성인 입원환자에게 유용한 낙상위험사정도구: 체계적 문헌고찰과 메타분석
Systematic Review and Meta-analysis for Usefulness of Fall Risk Assessment Tools in Adult Inpatients
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연구배경: 본 연구는 성인 입원환자의 낙상위험을 선별하는데 가장 적절한 낙상위험사정도구를 확인하고자 시도되었다. 방법: 문헌검색을 위한 데이터베이스는 Ovid Medline, Embase, CINAHL, KoreaMed, 국가과학기술정보센터(NDSL) 등을 이용하였으며, 1946년부터 2014년까지 출판된 논문을 대상으로 하였다. 검색어는 ‘falls’, ‘fall risk assessment’, ‘fall screening’, ‘mobility scale’과 ‘risk assessment tool’을 활용하였다. 문헌의 질 평가는 Quality Assessment of Diagnositic Accuracy Studies-2를 사용하였고, MetaDisc 1.4 프로그램을 이용하여 메타분석하였다. 결과: 성인 입원환자에게 사용된 낙상위험사정도구들의예측 타당도 평가 결과, More 낙상도구가 가장 효과적으로낙상위험을 예측하는 것으로 분석되었다. Morse 낙상도구의 선택된 문헌은 6편으로, 연구대상자는 총 9,255명이었다. 메타분석 결과, 통합 민감도는 0.73 (95% CI: 0.68-0.78), 통합 특이도는 0.75 (95% CI: 0.74-0.76), sROC AUC는0.79 (SE=0.02), Q*값은 0.72 (SE=0.01)였다. 결론: 성인 입원환자에게 Morse 낙상도구를 사용함으로써 보다 효과적으로 낙상위험을 사정할 수 있을 것이다. 이결과는 성인 입원환자에 있어 환자 안전과 낙상사고 예방을 위해 보다 과학적인 근거를 제공한다.
Abstract
Background:The aim of this study was to determine which fall-risk tool is most accurate for detecting and predicting adults in the hospital setting. Methods:A literature search was performed to identify all studies published between 1946 and 2014 from periodicals indexed in Ovid Medline, Embase, CINAHL, KoreaMed, NDSL and other databases, using the following keywords: ‘fall’, 'fall risk assessment', 'fall screening', 'mobility scale', and 'risk assessment tool'. The QUADAS-2 was applied to assess the internal validity of the diagnostic studies. Fourteen studies were analyzed using meta-analysis with MetaDisc 1.4. Results:The result of comparing twelve tools was that the Morse Fall Scale (MFS) is the best tool for predicting falls for acute hospitalized adult patients. Six prospective validation studies using MFS with high methodological quality, involving 9,255 patients, were included. Meta-analysis finding of MFS was as follows; pooled sensitivity 0.73 (95% confidence interval [CI]: 0.68-0.78), pooled specificity 0.75 (95% CI: 0.74-0.76), area under the curve (AUC) of summary receiver operating characteristics (sROC) curve 0.79 (standard error [SE] = 0.02), and value of index Q* 0.72 (SE = 0.01) respectively. Conclusions:Falls in hospitalized adult patients can be effectively prevented using the MFS. These findings provide scientific evidence for using appropriate tool to prevent accidental falls and improve the safety of patients.
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