Myung Sook Cho; Mi Ra Song; Sun Kyung Cha

doi:10.4040/jkan.2013.43.5.595

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Original Article
Risk Factors for Pediatric Inpatient Falls: Myung Sook Cho¹, Mi Ra Song², Sun Kyung Cha³; Journal of Korean Academy of Nursing 2013;43(5):595-604.
DOI: https://doi.org/10.4040/jkan.2013.43.5.595
Published online: October 15, 2013

¹Graduate School of Clinical Nursing Science, Sungkyunkwan University School of Medicine, Seoul

²Nursing Professional Development, Samsung Medical Center, Seoul

³Department of Nursing Science, Sun Moon University, Asan, Korea

¹Graduate School of Clinical Nursing Science, Sungkyunkwan University School of Medicine, Seoul

²Nursing Professional Development, Samsung Medical Center, Seoul

³Department of Nursing Science, Sun Moon University, Asan, Korea

Address reprint requests to : Cha, Sun Kyung Department of Nursing Science, Sun Moon University, 221 Sunmoon-ro, Tangjeong-myeon, Asan 336-708, Korea Tel: +82-41-530-2743 Fax: +82-41-530-2725 E-mail: skc0701@hanmail.net

• Received: March 18, 2013 • Revised: April 10, 2013 • Accepted: June 25, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of this study was to identify risk factors for pediatric inpatients falls.
Methods
The study was a matched case-control design. The participants were 279 patients under the age of 6 who were admitted between January 1, 2004 and December 31, 2009. Through chart reviews, 93 pediatric patients who fell and 186 ones who did not fall were paired by gender, age, diagnosis, and length of stay. Five experts evaluated the 38 fall risk factors selected by the researchers.
Results
In a general hospital, pediatric patients with secondary diagnosis, tests that need the patient to be moved, intravenous lines, hyperactivity, anxiolytics, sedatives and hypnotics, and general anesthetics showed significance for falls on adjusted-odds ratios. Conditional logistic regression analysis was performed to elucidate the factors that influence pediatric inpatient falls. The probability of falls increased with hyperactivity and general weakness. Patients who didn't have tests that required them to be moved and intravenous line had a higher risk of falls.
Conclusion
These findings provide information that is relevant in developing fall risk assessment tools and prevention programs for pediatric inpatient falls.
Keywords: Accidental falls; Risk factors; Inpatients

Table 1.

Risk Factors for Pediatric Inpatient Falls

Items	CVI
Age (month)*	1.00
Hyperactivity	1.00
Irritability	1.00
Gait balance	1.00
Medication	1.00
Medical diagnosis (primary and secondary diagnosis)	.80
History of falls	.80
Physical developmental status	.80
Assistive devices (wheelchair, walker, crutch, etc.)	.80
General weakness	.80
Dizziness	.80
Agitation	.80
Visual disturbance	.80
Urine catheter or tubes et al.	.80
Pain	.80
Intravenous line	.80
Test that need patient to be moved	.80
Alteration of caregivers	.80
Height of bed*	.80
Compliance of caregiver*	.80
Cognitive developmental status*	.60
Language disturbance*	.60
Physical deformity*	.40
Paralysis or neuromuscular dysfunction*	.40
Sleep disturbance*	.40
Voiding difficulty*	.40
Admission or discharge day*	.40
Hearing problem*	.40
Caregiver education at admission*	.40
Specific time (night, meal time, etc.)*	.40
Diarrhea*	.20
Length of stay*	.20
Operation day*	.20
Gender*	.20
Sensory disturbance*	.00
History of admission*	.00
Transfer day*	.00
Purpose of admission in hospital*	.00
Type of medication Anti-convulsants	1.00
General anesthetics	1.00
Anxiolytics, sedatives, & hypnotics	1.00
Analgesics & antipyretics	.80
Opiate antagonist*	.60
Psychotherapeutic agents*	.60
Skeletal muscle agents*	.60
Smooth muscle relaxants (propiverine)*	.60
Cathartics & laxatives*	.20
Cyclosporin*^†	.20
Antihistamines*	.20
Antidiabetic agents*	.20
Sympatomimetic agents*	.00
Cardiac drugs*	.00
Antihypertensive agents*	.00
Vasodilating agents*	.00
Local anesthetics*	.00
Others (cardiovascular agents)*	.00
Levosulpiride*^†	.00
Dimenhydrinate*^†	.00
Opthalmic agents (fluorescein)*	.00
Diagnostic agents (iodixanol, immeprol)*	.00

*Excluded items;

^†Single drug; CVI=Content validity index.

Table 2.

Matching Variables for the Participants (N=279)

Variables	Categories	Fallers (n=93)	Non-fallers (n=186
Variables	Categories	n (%) or M±SD	n (%) or M±SD
Gender	Male Female	54 (58.1) 39 (41.9)	108 (58.1) 78 (41.9)
Age	<5	0 (0.0)	0 (0.0)
(months)	5-12	25 (26.9)	50 (26.9)
	13-35	51 (54.8)	102 (54.8)
	36-71	17 (18.3)	34 (18.3)
LOS		10.51±13.63	10.0±13.50
Diagnosis	Hematology-oncology disease	53 (57.0)	106 (57.0)
	Cardiopulmonary disease Neuro-musculoskeletal disease	13 (14.0) 10 (10.8)	26 (14.0) 20 (10.8)
	Kidney & endocrine disease Gastrointestinal disease	8 (8.6) 4 (4.3)	18 (9.7) 8 (4.3)
	Head & neck disease	5 (5.4)	8 (4.3)

LOS=Length of stay.

Table 3.

Odds Ratios between Fallers and Non-fallers by Risk Factors (N=279)

Variables	Categories		Fallers (n=93)	Non-fallers (n=186)	Odds ratio	95% CI	p
Variables	Categories		n (%)	n (%)	Odds ratio	95% CI	p
General	History of falls	No	86 (92.5)	186 (100.0)		−
characteristics	(within 3 months)	Yes	7 (7.5)	0 (0.0)
	Alteration of caregivers	No	92 (98.9)	186 (100.0)		−
		Yes	1 (1.1)	0 (0.0)
	Developmental status	Before over rolling - before crawling	12 (48.0)	33 (66.0)	1.92	0.78_-4.74	.158
	(before walking)	Crawling - stand holding	13 (52.0)	17 (34.0)
	Assistive devices	No	22 (32.4)	57 (41.9)	1.52	0.82_-2.81	.187
	(after walking)	Yes	46 (67.7)	79 (58.1)
	Secondary diagnosis	No	84 (90.3)	148 (79.6)	2.75	1.19_-6.36	.018
		Yes	9 (9.7)	38 (20.4)
	Test that need patient	No	89 (95.7)	114 (61.3)	13.64	4.85-38.39	<.001
	to be moved	Yes	4 (4.3)	72 (38.7)
	Urinary catheter,	No	85 (91.4)	162 (87.1)	1.78	0.71-4.48	.216
	tubes, etc.	Yes	8(8.6)	24 (12.9)
	Intravenous line	No	35 (37.6)	22 (11.8)	5.95	2.81-12.57	<.001
		Yes	58 (62.4)	164 (88.2)
Physical status	Physical developmental	Normality	88 (94.6)	175 (94.1)	1.17	0.37-3.75	.793
	status	Abnormality	5 (5.4)	11 (5.9)
	Gait balance	Normality	56 (82.4)	123 (90.4)	2.11	0.88-5.05	.095
	(after walking)	Need help	12 (17.6)	13 (9.6)
	Visual disturbance	No Yes	89 (95.7) 4 (4.3)	177 (95.2) 9 (4.8)	1.13	0.33-3.84	.851
	General weakness	No Yes	57 (61.3) 36 (38.7)	131 (70.4) 55 (29.6)	1.75	0.93-3.27	.081
	Dizziness	No Yes	89 (95.7) 4 (4.3)	183 (98.4) 3 (1.6)	2.69	0.60-12.03	.196
	Pain	No Yes	78 (83.9) 15 (16.1)	146 (78.5) 40 (21.5)	1.50	0.75-2.97	.250
Behavioral status	Hyperactivity	No	74 (79.6)	182 (97.9)	12.88	3.77-44.00	<.001
		Yes	19 (20.4)	4 (2.2)
	Irritability	No Yes	69 (74.2) 24 (25.8)	139 (74.7) 47 (25.3)	1.03	0.57-1.84	.929
	Agitation	No Yes	92.9 (98.9) 1 (1.1)	185 (99.5) 1 (0.5)	1.96	0.12-31.50	.635
Medication	Anxiolytics, sedatives, & hypnotics	No Yes	82 (88.2) 11 (11.8)	144 (77.4) 42 (22.6)	2.25	1.09-4.66	.028
	General anesthetics	No Yes	92 (98.9) 1 (1.1)	165 (88.7) 21 (11.3)	15.45	1.98-120.44	.009
	Anti-convulsants	No Yes	87 (93.6) 6 (6.4)	166 (89.3) 20 (10.7)	2.01	0.72-5.59	.182
	Analgesics &	No	84 (90.3)	157 (84.4)	1.92	0.81-4.53	.137
	antipyretics	Yes	9 (9.7)	29 (15.6)

Table 4.

Logistic Regression Analysis of Risk Factors for Falls (N=204)

Variables	Wald	Odds ratio	95% CI	p
Test that need patient to be moved	8.80	9.65	2.16-43.17	.003
Intravenous line	10.08	8.69	2.29_-33.05	.002
General weakness	4.33	3.22	1.07-9.69	.038
Hyperactivity	11.64	30.55	4.28-217.90	<.001

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Risk Factors for Pediatric Inpatient Falls

J Korean Acad Nurs. 2013;43(5):595-604. Published online October 15, 2013

DOI: https://doi.org/10.4040/jkan.2013.43.5.595

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Risk Factors for Pediatric Inpatient Falls

Table 1.

Risk Factors for Pediatric Inpatient Falls

Items	CVI
Age (month)*	1.00
Hyperactivity	1.00
Irritability	1.00
Gait balance	1.00
Medication	1.00
Medical diagnosis (primary and secondary diagnosis)	.80
History of falls	.80
Physical developmental status	.80
Assistive devices (wheelchair, walker, crutch, etc.)	.80
General weakness	.80
Dizziness	.80
Agitation	.80
Visual disturbance	.80
Urine catheter or tubes et al.	.80
Pain	.80
Intravenous line	.80
Test that need patient to be moved	.80
Alteration of caregivers	.80
Height of bed*	.80
Compliance of caregiver*	.80
Cognitive developmental status*	.60
Language disturbance*	.60
Physical deformity*	.40
Paralysis or neuromuscular dysfunction*	.40
Sleep disturbance*	.40
Voiding difficulty*	.40
Admission or discharge day*	.40
Hearing problem*	.40
Caregiver education at admission*	.40
Specific time (night, meal time, etc.)*	.40
Diarrhea*	.20
Length of stay*	.20
Operation day*	.20
Gender*	.20
Sensory disturbance*	.00
History of admission*	.00
Transfer day*	.00
Purpose of admission in hospital*	.00
Type of medication Anti-convulsants	1.00
General anesthetics	1.00
Anxiolytics, sedatives, & hypnotics	1.00
Analgesics & antipyretics	.80
Opiate antagonist*	.60
Psychotherapeutic agents*	.60
Skeletal muscle agents*	.60
Smooth muscle relaxants (propiverine)*	.60
Cathartics & laxatives*	.20
Cyclosporin*^†	.20
Antihistamines*	.20
Antidiabetic agents*	.20
Sympatomimetic agents*	.00
Cardiac drugs*	.00
Antihypertensive agents*	.00
Vasodilating agents*	.00
Local anesthetics*	.00
Others (cardiovascular agents)*	.00
Levosulpiride*^†	.00
Dimenhydrinate*^†	.00
Opthalmic agents (fluorescein)*	.00
Diagnostic agents (iodixanol, immeprol)*	.00

*Excluded items;

^†Single drug; CVI=Content validity index.

Table 2.

Matching Variables for the Participants (N=279)

Variables	Categories	Fallers (n=93)	Non-fallers (n=186
Variables	Categories	n (%) or M±SD	n (%) or M±SD
Gender	Male Female	54 (58.1) 39 (41.9)	108 (58.1) 78 (41.9)
Age	<5	0 (0.0)	0 (0.0)
(months)	5-12	25 (26.9)	50 (26.9)
	13-35	51 (54.8)	102 (54.8)
	36-71	17 (18.3)	34 (18.3)
LOS		10.51±13.63	10.0±13.50
Diagnosis	Hematology-oncology disease	53 (57.0)	106 (57.0)
	Cardiopulmonary disease Neuro-musculoskeletal disease	13 (14.0) 10 (10.8)	26 (14.0) 20 (10.8)
	Kidney & endocrine disease Gastrointestinal disease	8 (8.6) 4 (4.3)	18 (9.7) 8 (4.3)
	Head & neck disease	5 (5.4)	8 (4.3)

LOS=Length of stay.

Table 3.

Odds Ratios between Fallers and Non-fallers by Risk Factors (N=279)

Variables	Categories		Fallers (n=93)	Non-fallers (n=186)	Odds ratio	95% CI	p
Variables	Categories		n (%)	n (%)	Odds ratio	95% CI	p
General	History of falls	No	86 (92.5)	186 (100.0)		−
characteristics	(within 3 months)	Yes	7 (7.5)	0 (0.0)
	Alteration of caregivers	No	92 (98.9)	186 (100.0)		−
		Yes	1 (1.1)	0 (0.0)
	Developmental status	Before over rolling - before crawling	12 (48.0)	33 (66.0)	1.92	0.78_-4.74	.158
	(before walking)	Crawling - stand holding	13 (52.0)	17 (34.0)
	Assistive devices	No	22 (32.4)	57 (41.9)	1.52	0.82_-2.81	.187
	(after walking)	Yes	46 (67.7)	79 (58.1)
	Secondary diagnosis	No	84 (90.3)	148 (79.6)	2.75	1.19_-6.36	.018
		Yes	9 (9.7)	38 (20.4)
	Test that need patient	No	89 (95.7)	114 (61.3)	13.64	4.85-38.39	<.001
	to be moved	Yes	4 (4.3)	72 (38.7)
	Urinary catheter,	No	85 (91.4)	162 (87.1)	1.78	0.71-4.48	.216
	tubes, etc.	Yes	8(8.6)	24 (12.9)
	Intravenous line	No	35 (37.6)	22 (11.8)	5.95	2.81-12.57	<.001
		Yes	58 (62.4)	164 (88.2)
Physical status	Physical developmental	Normality	88 (94.6)	175 (94.1)	1.17	0.37-3.75	.793
	status	Abnormality	5 (5.4)	11 (5.9)
	Gait balance	Normality	56 (82.4)	123 (90.4)	2.11	0.88-5.05	.095
	(after walking)	Need help	12 (17.6)	13 (9.6)
	Visual disturbance	No Yes	89 (95.7) 4 (4.3)	177 (95.2) 9 (4.8)	1.13	0.33-3.84	.851
	General weakness	No Yes	57 (61.3) 36 (38.7)	131 (70.4) 55 (29.6)	1.75	0.93-3.27	.081
	Dizziness	No Yes	89 (95.7) 4 (4.3)	183 (98.4) 3 (1.6)	2.69	0.60-12.03	.196
	Pain	No Yes	78 (83.9) 15 (16.1)	146 (78.5) 40 (21.5)	1.50	0.75-2.97	.250
Behavioral status	Hyperactivity	No	74 (79.6)	182 (97.9)	12.88	3.77-44.00	<.001
		Yes	19 (20.4)	4 (2.2)
	Irritability	No Yes	69 (74.2) 24 (25.8)	139 (74.7) 47 (25.3)	1.03	0.57-1.84	.929
	Agitation	No Yes	92.9 (98.9) 1 (1.1)	185 (99.5) 1 (0.5)	1.96	0.12-31.50	.635
Medication	Anxiolytics, sedatives, & hypnotics	No Yes	82 (88.2) 11 (11.8)	144 (77.4) 42 (22.6)	2.25	1.09-4.66	.028
	General anesthetics	No Yes	92 (98.9) 1 (1.1)	165 (88.7) 21 (11.3)	15.45	1.98-120.44	.009
	Anti-convulsants	No Yes	87 (93.6) 6 (6.4)	166 (89.3) 20 (10.7)	2.01	0.72-5.59	.182
	Analgesics &	No	84 (90.3)	157 (84.4)	1.92	0.81-4.53	.137
	antipyretics	Yes	9 (9.7)	29 (15.6)

Table 4.

Logistic Regression Analysis of Risk Factors for Falls (N=204)

Variables	Wald	Odds ratio	95% CI	p
Test that need patient to be moved	8.80	9.65	2.16-43.17	.003
Intravenous line	10.08	8.69	2.29_-33.05	.002
General weakness	4.33	3.22	1.07-9.69	.038
Hyperactivity	11.64	30.55	4.28-217.90	<.001

Table 1. Risk Factors for Pediatric Inpatient Falls

*Excluded items;

†

Single drug; CVI=Content validity index.

Table 2. Matching Variables for the Participants (N=279)

LOS=Length of stay.

Table 3. Odds Ratios between Fallers and Non-fallers by Risk Factors (N=279)