Assessing the Alignment Between the Humpty Dumpty Fall Scale and Fall Risk Nursing Diagnosis in Pediatric Patients: A...

Background/Objectives: Falls in hospitalized pediatric patients are frequent and can lead to serious complications and increased healthcare costs. Nurses typically assess fall risk using structured tools such as the Humpty Dumpty Fall Scale (HDFS), alongside nursing diagnoses such as Fall risk ND, which are based on clinical reasoning. However, the degree of alignment between the HDFS and the nursing reasoning-based diagnostic approach in assessing fall risk remains unclear. This study aims to assess the alignment between the HDFS and Fall risk ND in identifying fall risk among hospitalized pediatric patients. Methods: A retrospective observational study was conducted in a tertiary pediatric hospital in Italy, including all pediatric patients admitted in 2022. Fall risk was assessed within 24 h from hospital admission using two approaches, the HDFS (risk identified with the standard cutoff, score ≥ 12) and Fall risk ND, based on the nurse's clinical reasoning and recorded through the PAIped clinical nursing information system. Discriminative performance was analyzed using receiver operating characteristic curve analysis. The area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A confusion matrix evaluated classification performance at the cutoff (≥12). Results: Among 2086 inpatients, 80.9% had a recorded Fall risk ND. Of the 1853 patients assessed with the HDFS, 52.7% were classified as at risk (HDFS score ≥ 12). The HDFS showed low discriminative ability in detecting patients with a Fall risk ND (AUC = 0.568; 95% CI: 0.535-0.602). The PPV was high (85.1%), meaning that most patients identified as at risk by the HDFS were also judged to be at risk by nurses through Fall risk ND. However, the NPV was low (20.1%), indicating that many patients with low HDFS scores were still diagnosed with Fall risk ND by nurses. Conclusions: The HDFS shows limited ability to discriminate pediatric patients with Fall risk ND, capturing a risk profile that does not fully align with nursing clinical reasoning. This suggests that standardized tools and clinical reasoning address distinct yet complementary dimensions of fall risk assessment. Integrating the HDFS into a structured nursing diagnostic process-guided by clinical expertise and supported by continuous education-can strengthen the effectiveness of fall prevention strategies and enhance patient safety in pediatric settings.