The revised Humpty Dumpty Fall Scale: An update to improve tool performance and predictive validity.

PURPOSE: The purpose of this study was to identify potential modifications to the Humpty Dumpty Fall Scale (HDFS) in order to enhance the accuracy of fall prediction in the pediatric population, thus contributing to the safest possible environment for the hospitalized child. DESIGN AND METHODS: A secondary analysis of data collected by Gonzalez et al. (2020), including a total of 2428 patients, was conducted for this study. Multiple logistic regression was used to examine the relationship between each parameter of the HDFS (e.g., age, gender, diagnosis, cognitive impairments, environmental factors, response to surgery/sedation/anesthesia, and medication usage) and the outcome of fall status. RESULTS: After reviewing associations between HDFS parameters and fall risk, neither gender nor medication use were found to be associated with fall risk. These two parameters were removed from the scoring algorithms, and the HDFS was modified to a minimum score of 5 and maximum score of 20, with a score of 12 or above indicative of high risk of fall. The modified scale demonstrated a sensitivity of 84% and specificity of 57%. CONCLUSIONS: These revisions are anticipated to help support clinical practice and improve fall prevention, thus supporting a safer pediatric environment for the hospitalized child.

Evaluating the Humpty Dumpty Fall Scale: An International, Multisite Study.

BACKGROUND: The Humpty Dumpty Falls Prevention Program was developed to address an unmet need to identify pediatric patients at risk of a fall event. PURPOSE: The aim of this study was to evaluate the performance of the Humpty Dumpty Fall Scale-Inpatient (HDFS) across a diverse, international pediatric population. In addition, the characteristics of patients who experienced a fall were analyzed. METHODS: A retrospective, cross-sectional design was used to assess fall risk across 16 hospitals and 2238 pediatric patients. Multiple and simple logistic regressions were performed to evaluate association of individual scale items and total score with falls during hospitalization. Reliability, sensitivity, and specificity of the HDFS were also assessed. RESULTS: Several of the HDFS items were significantly associated with the risk of falls in the pediatric population, but specificity of the tool is a concern to consider for future tool enhancement. CONCLUSIONS: Characteristics for further refinement of the HDFS were identified.