The revised Humpty Dumpty Fall Scale: An update to improve tool performance and predictive validity


      • The Humpty Dumpty Fall Scale is widely used to identify hospitalized children at risk of fall.
      • After analysis, several parameters were removed from the scale, and the scoring was updated.
      • The modified scale demonstrated a sensitivity of 84% and specificity of 57%.
      • These changes support clinical practice and improve fall prevention.
      • The updated tool is anticipated to provide a safer pediatric environment for the hospitalized child.



      The purpose of this study was to identify potential modifications to the Humpty Dumpty Fall Scale (HDFS) in order to enhance the accuracy of fall prediction in the pediatric population, thus contributing to the safest possible environment for the hospitalized child.

      Design and methods

      A secondary analysis of data collected by Gonzalez et al. (2020), including a total of 2428 patients, was conducted for this study. Multiple logistic regression was used to examine the relationship between each parameter of the HDFS (e.g., age, gender, diagnosis, cognitive impairments, environmental factors, response to surgery/sedation/anesthesia, and medication usage) and the outcome of fall status.


      After reviewing associations between HDFS parameters and fall risk, neither gender nor medication use were found to be associated with fall risk. These two parameters were removed from the scoring algorithms, and the HDFS was modified to a minimum score of 5 and maximum score of 20, with a score of 12 or above indicative of high risk of fall. The modified scale demonstrated a sensitivity of 84% and specificity of 57%.


      These revisions are anticipated to help support clinical practice and improve fall prevention, thus supporting a safer pediatric environment for the hospitalized child.


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