Child Health Nursing Research

Korean Academy of Child Health Nursing (한국아동간호학회)
권호 표지
DOI QR코드

DOI QR Code

A Pediatric Fall-Risk Assessment Tool for Hospitalized Children

입원 아동의 낙상 위험 예측 도구

  • Shin, Hyeon Ju (Children's Nursing Department, Seoul National University Hospital) ;
  • Kim, Young Nam (Children's Nursing Department, Seoul National University Hospital) ;
  • Kim, Ju Hee (Children's Nursing Department, Seoul National University Hospital) ;
  • Son, In Sook (Children's Nursing Department, Seoul National University Hospital) ;
  • Bang, Kyung-Sook (College of Nursing and The Research Institute of Nursing Science, Seoul National University)
  • 신현주 (서울대학교병원 소아간호과) ;
  • 김영남 (서울대학교병원 소아간호과) ;
  • 김주희 (서울대학교병원 소아간호과) ;
  • 손인숙 (서울대학교병원 소아간호과) ;
  • 방경숙 (서울대학교 간호대학)
  • Received : 2014.05.09
  • Accepted : 2014.06.10
  • Published : 2014.07.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study was conducted to identify risk factors in hospitalized children, and to develop and validate a fall-risk assessment tool for hospitalized children. Methods: A retrospective chart review was performed at one university children's hospital, and an analysis was done of the characteristics of all patients who fell during a 44-month period (n=48). These patients were compared with another 149 hospitalized children who did not fall. Results: Significant predictors of falls as identified in a multivariate logistic regression analyses were age of less than 3 years old, neurological diagnosis including epilepsy, children's dependency of ADL, physical developmental delay, multiple usage of fall-risk-increasing drugs. The respective odds ratios ranged from 2.4 to 7.1 with 95% confidence interval (p<0.05). Accordingly, defining patients with either 5 risk factors as fall-prone hospitalized children provided a sensitivity of 93.6% and specificity of 16.2%. Conclusion: The results show that this tool has an acceptable level of sensitivity to assess the risk factors of fall in hospitalized children even though the specificity was low, suggesting that this tool may enable nurses to predict the risk level of childhood falls, and develop preventive strategies against pediatric falls in children's units.

목적 본 연구는 입원 환아의 낙상위험 요인을 확인하여 낙상위험 예측도구를 개발하고 민감도와 특이도를 확인하기 위한 것이다. 방법 문헌고찰과 서울시내 1개 어린이 병원에 2006년 1월부터 2009년 8월까지 3년 8개월 동안 입원한 환아 중 낙상한 경험이 있는 환아 48명 전체와 2009년 5월 25일부터 6월 24일까지 한 달 동안 입원한 환아 중 낙상 경험이 없는 환아 149명을 비교한 자료를 바탕으로 낙상위험요인 8개를 추출하였으며, 로지스틱 회귀분석을 통해 유의한 위험요인 5개를 확인하였다. 8개 문항과 5개 문항으로 구성된 도구를 이용하여 실제 낙상을 경험한 군과 비낙상군을 비교하여 민감도, 특이도, 양성예측도, 음성예측도를 확인하였다. 결과 로지스틱 회귀분석 결과 입원 환아의 낙상 발생 위험의 유의한 예측 요인은 다음의 5가지였다. 연령은 3세 미만인 경우 3.00배, 뇌신경질환 진단이 있는 경우 2.41배, 활동 및 기능은 도움이 필요한 경우 3.18배, 신체발달은 정상인 경우에 7.09배, 위험약품 처방 수가 3개 이상인 경우 3.475배로 낙상위험이 높은 것으로 나타났다. 8개 문항의 경우 12점 이상을 고위험으로 보았을 때 민감도는 76.6%, 특이도는 30.3%였으며, 5개 문항의 경우 7점 이상을 고위험으로 보았을 때 민감도는 93.6%, 특이도는 16.2%로 나타났다. 결론 입원환아의 낙상위험예측도구로서 8개 문항과 5개 문항의 도구 모두 민감도는 높으나 특이도는 낮은 제한점을 갖고 있다. 그러나 낙상위험을 예방하기 위한 목적으로 사용됨을 감안하면 특이도는 낮지만 민감도가 높으므로 임상현장에서 사용 가능할 것으로 판단된다.

Keywords

References

  1. Agran, P. F., Anderson, C., Winn, D., Trent, R., Walton-Haynes, L., & Thayer, S. (2003). Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age. Pediatrics, 111(6 Pt 1), 683-692. https://doi.org/10.1542/peds.111.6.e683
  2. Bagnasco, A., Sobrero, M., Sperlinga, L., Tibaldi, L., & Sasso, L. (2010). Accidental falls in hospitalized children: An analysis of the vulnerabilities linked to the presence of caregivers. Journal of Preventive Medicine and Hygiene, 51(2), 92-96. https://doi.org/10.1016/j.ypmed.2010.04.010
  3. Bang, K. S. (2005). Effect of safety education for mothers with infants. Journal of Korean Academy of Child Health Nursing, 11(2), 221-228.
  4. Cho, M. S., Song, M. R., & Cha, S. K. (2013). Risk factors for pediatric inpatient falls. Journal of Korean Academy of Nursing, 43(5), 595-604. http://dx.doi.org/10.4040/jkan.2013.43.5.595
  5. Cooper, C. L., & Nolt, J. D. (2007). Development of an evidence-based pediatric fall prevention program. Journal of Nursing Care Quality, 22(2), 107-112. https://doi.org/10.1097/01.NCQ.0000263098.83439.8c
  6. Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., et al. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. http://dx.doi.org/10.1016/j.outlook.2007.02.006
  7. Hendrich, A. L., Bender, P. S., & Nyhuis, A. (2003). Validation of the Hendrich II fall risk model: A large concurrent case/control study of hospitalized patients. Applied Nursing Research, 16(1), 9-21. http://dx.doi. org/10.1053/apnr.2003.016009
  8. Hill-Rodriguez, D., Messmer, P. R., Williams, P. D., Zeller, R. A., Williams, A. R., Wood, M., et al. (2009). The Humpty Dumpty Falls Scale: A case-control study. Journal for Specialists in Pediatric Nursing, 14(1), 22- 32. http://dx.doi.org/10.1111/j.1744-6155.2008.00166.x
  9. Institute of Medicine. (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academies Press.
  10. Kim, C. G., & Shoe, M. J. (2002). An analysis of fall incidence rate and its related factors of fall in inpatients. Journal of Korean Society of Quality Assurance in Health Care, 9(2), 210-228.
  11. Kim, I. O., & Shin, S. H. (2002). A survey on the experience of accident of infant, toddler and preschooler, and the education about emergency care for parents. Korean Journal of Child Health Nursing, 8(2), 174-182.
  12. Kim, K. S., Kim, J. A., Chow, Y. K., Kim, Y. J., Song, M. S., & Kim, E. S. (2011). Validity and reliability assessment of the performance measures based on the nursing process for prevention and management of pressure ulcers, falls and pain. Journal of Korean Clinical Nursing Research, 16(3), 5-23.
  13. Kim, M. R. (2011). Concept analysis of patient safety. Journal of Korean Academy of Nursing, 41(1), 1-8. http://dx.doi.org/10.4040/jkan.2011.41.1.1
  14. Lee, G. S., Jang, Y. H., Jeoung, M. R., Bae, S. Y., & Park, H. S. (1997). Safety education for infant-toddlers. Seoul: Yangsoewon.
  15. Morse, J. M., Prowse, M. D., Morrow, N., & Federspeil, G. (1985). A retrospective analysis of patient falls. Canadian Journal of Public Health, 76(2), 116-118.
  16. Murray, J. A., Chen, D., Velmahos, G. C., Alo, K., Belzberg, H., Asensio, J. A., et al. (2000). Pediatric falls: Is height a predictor of injury and outcome. The American Surgeon, 66(9), 863-865.
  17. O'Connell, B., & Myers, H. (2002). The sensitivity and specificity of the Morse Fall Scale in an acute care setting. Journal of Clinical Nursing, 11(1), 134-136. https://doi.org/10.1046/j.1365-2702.2002.00578.x
  18. Pickett, W., Streight, S., Simpson, K., & Brison, R. J. (2003). Injuries experienced by infant children: A population-based epidemiological analysis. Pediatrics, 111(4), e365-370. https://doi.org/10.1542/peds.111.4.e365
  19. Rannie, M., & Neiman, J. (2008). I'm Safe: Development of a fall prevention program to enhance quality and patient safety. Denver. Colorado: The Children's Hospital, Denver, Colorado.
  20. Razmus, I., Wilson D., Smith, R., & Newman, E. (2006). Falls in Hospitalized Children. Pediatric Nursing, 32(6), 568-572.
  21. Sherwood, G. (2011). Integrating quality and safety science in nursing education and practice. Journal of Research in Nursing, 16(3), 226-240. http://dx.doi.org/10.1177/1744987111400960

Cited by

  1. 치과적 외상이 있는 소아청소년 입원환자의 치과 협진 의뢰 vol.44, pp.4, 2014, https://doi.org/10.5933/jkapd.2017.44.4.403
  2. 아동낙상예방교육이 입원아동 보호자의 낙상관련 지식과 예방행위에 미치는 효과 vol.23, pp.4, 2017, https://doi.org/10.5977/jkasne.2017.23.4.398
  3. A risk-factor analysis of medical litigation judgments related to fall injuries in Korea vol.58, pp.1, 2014, https://doi.org/10.1177/0025802417735265
  4. 입원아동의 안전사고 유형과 특성 vol.25, pp.3, 2014, https://doi.org/10.22705/jkashcn.2018.25.3.182
  5. Meta-analysis of the Diagnostic Test Accuracy of Pediatric Inpatient Fall Risk Assessment Scales vol.25, pp.1, 2014, https://doi.org/10.4094/chnr.2019.25.1.56
  6. Development of Educational Content for Nurses to Prevent Safety Accidents of Hospitalized Children: Delphi Approach vol.25, pp.1, 2014, https://doi.org/10.4094/chnr.2019.25.1.74
  7. 입원 아동의 낙상영향요인 -퇴원손상심층조사 자료를 이용하여- vol.21, pp.7, 2014, https://doi.org/10.5762/kais.2020.21.7.510
  8. Developing a conceptual model of pediatric inpatient safety accidents: A mixed methods approach vol.22, pp.3, 2014, https://doi.org/10.1111/nhs.12728
  9. An electronic medical record-based fall risk assessment tool for pediatric inpatients in South Korea: Improved sensitivity and specificity vol.27, pp.2, 2021, https://doi.org/10.4094/chnr.2021.27.2.137