Franck Linda S, Gay Caryl L, Cooper Bruce, Ezrre Suzanne, Murphy Barbette, Chan June Shu-Ling, Buick Maureen, Meer Carrie R
Department of Family Health Care Nursing, University of California, San Francisco, CA, United States.
Department of Family Health Care Nursing, University of California, San Francisco, CA, United States.
Int J Nurs Stud. 2017 Mar;68:51-59. doi: 10.1016/j.ijnurstu.2016.12.011. Epub 2017 Jan 4.
Falls are among the most common potentially preventable adverse events. Current pediatric falls risk assessment methods have poor precision and accuracy.
To evaluate an inpatient pediatric fall risk assessment index, known as the Little Schmidy, and describe characteristics of pediatric falls.
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).
Pediatric medical and surgical inpatient units of an academic medical center in the western United States.
Pediatric hospital inpatients <25 years of age.
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.
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.
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.
跌倒属于最常见的潜在可预防不良事件。当前儿科跌倒风险评估方法的精准度和准确性欠佳。
评估一种名为“小施密迪”的儿科住院患者跌倒风险评估指数，并描述儿科跌倒的特征。
回顾性病例对照和描述性研究。数据集包括在5年研究期间（2007 - 2011年）医疗记录中报告的114起跌倒事件和151,678个小施密迪评分。
美国西部一家学术医疗中心的儿科内科和外科住院病房。
年龄小于25岁的儿科住院患者。
护士在患者住院期间的每个日班和夜班使用包含5项、7分制的小施密迪来评估跌倒风险。采用条件固定效应逻辑回归来检验小施密迪评分（入院时、跌倒前最高评分以及即将跌倒前）与患者跌倒状态（跌倒或未跌倒）之间的预测关系。探讨了不同截断分数的敏感性和特异性。使用多水平混合效应逻辑回归和多水平混合效应有序逻辑回归来检验小施密迪评分与患者及住院因素之间的关联。
小施密迪评分与儿科跌倒显著相关（p < 0.005）。使用截断分数为1的4项、4分制小施密迪指数（LS4）可达到最佳效果，其指示跌倒风险的敏感性为79%，特异性为49%。LS4评分≥1的患者在下一次评估前跌倒的可能性是评分为0的患者的4倍。指示跌倒风险的LS4评分与年龄≥5岁、神经学诊断、多次住院以及夜班相关，但与性别、住院时长或医院科室无关。在报告的114起跌倒事件中，64%涉及男性患者，近三分之一（32%）涉及青少年（13 - 17岁），大多数（59%）未造成伤害或（36%）造成轻度伤害，且大多数（54%）与诊断或临床特征有关。对于60%的跌倒事件，在跌倒前已实施了跌倒预防措施。
修订后的4项小施密迪指数（LS4）在每日和夜班使用时可预测儿科跌倒，但将大多数患者（65%）识别为有跌倒风险。提出了提高评估准确性和效率的策略。需要进一步研究以制定更有效的针对患者年龄、诊断和日间时间的儿科跌倒预防策略。
