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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Assessing the Alignment Between the Humpty Dumpty Fall Scale and Fall Risk Nursing Diagnosis in Pediatric Patients: A Retrospective ROC Curve Analysis Manuele Cesare, Fabio D’Agostino, Deborah Hill-Rodriguez, Danielle Altares Sarik, Antonello Cocchieri Healthcare.2025; 13(14): 1748. CrossRef
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PURPOSE This study was conducted to identify risk factors in hospitalized children, and to develop and validate a fall-risk assessment tool for hospitalized children. METHODS A retrospective chart review was performed at one university children's hospital, and an analysis was done of the characteristics of all patients who fell during a 44-month period (n=48). These patients were compared with another 149 hospitalized children who did not fall. RESULTS Significant predictors of falls as identified in a multivariate logistic regression analyses were age of less than 3 years old, neurological diagnosis including epilepsy, children's dependency of ADL, physical developmental delay, multiple usage of fall-risk-increasing drugs. The respective odds ratios ranged from 2.4 to 7.1 with 95% confidence interval (p<0.05). Accordingly, defining patients with either 5 risk factors as fall-prone hospitalized children provided a sensitivity of 93.6% and specificity of 16.2%. CONCLUSION The results show that this tool has an acceptable level of sensitivity to assess the risk factors of fall in hospitalized children even though the specificity was low, suggesting that this tool may enable nurses to predict the risk level of childhood falls, and develop preventive strategies against pediatric falls in children's units.
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