downton. Rev Calid Asist. [serie en Internet]. 30 (2015), 195–202 [consultado 30 Sep 2015]. Disponible en: http://www.juntadeandalucia.es/agenciadecalidadsanitaria/observatorioseguridadpaciente/opencm/.content/descargas/Otros/errores_traduccion_escala_downton_espanol.pdf.
  • Sebastián Viana, T., García Martín, M.R., Núñez Crespo, F., Velayos Rodríguez, E.M., Martín Merino, G., González Ruiz, J.M., et al. ¿Cuál es la incidencia de caídas real en un hospital?. Enferm Clínica.[serie en Internet]. 21 (2011), 271–274 [consultado 30 Ene 2016]. Disponible en: http://www.elsevier.es/es-revista-enfermeria-clinica-35-articulo-cual-es-incidencia-caidas-real-S113086211100091.
  • Labrador MV, Lizarbe V. Molina M (Coord). Documento de consenso sobre prevención de fragilidad y caídas en la persona mayor. Estrategia de Promoción de la Salud y Prevención en el SNS Informes, estudios e investigación.2014. Ministerio de Sanidad, Servicios Sociales e Igualdad. [consultado 6 May 2016]. Disponible en: http://www.msssi.gob.es/profesionales/saludPublica/prevPromocion/Estrategia/docs/FragilidadyCaidas_personamayor.pdf.
  • Kiel DP. Falls in older persons: Risk factors and patient evaluation. Falls risk assessment.2016. En: UpToDate, Kenneth E Schmader, editor. UpTo-Date, Waltham, MA. [consultado 3 Ago 2016]. Disponible en: http://www.uptodate.com/contents/falls-in-older-personsrisk-factors-and-patient-evaluation?source=machineLearning&search=ca%C3%ADdas&selectedTitle=1%7E150&sectionRank=3&anchor=H30#H21.
  • Cameron, I.D., Gillespie, L.D., Robertson, M.C., Murray, G.R., Hill, K.D., Cumming, R.G., et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev., 2012 [consultado 12 Feb 2016]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005465.pub3/full.
  • Ryan-Wenger, N.A., Kimchi-Woods, J., Erbaugh, M.A., LaFollette, L., Lathrop, J., Challenges and conundrums in the validation of Pediatric Fall Risk Assessment tools. Pediatr Nurs. [serie en Internet]. 38 (2012), 159–167 [consultado 24 May 2016]. Disponible en: http://search.proquest.com/docview/1040421491/fulltextPDF/99A9430C690C4A56PQ/1?accountid=50037.
  • Olsson-Möller, U., Kristensson, J., Midlöv, P., Ekdahl, C., Jakobsson, U., Predictive validity and cut-off scores in four diagnostic tests for falls–a study in frail older people at home. Phys Occup Ther Geriatr [serie en Internet]. 30 (2012), 189–201 [consultado 2 Jun 2016]. Disponible en: http://www.tandfonline.com/doi/full/10.3109/02703181.2012.694586?scroll=top&needAccess=true.
  • Da Costa, B.R., Rutjes, A.W.S., Mendy, A., Freund-Heritage, R., Vieira, E.R., Can Falls risk prediction tools correctly identify fall-prone elderly rehabilitation inpatients? A systematic review and meta-analysis. Baradaran HR, editor. PLoS ONE. [serie en Internet], 7, 2012, e41061 [consultado 5 Jun 2016]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398864/.
  • Rosendahl, E., Lundin-Olsson, L., Kallin, K., Jensen, J., Gustafson, Y., Nyberg, L., Prediction of falls among older people in residential care facilities by the Downton index. Aging Clin Exp Res. [serie en Internet] 15 (2003), 142–147 [consultado 15 Jun 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/12889846.
  • Meyer, G., Köpke, S., Haastert, B., Mühlhauser, I., Comparison of a fall risk assessment tool with nurses’ judgement alone: a cluster-randomised controlled trial. Age Ageing. [serie en Internet] 38 (2009), 417–423 [consultado 1 Jun 2016]. Disponible en: http://ageing.oxfordjournals.org/content/38/4/417.long.
  • Vassallo, M., Poynter, L., Sharma, J.C., Kwan, J., Allen, S.C., Fall risk-assessment tools compared with clinical judgment: an evaluation in a rehabilitation ward. Age Ageing. [serie en Internet] 37 (2008), 277–281 [consultado 11 May 2016]. Disponible en: http://ageing.oxfordjournals.org/content/37/3/277.long.
  • Vassallo, M., Stockdale, R., Sharma, J.C., Briggs, R., Allen, S., A comparative study of the use of four fall risk assessment tools on acute medical wards: a comparison of four falls risk assessment tools. Enferm Clin. [serie en Internet] 53 (2005), 1034–1038 [consultado 4 May 2016]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2005.53316.x/full.
  • Mattison M. Hospital management of older adults. 2016. En: UpToDate, Schmader KE, editor. UpToDate,Waltham, MA [consultado 7 Ago 2016]. Disponible en: http://www.uptodate.com/contents/hospital-management-ofolder-adults?source=search result&search=Hospital+management+of+older+adults&selectedTitle=1%7E150.
  • Aranda-Gallardo, M., Morales Asencio, J.M., Canca-Sanchez, J.C., Mora-Banderas, A.M., Moya-Suarez, A.B., Group for preventing falls in Hospital Costa del Sol. Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review protocol. Journal of Advanced Nursing [serie en Internet] 69 (2013), 185–193 [consultado 14 Jun 2016]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2012.06104.x/full.
  • Huete, M.E.G., Viana, T.S., Lorenzo, I.L., Martín, M.G., Lobo, N.B., Reina, M., et al. Las caídas hospitalarias, estrategia de mejora para disminuir su incidencia. Enfermería clínica. [serie en Internet] 26 (2016), 96–101 Disponible en: https://www.clinicalkey.es/#!/content/journal/1-s2.0-S1130862116000036.
  • Tazim, J., Schouten, H., McConell, S., Lappan, J., Santos, B., Russell, C., et al. Prevención de caídas y lesiones derivadas de las caídas en personas mayores. Registered Nurses Assosiation of Ontario RNAO [en línea], 2005 [consultado 15 May 2015] Disponible en: http://rnao.ca/sites/rnaoca/files/2014_PrevencionCaidas_022014__with_supplement.pdf.
  • Matarese, M., Ivziku, D., Bartolozzi, F., Piredda, M., de Marinis, M.G., Systematic review of fall risk screening tools for older patients in acute hospitals. J Adv Nurs. [serie en Internet] 71 (2015), 1198–1209 [consultado 15 Jun 2016]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/jan.12542/full.
  • Oliver, D., Assessing the risk of falls in hospitals: time for a rethink?. Can J Nurs Res. [serie en Internet], 38, 2006 89-94-96. [consultado 8 Jun 2016]. Disponible en: http://www.murciasalud.es/sod.php?c=misarticulos&a=editar&id=276266.
  • Oliver, D., Daly, F., Martin, F.C., McMurdo, M.E.T., Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age Ageing. [serie en Internet] 33 (2004), 122–130 [consultado 19 Jun 2016]. Disponible en: http://ageing.oxfordjournals.org/content/33/2/122.long.
Fuente de los datos: Dialnet