An investigation of the predictive validity of the Morse Fall Scale regarding falls in patients with medical disorders referred to emergency departments of hospitals affiliated with Shahid Beheshti University of Medical Sciences

Patient falls are one of the most common and challenging unwanted events in hospitals and healthcare centers, and their prevention begins with accurate identification of high-risk patients. The Morse Fall Scale (MFS) is widely used in Iran for fall risk assessment. This study aims to investigate the predictive validity of the MFS in emergency setting. This prospective descriptive-cross-sectional study was conducted over 8 months in the emergency departments of three hospitals in Tehran using convenience sampling. The collected data included completing the MFS questionnaire by the researcher and extraction of data from patient records. A total of 675 participants were included in the study, of whom 43 (6.37%) experienced falls. Analyses showed that the variables of fall history, mental state, gait, and use of mobility aids in the MFS were significantly associated with the occurrence of falls (P < 0.001). An optimal cut-off point of 40 for MFS was determined based on the ROC curve, indicating a sensitivity of 51.2% (95% CI: 36.2–66.1%), a specificity of 59.1% (95% CI: 55.3–62.9%), and an overall accuracy of 58.7% (95% CI: 55.0–62.4%). The area under the curve (AUC) was 0.563 (95% CI: 0.474–0.653), indicating a low diagnostic power of the MFS in identifying high-risk patients in the emergency department. The negative predictive validity was 94.6% (95% CI: 92.4–96.8%), and the positive predictive validity was 7.9% (95% CI: 4.7–11.0%). Logistic regression results also showed that the risk of falls increases by approximately 4.7% (OR = 1.05, P < 0.0001) with every one-year increase in age, and by approximately 9.4% (OR = 1.09, P < 0.0001) with every one-hour increase in hospitalization. The MFS alone is not sufficient to accurately predict the risk of falls in patients in the emergency department. The low sensitivity and specificity of this tool are likely due to the dynamic and complex nature of the emergency department setting, as well as differences in patient demographic characteristics compared to other departments. Age and length of stay were identified as two independent and important risk factors contributing to an increased risk of falls. To effectively reduce the risk of falls in this setting, there is a need to modify the MFS or develop more accurate and specific risk assessment tools for the emergency department, as well as to implement multifaceted and comprehensive interventions.