The Modified Humpty Dumpty Falls Scale in Predicting Pediatric Falls

Purpose:
This study examined the accuracy of the Modified Humpty Dumpty Falls Scale (HDFS) in identifying pediatric patients at risk of falling.

Background/Significance:
The JC and IHI recognize the importance of decreasing falls in hospitals. Falls, a significant patient safety risk, occurs across the lifespan. A significant body of evidence exists about the use of falls risk tools for adult patients (Hendrich II and Morse. However, there is limited information about the validity of these tools in pediatric populations (Razmus, 2006.) Hill-Rodriguez and Messmer (2008)reported high risk pediatric patients fell twice as often as low risk.

Methods:
The HDFS examines the patient's age, gender, diagnosis, cognitive impairments, environmental factors, response to surgery and medication usage. Patients scored at 12 or above are considered at high risk for falls. This case-control research examined the sensitivity and specificity of the HDFS Risk Score in 76 patients who fell compared with 60 that did not fall (fall prevalence rate of 55.9%). The HDFS risk score was retrospectively applied to all patients who fell during 2008 and a random sampled control group of 60 patients who did not fall during 2008.

Results:
Preliminary results indicated the HDFS had a sensitivity of 75% and specificity of 42% at a cut-point of 11. The unadjusted odds ratio of the total score was 2.14 (95% CI: 0.97 - 4.57; p = .04). When gender was removed from the HDFS, the sensitivity was reduced to 65%; specificity was improved to 50%, at a cut-point of 10. The HDFS identifies pediatric patients at risk for falling, but produces a large number of false negatives, predicted NOT to fall but the patient falls. The HDFS provides a means of identifying pediatric patients at high risk of falling, but improvements in specificity are needed.

Conclusions and Implications for Practice:
Use of the tool to develop an action plan for prevention of falls is vital to pediatric patient safety. The tool appears to have properties at this stage of development that are useful for applied research into patient safety.