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

Area of Science:

• Pediatric Nursing
• Patient Safety
• Clinical Assessment Tools

Background:

• Falls in hospitalized children are common, leading to complications and increased costs.
• Nurses use tools like the Humpty Dumpty Fall Scale (HDFS) and clinical reasoning (Fall risk ND) to assess fall risk.
• The alignment between HDFS and nursing clinical reasoning for fall risk assessment is not well understood.

Purpose of the Study:

• To evaluate the agreement between the HDFS and Fall risk ND in identifying fall risk in hospitalized pediatric patients.
• To determine the discriminative performance of the HDFS compared to nursing clinical reasoning.

Main Methods:

• Retrospective observational study of pediatric inpatients in an Italian tertiary hospital (2022).
• Fall risk assessed within 24 hours using HDFS (score ≥ 12) and Fall risk ND (nursing clinical reasoning via PAIped system).
• Receiver operating characteristic (ROC) curve analysis, including AUC, sensitivity, specificity, PPV, and NPV, was performed.

Main Results:

• 80.9% of inpatients had a Fall risk ND; 52.7% were classified as high risk by HDFS.
• HDFS demonstrated low discriminative ability for Fall risk ND (AUC = 0.568).
• HDFS had high PPV (85.1%) but low NPV (20.1%), indicating overlap and discrepancies with nursing diagnoses.

Conclusions:

• The HDFS has limited ability to discriminate pediatric patients identified as fall risk by nursing clinical reasoning.
• Standardized tools and clinical reasoning capture different, yet potentially complementary, aspects of fall risk.
• Integrating HDFS within a structured nursing diagnostic process, supported by education, can improve pediatric fall prevention.