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The Little Schmidy Pediatric Hospital Fall Risk Assessment Index: A diagnostic accuracy study
Linda S Franck1, Caryl L Gay1, Bruce Cooper2
1Department of Family Health Care Nursing, University of California, San Francisco, CA, United States.
Insights
A revised pediatric fall risk assessment, the LS4, shows promise in predicting inpatient falls. While it identifies many patients as high-risk, further research is needed for more accurate and efficient fall prevention strategies.
Area of Science:
- Pediatrics
- Patient Safety
- Healthcare Quality Improvement
Background:
- Falls are a common, preventable adverse event in pediatric healthcare settings.
- Existing pediatric fall risk assessment tools lack precision and accuracy.
Purpose of the Study:
- To evaluate the Little Schmidy fall risk assessment index for inpatient pediatric falls.
- To characterize the nature and contributing factors of pediatric falls.
Main Methods:
- Retrospective study of 114 falls and 151,678 Little Schmidy scores in pediatric inpatients.
- Used logistic regression to analyze the predictive relationship between Little Schmidy scores and fall status.
- Evaluated sensitivity and specificity of different cut-off scores for a revised 4-item index (LS4).
Main Results:
- The revised 4-item Little Schmidy index (LS4) significantly predicted pediatric falls (p<0.005).
- An LS4 cut-off score of 1 yielded 79% sensitivity and 49% specificity, identifying patients 4 times more likely to fall.
- Fall risk was associated with age ≥5 years, neurological diagnosis, and night shifts.
Conclusions:
- The LS4 demonstrates predictive value for pediatric falls but over-identifies patients as high-risk (65%).
- Proposed strategies aim to improve assessment accuracy and efficiency.
- Further research is necessary for tailored pediatric fall prevention strategies based on age, diagnosis, and time of day.
Background:
Falls are among the most common potentially preventable adverse events. Current pediatric falls risk assessment methods have poor precision and accuracy.
Objective:
To evaluate an inpatient pediatric fall risk assessment index, known as the Little Schmidy, and describe characteristics of pediatric falls.
Design:
Retrospective case control and descriptive study. The dataset included 114 reported falls and 151,678 Little Schmidy scores documented in medical records during the 5-year study period (2007-2011).
Setting:
Pediatric medical and surgical inpatient units of an academic medical center in the western United States.
Participants:
Pediatric hospital inpatients <25 years of age.
Methods:
Nurses used the 5-item, 7-point Little Schmidy to assess fall risk each day and night shift throughout the patient's hospitalization. Conditional fixed-effects logistic regressions were used to examine predictive relationships between Little Schmidy scores (at admission, highest prior to fall, and just prior to fall) and the patient's fall status (fell or not). The sensitivity and specificity of different cut-off scores were explored. Associations between Little Schmidy scores and patient and hospitalization factors were examined using multilevel mixed-effects logistic regression and multilevel mixed-effects ordinal logistic regression.
Results:
Little Schmidy scores were significantly associated with pediatric falls (p<0.005). Maximal performance was achieved with a 4-item, 4-point, Little Schmidy index (LS4) using a cut-off score of 1 to indicate fall risk with sensitivity of 79% and specificity of 49%. Patients with an LS4 score ≥1 were 4 times more likely to fall before the next assessment than patients with a score of 0. LS4 scores indicative of fall risk were associated with age ≥5 years, neurological diagnosis, multiple hospitalizations, and night shift, but not with sex, length of hospital stay, or hospital unit. Of the 114 reported falls, 64% involved a male patient, nearly one third (32%) involved adolescents (13-17 years), most resulted in no (59%) or mild (36%) injury, and most (54%) were related to diagnosis or clinical characteristics. For 60% of the falls, fall precautions had been implemented prior to the fall.
Conclusions:
The revised 4-item Little Schmidy, the LS4, predicts pediatric falls when administered every day and night shift, but identifies most patients (65%) as being at risk for fall. Strategies for improving the accuracy and efficiency of the assessments are proposed. Further research is needed to develop more effective pediatric fall prevention strategies tailored to patient's age, diagnosis, and time of day.
