Related Experiment Video
Updated: May 19, 2026
Using Motion Capture Technology in the Instrumented Timed Up and Go Test to Detect the Risk of Falling in Aged Adults
Published on: October 25, 2024
Challenges and conundrums in the validation of Pediatric Fall Risk Assessment tools
Nancy A Ryan-Wenger1, Judy Kimchi-Woods, Melanie A Erbaugh
1Nationwide Children's Hospital, Columbus, OH, USA.
Insights
The Pediatric Fall Risk Assessment (PFRA) tool shows poor accuracy in identifying children at high risk for falls. Current pediatric fall risk scales lack the precision needed for effective clinical implementation.
Area of Science:
- Pediatric healthcare
- Patient safety
- Clinical assessment tools
Background:
- The Pediatric Fall Risk Assessment (PFRA) was designed to stratify children into low- or high-risk categories for falls.
- Accurate identification of high-risk children is crucial for targeted, resource-efficient fall prevention interventions.
Purpose of the Study:
- To evaluate the precision, accuracy, and error rates of the PFRA in a pediatric population (1 month to 24 years).
- To determine if the PFRA is suitable for clinical implementation in fall risk stratification.
Main Methods:
- Retrospective, case-control study design.
- Evaluated 326 children who fell (cases) and 326 who did not fall (controls).
- Assessed inter-rater agreement (precision) and calculated accuracy metrics including false-positive and false-negative rates.
Main Results:
- High inter-rater agreement (95.1%) was observed for PFRA cut-off scores, indicating good precision.
- However, the PFRA demonstrated unacceptably low accuracy, with 60% false-positive and 58.5% false-negative ratings.
- Similar limitations in precision and accuracy were noted for three other widely used pediatric fall risk scales.
Conclusions:
- The PFRA, and other current pediatric fall risk scales, lack the necessary accuracy for reliable clinical use.
- Significant logistic and methodological challenges impede the development and implementation of effective pediatric fall risk assessment tools.
- Further research is required to refine these instruments before they can be confidently applied in clinical settings.
Abstract:
The 10-item Pediatric Fall Risk Assessment (PFRA) was developed to evaluate patients at low- or high-risk for falling. To avoid the unnecessary use of resources for children not likely to fall, children evaluated as high-risk are targeted for more intensive fall prevention interventions. In a retrospective, case-control design, the precision, accuracy, and error rate of the PFRA with patients ages 1 month to 24 years were evaluated. Cases included children who fell (n = 326), and controls (n = 326) were children from the same cohort who did not fall. Inter-rater agreement (precision) on PFRA cut-off scores was 95.1%, but accuracy was unacceptably low due to 60% false-positive and 58.5% false-negative risk ratings. Neither the PFRA nor three other widely used pediatric fall risk scales have sufficient precision or accuracy to justify implementing or withholding a high-risk fall prevention protocol. Several logistic and methodological challenges must be addressed before further development of these tools.
