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AUTHORS' RESPONSE TO LETTER FROM WEBSTER AND COURTNEY

¹ School of Health and Rehabilitation Sciences University of Queensland and Princess Alexandra Hospital Woolloongabba, Queensland
² School of Physiotherapy LaTrobe University and Northern Health
³ Centre for Health, Exercise and Sports Medicine The University of Melbourne
⁴ AFV Centre for Rheumatic Disease The University of Melbourne and Royal Melbourne Hospital Australia

Address correspondence to Dr. Terry Haines, University of Queensland and Princess Alexandra Hospital, School of Health and Rehabilitation Sciences, c/o Physiotherapy Department, GARU, Princess Alexandra Hospital, Ipswich Rd., Woolloongabba, QLD 4103, Australia. E-mail: terrence_haines{at}health.qld.gov.au

To the Editor:

We have read with interest the additional data provided by Webster and Courtney in their letter and congratulate them for being able to blind the nursing staff from the STRATIFY score, certainly a methodological strength of their trial. Of note was the concordance of their results in regard to the accuracy of nursing staff clinical judgement with several other trials included in our review. Their concern that falls risk screening may be an inefficient use of hospital resources due to low positive predictive value is valid, though we consider this question largely unresolved due to the paucity of economic evaluations in this field. Here the costs of completing a falls risk screening tool must be weighed against the cost of falls that may result if the screening is not completed.

We disagree that our original conclusion in regards to the STRATIFY was misleading and question why Webster and Courtney assert that this instrument is not of any use on the basis of their own data. We raise two points in this regard.

First, it is apparent from the data presented by Webster and Courtney that, in their trial, the STRATIFY (Youden Index = 0.417) exceeded the performance of tools evaluated in 16 of 19 other prospective evaluations included in our review and substantially exceeded the pooled estimate of STRATIFY Youden Index attained by our meta-analysis (1). If anything, this data would lend itself to a conclusion providing greater support for the STRATIFY than what we gave it.

Second, to assert that a particular tool is not useful in any setting would require an investigation across all settings and for the tool to have performed poorly in all settings. To our knowledge, this has not been done and there is some evidence available to the contrary (2,3).

References

2. Haines TP, Hill K, Walsh W, Osborne R. Design-related bias in hospital fall risk screening tool predictive accuracy evaluations: systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2007;62A:664-672.[Abstract/Free Full Text]
3. Oliver D, Britton M, Seed P, Martin F, Hopper A. Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. Brit Med J. 1997;315:1049-1053.[Abstract/Free Full Text]
4. Vassallo M, Stockdale R, Sharma J, Briggs R, Allen S. A comparative study of the use of four falls risk assessment tools on acute medical wards. J Am Geriatr Soc. 2005;53:1034-1038.[Medline]

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