Flaws predicting falls . . . and other stories

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3258 (Published 13 July 2017) Cite this as: BMJ 2017;358:j3258

Falls prediction scores might not predict falls

In the busy emergency department of a major metropolitan adult tertiary hospital in Perth, Western Australia, patients aged over 65 who were considered fit to discharge home were assessed for their future risk of falls using the Falls Risk for Older Persons Community Setting Screening Tool and the Two-Item Screening Tool (Emerg Med J doi:10.1136/emermed-2016-206233). Just over a third of the patients had experienced a previous fall, but for them and for those who had not, these tools were little better than the toss of a coin in predicting falls within the next six months.

Strokes at unsocial hours

Acute stroke management needs thrombectomy teams to be available night and day. Recent randomised controlled trials have shown the benefit of mechanical clot retrieval for anterior circulation large vessel occlusion, and some US hospitals have set up services to provide this. But a survey of 10 of them reveals that most eligible patients arrive outside normal work hours, when they are kept waiting on average 52 minutes longer than during work hours (J NeuroInterv Surg doi:10.1136/neurintsurg-2017-013147). Providing a rapid thrombectomy service every day and at all times in the UK might be a logistical challenge.

Sectioning across sections of England

Patterns of variation in compulsory admission under the Mental Health Act in the English NHS can be tracked using the Mental Health Minimum Data Set. An analysis of data from 2010 to 11 shows a wide range of geographical variation, in part explained by a higher rate of admission in areas of socioeconomic deprivation or with more non-white residents (Lancet Psychiatry doi:10.1016/S2215-0366(17)30207-9). Black patients were almost three times more likely to be admitted compulsorily than were white patients (odds ratio 2.94, 95% confidence interval 2.90–2.98).

Urinary incontinence in very sporty women

A questionnaire survey of elite Portuguese female athletes achieved a laudable response rate of 92%, allowing the investigators to compare the athletes’ rates of urinary incontinence with those of matched controls. Although these agile young people had an average age of 19, their rates of urinary incontinence were already three times that of their less sporty peers (Br J Sports Med doi:10.1136/bjsports-2017-097587).

Taking blood pressure meds and outcomes

Patients who take their medication in trials usually do better than those who don’t, even if what they are taking is placebo. Among 155 597 older Medicare beneficiaries newly started on blood pressure lowering agents, about 40% were found to be taking them less than 80% of the time (J Am Heart Assoc doi:10.1161/JAHA.117.006056). During a follow-up of 5.8 years, these “non-adherent” patients had more than twice the risk of a composite outcome that included a first incident of fatal/non-fatal acute myocardial infarction, ischaemic heart disease, stroke/transient ischaemic attack, and heart failure.

Coping with multiple sclerosis

Multiple sclerosis is a hard condition to cope with, involving uncertainty, deterioration, and a range of hidden as well as overt disabilities. The coping strategies of 135 patients with multiple sclerosis from a large centre in Sardinia were compared with those of healthy controls (BMJ Support Palliat Care doi:10.1136/bmjspcare-2017-001324). Sadly, aspects such as social support and problem solving tend to deteriorate with duration of disease, independently of severity. Patients who use avoidance strategies tended to have the worst functional status.

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