Use of traffic crash as a risk assessment scale in hospitalized seniors: a perspective observational study

Use of traffic crash as a risk assessment scale in hospitalized seniors: a perspective observational study


  • Massimo Guasconi Department of Medicine and Surgery, University of Parma, Italy. School of Nursing, Piacenza
  • Nicola Pisaroni Casa Residenza per Anziani Istituto "E. Biazzi"
  • Maria Bertuol Department of Medicine and Surgery, University of Parma, Italy
  • Martina Scazzariello Student of Nursing Degree, University of Parma, Italy
  • Federica Delfino Student of Nursing Degree, University of Parma, Italy
  • Marina Bolzoni Azienda USL Piacenza
  • Cinzia Franca Grossi Azienda USL Piacenza
  • Maurizio Beretta Department of Medicine and Surgery, University of Parma, Italy. School of Nursing, Piacenza
  • Annalisa Marchetti Azienda USL Piacenza
  • Andrea Boselli Azienda USL Piacenza
  • Leopoldo Sarli Department of Medicine and Surgery, University of Parma, Italy
  • Giovanna Artioli Azienda USL –IRCCS, Reggio Emilia, Italy


Fall risk; Older adults; Tools; Assessment; Hospital, hospitalization; Rating scale; Scale; Score; Fall’s Prevention;


Background and aim: According to the World Health Organization (WHO), falls represent the second main cause of accidental and involuntary deaths worldwide, which led to define them as one of the “four giants of the geriatrician” that particularly affect the elderly aged ≥ 65 years. The study’s aim is to evaluate whether the Traffic Crash scale is valid in identifying patients at risk of falling by comparing it to the Conley scale currently used. Methods: Prospective observational study evaluating the fall risk using TC on a sample of patients aged ≥ 65 years, hospitalized in General Medicine Ward and Gastroenterology, after informed consent and favorable opinion of the AVEN Ethics Committee. The results are compared with those obtained from the Conley scale, and with those obtained from the indications of the Business Operating Instruction. The method of administration occurred concurrently and distinctly on the same patient by two researchers in order to demonstrate the scale inter-rater reliability. Results: The final sample was made up of 88 patients. Data shows that 46 out of 55 patients (84%) are medium / high risk for both scales. According to the indications of the Company Operating Instruction, the entire sample is at risk. The inter-rater reliability was confirmed with Cohen’s K which is equal to p = 1. Conclusions: The TC scale is comparable to Conley scale, for the fall risk identification but specifically the stratification is low-medium-high. Therefore, in future, this will make it possible to implement personalized prevention interventions in care planning.


Chiari P. Suggerimenti di pratica clinica per la prevenzione delle cadute dei pazienti in ospedale. [Clinical practice suggestions for the prevention of patient falls in hospital.] Centro Studi EBN Azienda Osp-Univ Bologna Policlin Orsola-Malpighi Bologna. 2004;

Morse JM. Enhancing the safety of hospitalization by reducing patient falls. Am J Infect Control. 2002;30(6):376–380.

WHO Falls [Internet]. 2018 [visitato 4 marzo 2020]. Available at:

Regione Emilia-Romagna, Direzione Generale Cura della Persona, Sanità e Welfare. Linee di indirizzo su prevenzione e gestione delle cadute del paziente in ospedale. [Internet]. 2016. [Guidelines on prevention and management of patient falls in hospital.] Available at:

Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006;12(5):290–295.

Ministero della Salute DIREZIONE GENERALE DELLA PROGRAMMAZIONE SANITARIA UFFICIO III EX DGPROGS. Protocollo di Monitoraggio degli eventi sentinella 5° Rapporto [Ministry of Health GENERAL HEADQUARTER FOR HEALTH PLANNING OFFICE III EX DGPROGS. Monitoring Protocol for sentinel events 5th Report] (settembre 2005-dicembre 2012).

Kalisch BJ, Tschannen D, Lee KH. Missed nursing care, staffing, and patient falls. J Nurs Care Qual. marzo 2012;27(1):6–12.

Almost J. Nursing sensitive outcomes: the state of the science. Jones & Bartlett Learning; 2003.

Artioli G, Copelli P, Foà C. Valutazione infermieristica della persona assistita. Approccio integrato [Nursing assessment of the assisted person. Integrated approach]. Poletto; 2016.

Conley D, Schultz AA, Selvin R. The challenge of predicting patients at risk for falling: development of the Conley Scale. Medsurg Nurs. 1999;8(6):348.

Morse JM, Morse RM, Tylko SJ. Development of a Scale to Identify the Fall-Prone Patient. Can J Aging Rev Can Vieil. 1989;8(4):366–377.

Palese A, Gonella S, Lant A, Guarnier A, Barelli P, Zambiasi P, et al. Post-hoc validation of the Conley Scale in predicting the risk of falling with older in-hospital medical patients: findings from a multicentre longitudinal study. Aging Clin Exp Res. 2016;28(1):139–146.

Guzzo A, Meggiolaro A, Mannocci A, Tecca M, Salomone I, La Torre G. Conley Scale: assessment of a fall risk prevention tool in a General Hospital. J Prev Med Hyg. 2015;56(2):E77.

Watson BJ, Salmoni AW, Zecevic AA. The use of the Morse Fall Scale in an acute care hospital. Clin Nurs Stud. 2016;4(2):32–40.

Collins T, McGann A, Jessup R, Vrantsidis F, Hill KD, Pearce J, et al. Validation of a falls risk assessment tool in the sub-acute hospital setting: a pilot study. 2004;

Chang Y-W, Chang Y-H, Pan Y-L, Kao T-W, Kao S. Validation and reliability of Falls Risk for Hospitalized Older People (FRHOP): Taiwan version. Medicine (Baltimore). 2017;96(31).

Falls N. assessment and prevention of falls in older people. June 2013. NICE clinical guideline 161 guidance. nice. org. uk/cg161. Natl Inst Health Care Excell. 2013;

Azienda USL Piacenza. Procedura per la prevenzione e gestione delle cadute dei pazienti ricoverati. Recepimento linee di indirizzo Servizio Sanitario Regionale Emilia-Romagna. 2017 [Local health authority Piacenza. Procedure for the prevention and management of falls of hospitalized patients. Transposition of the guidelines for the Emilia-Romagna Regional Health Service. 2017].

Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34(2):119–126.

Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2018;(9).

Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198.




How to Cite

Use of traffic crash as a risk assessment scale in hospitalized seniors: a perspective observational study . Acta Biomed [Internet]. 2020 Jun. 20 [cited 2024 Jun. 24];91(6-S):92-9. Available from: