Purpose This study was conducted to obtain data for the development of an effective fall risk assessment tool for pediatric inpatients through a systematic review and meta-analysis of the diagnostic test accuracy of existing scales.
Methods A literature search using Medline, Science Direct, CINAHL, EMBASE, and the Cochrane Library was performed between March 1 and 31, 2018. Of 890 identified papers, 10 were selected for review. Nine were used in the meta-analysis. Stata version 14.0 was used to create forest plots of sensitivity and specificity. A summary receiver operating characteristic curve was used to compare all diagnostic test accuracies.
Results Four studies used the Humpty Dumpty Falls Scale. The most common items included the patient's diagnoses, use of sedative medications, and mobility. The pooled sensitivity and specificity of the nine studies were .79 and .36, respectively.
Conclusion Considering the low specificity of the pediatric fall risk assessment scales currently available, there is a need to subdivide scoring categories and to minimize items that are evaluated using nurses' subjective judgment alone. Fall risk assessment scales should be incorporated into the electronic medical record system and an automated scoring system should be developed.
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Citations to this article as recorded by
Development of HARIZMI II Pediatric Fall Risk Assessment Scale and Evaluation of Its Validity and Reliability Veysel Barış, İsa Çelik, Şeyda Seren İntepeler, Murat Bektaş, Demet Gökmen Kavak, Şerife Engeloğlu Etkili Hemşirelik Dergisi.2026; 19(3): 397. CrossRef
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