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Original Article
- Risk Factors for Pediatric Inpatient Falls
- Myung Sook Cho1, Mi Ra Song2, Sun Kyung Cha3
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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
Copyright © 2013 Korean Society of Nursing Science
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
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Purpose
- The purpose of this study was to identify risk factors for pediatric inpatients falls.
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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.
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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.
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Conclusion
- These findings provide information that is relevant in developing fall risk assessment tools and prevention programs 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 |
Table 2.Matching Variables for the Participants (N=279)
Table 3.Odds Ratios between Fallers and Non-fallers by Risk Factors (N=279)
Table 4.Logistic Regression Analysis of Risk Factors for Falls (N=204)
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Risk Factors for Pediatric Inpatient Falls
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.
Matching Variables for the Participants (N=279)
| Variables | Categories | Fallers (n=93) | Non-fallers (n=186 |
|---|---|---|---|
| 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.
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 | |
|---|---|---|---|---|---|---|---|
| n (%) | n (%) | ||||||
| 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) |
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)
Table 4. Logistic Regression Analysis of Risk Factors for Falls (N=204)
