Challenges and conundrums in the validation of Pediatric Fall Risk Assessment tools.
The 10-item Pediatric Fall Risk Assessment (PFRA) was developed to evaluate patients at low- or high-risk for falling. To avoid the unnecessary use of resources for children not likely to fall, children evaluated as high-risk are targeted for more intensive fall prevention interventions. In a retrospective, case-control design, the precision, accuracy, and error rate of the PFRA with patients ages 1 month to 24 years were evaluated. Cases included children who fell (n = 326), and controls (n = 326) were children from the same cohort who did not fall. Inter-rater agreement (precision) on PFRA cut-off scores was 95.1%, but accuracy was unacceptably low due to 60% false-positive and 58.5% false-negative risk ratings. Neither the PFRA nor three other widely used pediatric fall risk scales have sufficient precision or accuracy to justify implementing or withholding a high-risk fall prevention protocol. Several logistic and methodological challenges must be addressed before further development of these tools.
Nationwide Children's Hospital, Columbus, OH, USA.
Nancy A
NA
Ryan-Wenger
Judy
J
Kimchi-Woods
Melanie A
MA
Erbaugh
Lauren
L
LaFollette
Janet
J
Lathrop
D000058:Accidental Falls; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult