A Case Control Study of Pediatric Falls Using Electronic Medical Records (EMR)

Wednesday, July 13, 2011: 1:45 PM

Patricia R. Messmer, PhD, RN, BC, FAAN
School of Nursing, Miami Dade College, Hollywood, FL
Arthur R. Williams, PhD, MPA, MA
Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa, FL

Learning Objective 1: To discuss case control studies of pediatric falls

Learning Objective 2: To compare and contrast pediatric falls to falls in adults over 18.

Purpose:  to retrospectively review Humpty Dumpty Falls Scale (HDFS) scores in the electronic medical records (EMR) to determine characteristics and related injuries.  

Background: The Joint Commission and IHI identified inpatient falls as a significant patient safety risk. However, pediatric fall research is limited (CHCA, 2009; Cooper, 2007; Graft, 2008; Harvey, 2010; Hill-Rodriguez, 2008; Kingston, 2010; Messmer, 2010, Razmus, 2006).

Conceptual Framework: King’s (1981) Goal Attainment concepts of growth & development, perception, communication, interaction and transaction. 

Methods: A 1:3 case control study design using occurrence reports and EMR of HDFS scores on 76 falls with 245 randomly selected controls, total of 321 observations. Descriptive statistics and odds ratios (OR). Pediatrics is unique; developmental stages germane in analyzing fall data: infants (<2); toddler/pre-school (2-4); school aged (5-12); teenagers (13-18).

Results:  Medical record review revealed all patients had been assessed for falls. Of those in the study, 33 cases incorrectly not scored as high risk. 151 controls (62%) were incorrectly scored as high risk. Usual HDFS scores 7-11(low risk); 12-23 (high risk). At cut-off point of 12: OR=.81, CI: .46, 1.42, p=.43: sensitivity 57%; specificity 39%.  At cut-off point of 11: OR=1.18, CI: .63, 2.25, p=.59; sensitivity 75%, specificity 28%.

Conclusion: Pediatric patients who fell were alert, oriented and ambulating, adult supervision with family centered care but low prevalence of falls in study population and minor injury. Developmental age not gender was risk factor.   HDFS of ≥12 identified 62% of controls (non-fall) subjects at high risk; extraordinary rate of false positives.

Implications: If the difficulties of creating valid and reliable pediatric fall screening tools can be overcome, pediatric patients at risk could be flagged in EMR.

Recommendations: Further research should consider increasing number of parameters adding family attentiveness and behavioral actions. Focus on reducing false positives in HDFS.