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Predictive qualities of a pediatric fall risk tool (Generalized Risk Assessment for Pediatric Inpatient Falls [GRAF-PIF]) were evaluated. Pediatric fall risk tools' predictive abilities vary when applied to different populations and settings. This observational study used retrospective review of GRAF-PIF scores, demographic characteristics, and fall incident reports for the period of January 2017 to December 2018 in a 407-bed pediatric hospital. One hundred thirty-six fallers were age-matched with 272 non-fallers (N = 408). GRAF-PIF sensitivity, specificity, odds ratio, and estimated area under the receiver operating characteristic curve were calculated. Odds ratios of falling were calculated across sex and diagnoses. The GRAF-PIF sensitivity in this patient population was 61%, and specificity was 58%. Results yielded an estimated receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.59. For children with high GRAF-PIF scores, odds of falling were 2.08 times that of children with lower scores. Longer length of stay and cardiac and neurologic diagnoses were associated with higher odds of falling. Musculoskeletal diagnoses were associated with lower odds of falling. Although the sensitivity, specificity, and ROC AUC were not optimal, a GRAF-PIF score of greater than or equal to 2 points was associated with higher odds of falling. Weakness of tools to predict hospital falls may be due to prevention interventions implemented for those with high scores. Fall risk tools can be used to raise awareness of patient characteristics associated with falling. The recommendation is to continue to use the GRAF-PIF tool at this pediatric hospital. However, tool utilization should be accompanied with a critical evaluation of other fall risk factors (environmental, system, staff, and caregiver).
Key Words:
Receiver operating characteristic (ROC), area under the curve (AUC), risk assessment, pediatric fall risk tool, falls, Generalized Risk Assessment for Pediatric Inpatient Falls, GRAF-PIF.
A fall is "an unintentional descent...that results in the patient coming to rest" at a lower position (National Database of Nursing Quality Indicators, 2016, p. 2). Falls are the most common cause of hospital accidents in children, accounting for about 42% of inpatient accidents (Alemdaroglu et al., 2017; Da Rin Della Mora, Bagnasco et al., 2012; Fujita et al., 2013; Lee et al., 2013). Pediatric inpatient fall prevalence ranges from 0.4 to 3.8 falls per 1000 patient days (Almis...