Falls in a hospital setting are preventable, possibly life-threatening, adverse events that impact the patient and the healthcare system. Between 700,000 and 1 million patients are estimated to fall in United States (US) hospitals each year [1]. This approximation accounts for falls within the hospital; however, there is difficulty in discerning what proportion of these falls occur in the emergency department (ED). According to a 2013 study, 0.73 per 1000 falls occur within the ED prior to interventions [2]. Furthermore, rates of up to 11.5 falls per 1000 patient days have been previously reported, with 25% of incidents resulting in subsequent injuries [3]. Patient falls can cause severe or fatal injuries, increase morbidity, and raise healthcare costs [4,5]. In 2015, direct medical expenses related to falls totaled $637.5 million and $31.3 billion for fatal and non-fatal related injuries, respectively [6]. Recognizing the negative impact that falls have on patient safety, The Joint Commission International Accreditation Standards for Hospitals outlines a goal for fall reduction stating, “The hospital develops and implements a process to reduce the risk of patient harm resulting from falls for the inpatient population” [7]. Identifying patients at risk for falls can be challenging given their various clinical presentations, comorbidities, and confounders that may contribute to the fall. While there are many fall risk assessment tools within the inpatient setting, there are limited fall risk assessment tools designed for the ED [2,8,9].

A recent study by Stoeckle and colleagues tested different mitigation strategies focused on fall prevention in the ED. Despite their multifactorial intervention approach and compliance with universal fall precautions, results showed they maintained a high fall rate, indicating the need for continued research to prevent falls and injuries, specifically in the ED [10]. In 2013, Flarity and colleagues constructed The Memorial Emergency Department Fall Risk Assessment Tool (MEDFRAT), which was validated within a two-hospital ED system with a combined annual volume of 140,000 annual patient visits. While a few studies have validated the MEDFRAT's effectiveness in predicting patients fall risk [2,[11], [12], [13], [14]], it requires more research to further assess its validity and reliability throughout different healthcare systems, including major trauma centers. This study assessed the validity and usefulness of the MEDFRAT in a level 1 trauma center compared to the Moving Safety Risk Assessment (MSRA) tool. We offer a unique analysis of the MEDFRAT by using receiver operating characteristic (ROC) curves and likelihood ratios, identifying optimal fall risk screening characteristics by the comparison of sensitivity and specificity. We hypothesized that the MEDFRAT would demonstrate efficacy in stratifying fall risks and improve quality and patient safety in the ED at a level 1 trauma center.