Risk Assessment of Pediatric Inpatient Falls: A Systematic Review of Current Instruments

Wednesday, 24 July 2013

Ya-Hui Huang, BSN, RN1
Shin-Yu Chang, BSN, RN2
Chia-Chen Chang, BSN2
Yueh-Yen Fang, PhD, RN3
(1)Nursing Department, Kaohsiung Municiple Hsiao-Kang Hospital, Kaohsiung, Taiwan
(2)Nursing Department, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan
(3)School of Nursing, Fooyin University, Kaohsiung, Taiwan

Learning Objective 1: Identify constructs measured in current pediatric falls risk assessment instruments.

Learning Objective 2: Recognize measurement problems in current pediatric falls risk assessment instruments.


 The purposes of this study were to systematically review current evidence of in-hospital pediatric falls assessment instruments and to compare their effectiveness in predicting in-hospital pediatric falls.


  A systematic review was conducted to respond to the study purposes. Footnote chasing as well as six English and two Chinese databases were used to search English and Chinese literature published up to August, 2011. The term ‘fall’ with an age limit of 6 months to 12 years was used in an inclusive literature search. The study quality was evaluated by the Johns Hopkins Nursing Evidence-based practice Quality Rating Scale.


 Nine studies that met the inclusion criteria were located from a review of 6,299 articles. Eight instruments were identified. One of these instruments was originally a measure of geriatric falls risk and assessed for its applicability in a pediatric population. Measures involved intrinsic and extrinsic factors. Intrinsic factors are physical alterations or impairment, cognitive/mental/behavioral dysfunctions, age, gender, and history of falls. Extrinsic factors are invasive procedures, medication use, length of stay, and equipment/environment hazards. However, inclusions of factors and scoring rationales vary across instruments. Redundant items within a scale are commonly seen, especially items related to medication use and physical functions. Sensitivities of included instruments in predicting general risk of pediatric falls ranged from .29 to 1.00, and .30 to .82 for high risk criterion. The instrument specificities ranged from .24 to .79. Their reliabilities ranged from .40 to .77. All included studies used a convenient sample retrieved from chart reviews. The study qualities ranged from III-b to III-c.


Lacks of rigorous measurement development processes impede the quality of current pediatric falls risk assessment instruments. A comprehensive construct identification presented in this review would benefit future development in measuring risks of pediatric falls in hospitals.