TY - JOUR
T1 - Diagnostic accuracy of the STRATIFY clinical prediction rule for falls
T2 - A systematic review and meta-analysis
AU - Billington, Jennifer
AU - Fahey, Tom
AU - Galvin, Rose
PY - 2012
Y1 - 2012
N2 - Background: The STRATIFY score is a clinical prediction rule (CPR) derived to assist clinicians to identify patients at risk of falling. The purpose of this systematic review and meta-analysis is to determine the overall diagnostic accuracy of the STRATIFY rule across a variety of clinical settings. Methods: A literature search was performed to identify all studies that validated the STRATIFY rule. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. A STRATIFY score of ≥2 points was used to identify individuals at higher risk of falling. All included studies were combined using a bivariate random effects model to generate pooled sensitivity and specificity of STRATIFY at ≥2 points. Heterogeneity was assessed using the variance of logit transformed sensitivity and specificity. Results: Seventeen studies were included in our meta-analysis, incorporating 11,378 patients. At a score ≥2 points, the STRATIFY rule is more useful at ruling out falls in those classified as low risk, with a greater pooled sensitivity estimate (0.67, 95% CI 0.520.80) than specificity (0.57, 95% CI 0.45 0.69). The sensitivity analysis which examined the performance of the rule in different settings and subgroups also showed broadly comparable results, indicating that the STRATIFY rule performs in a similar manner across a variety of different at risk patient groups in different clinical settings. Conclusion: This systematic review shows that the diagnostic accuracy of the STRATIFY rule is limited and should not be used in isolation for identifying individuals at high risk of falls in clinical practice.
AB - Background: The STRATIFY score is a clinical prediction rule (CPR) derived to assist clinicians to identify patients at risk of falling. The purpose of this systematic review and meta-analysis is to determine the overall diagnostic accuracy of the STRATIFY rule across a variety of clinical settings. Methods: A literature search was performed to identify all studies that validated the STRATIFY rule. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. A STRATIFY score of ≥2 points was used to identify individuals at higher risk of falling. All included studies were combined using a bivariate random effects model to generate pooled sensitivity and specificity of STRATIFY at ≥2 points. Heterogeneity was assessed using the variance of logit transformed sensitivity and specificity. Results: Seventeen studies were included in our meta-analysis, incorporating 11,378 patients. At a score ≥2 points, the STRATIFY rule is more useful at ruling out falls in those classified as low risk, with a greater pooled sensitivity estimate (0.67, 95% CI 0.520.80) than specificity (0.57, 95% CI 0.45 0.69). The sensitivity analysis which examined the performance of the rule in different settings and subgroups also showed broadly comparable results, indicating that the STRATIFY rule performs in a similar manner across a variety of different at risk patient groups in different clinical settings. Conclusion: This systematic review shows that the diagnostic accuracy of the STRATIFY rule is limited and should not be used in isolation for identifying individuals at high risk of falls in clinical practice.
KW - Accidental Falls
KW - Aged
KW - Humans
KW - Predictive Value of Tests
KW - Quality Control
KW - Reference Standards
KW - Risk Assessment
KW - Sensitivity and Specificity
UR - http://www.scopus.com/inward/record.url?scp=84864742283&partnerID=8YFLogxK
U2 - 10.1186/1471-2296-13-76
DO - 10.1186/1471-2296-13-76
M3 - Review article
C2 - 22870921
AN - SCOPUS:84864742283
SN - 1471-2296
VL - 13
SP - 76
JO - BMC Family Practice
JF - BMC Family Practice
M1 - 76
ER -