A Retrospective Analysis of Falls in Hospitalized Children

Although the incidence of falls in hospitalized children is less than adults, pediatric falls remain a challenging quality and safety issue in acute care hospitals. Fall risk assessment tools are intended to help identify children at risk and provide specific interventions designed to reduce falls. Children often fall as they grow and gain motor coordination skills and their natural curiosity makes them prone to injury. Lack of awareness, hazards in the hospital environment, medication usage, neurological conditions, and sedation increase the probability that a hospitalized child will fall (Hill-Rodriguez et al. 2009; Harvey, Kramlich, Chapman, Parker & Blades, 2010; Kramlich & Dende, 2016). In addition, physical illness, injury and the unfamiliar hospital environment increase the risk for patient falls. Sources site accidental hospital fall rates in children between 0.56 to 2.19 falls per 1,000 patient days (Gonzalez et al, 2016, Jamerson et al, 2014; Schaffer et al. 2011). The Joint Commission identifies inpatient falls as a significant safety risk and requires pediatric hospitals to implement and evaluate the effectiveness of fall prevention programs (Joint Commission, 2007).

This retrospective study evaluated three pediatric fall risk assessment tools, the Humpty Dumpty Falls Scale, Cummings Pediatric Fall Assessment Scale and the General Risk Assessment for Pediatric Inpatient Falls, and identified patient characteristics and risk factors in 106 children who fell while hospitalized at one Midwestern Children’s Hospital. Of the children who fell, the majority were male (56%), adolescents (28%) or toddlers (27%), with an oncology (23%) or neurology (21%) diagnosis, a length of stay of three days or less (63%). The majority of children who fell experienced little to no injury (86%) and had adult supervision (85%). Twenty percent of children who fell had a procedure in the previous 24 hours. Of the children who fell 28% were identified as having developmental delay, altered mental status (21%), or attention deficit hyperactivity disorder (11%). Sixty percent of falls happened between the hours of 0700 and 1900 with nearly 75% occurring in the patient’s room followed by the bathroom or shower (18.9%).

These findings highlight the need for additional research to standardize patient characteristics and risk factors for falls in hospitalized children and pursue interventions which reduce fall risk. In this study, the majority of children who fell had adult supervision; therefore, including caregivers in fall prevention education could prove beneficial. Hospitals should consider validating a fall risk assessment tool based on the hospitals identified risk factors and unique patient population.