The revised Humpty Dumpty Fall Scale: An update to improve tool performance and predictive validity Danielle Altares Sarik, PhD, APRN, CPNP-PC a, ⁎, Deborah Hill-Rodriguez, MBA, MSN, APRN, NE-BC a , Karina A. Gattamorta, PhD b , Jacqueline L. Gonzalez, DNP, APRN, MBA, NEA-BC, FAAN a , Jenny Esteves, MBA, MHSA, LBBP a , Katherine Zamora, BSN, RN, CPHON a , Jennifer Cordo, DNP, APRN, NE-BC a a Nicklaus Children's Hospital, USA b University of Miami School of Nursing and Health Studies, USA abstract article info Article history: Received 25 May 2022 Revised 15 July 2022 Accepted 19 July 2022 Available online xxxx Purpose: 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 pa- tients, 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. Results: 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%. Conclusions: These revisions are anticipated to help support clinical practice and improve fall prevention, thus supporting a safer pediatric environment for the hospitalized child. © 2022 Published by Elsevier Inc. Keywords: Pediatrics Falls Humpty dumpty Risk classification Risk factors Practice measures Introduction The Humpty Dumpty Falls Prevention Scale (HDFS) and Program was developed in 2005, addressing an unmet need to identify the pedi- atric population at risk for a fall event while hospitalized. The program, which consists of a risk identification scale and associated risk reduction protocols, is currently utilized in over 1500 institutions across six conti- nents and translated into 15 languages. The HDFS is globally recognized as the leading tool for identification and prevention of pediatric falls. As the Program has matured, so has the knowledge of pediatric falls and the rationale behind why children fall while hospitalized. Prevent- ing injury in hospitalized children is a key patient safety focus, and nurs- ing research, evidence-based practice, and quality improvement work are all needed to help guide interventions (Benning & Webb, 2019; Christian, 2022). As a result, the HDFS is routinely evaluated for refine- ments based on evidence-based outcomes and research. The purpose of this study is to identify potential modifications to the scale in response to published critiques, as well as to enhance the accuracy of fall prediction in the pediatric population, thus contributing to the safest possible environment for the hospitalized child. Literature review Several articles have been published focusing on the Humpty Dumpty Falls Prevention Program (HD Program), performance of the HDFS, and potential gaps (AlSowailmi et al., 2018; Ciofi et al., 2020; Craig et al., 2018, Gonzalez et al., 2020; Kim, Kim, et al., 2019; Kim, Lim, et al., 2019; Kim, Lim, et al., 2021; Kim, Kim, & Lim, 2021). A review of fall assessment risk factors and associated fall prevention interven- tions for hospitalized children recognized that the HDFS included pru- dent prevention measures utilized for children classified as being high-risk for fall (Brás et al., 2020). Studies have also demonstrated that comprehensive scoring components of the HDFS have adequately predicted hospitalized children at risk for falls, in comparison to other pediatric fall risk assessment tools that did not demonstrate the same or better results (Craig et al., 2018; McNeely et al., 2018). Additional studies have identified opportunities to enhance the HDFS scoring components to include additional risk factors for children at risk of falls. Having a family member present at the bedside, for Journal of Pediatric Nursing 67 (2022) 34–37 ⁎ Corresponding author at: 3100 SW 62 nd Ave., Miami, FL 33155, USA. E-mail address: Danielle.sarik@nicklaushealth.org (D.A. Sarik). https://doi.org/10.1016/j.pedn.2022.07.023 0882-5963/© 2022 Published by Elsevier Inc. Contents lists available at ScienceDirect Journal of Pediatric Nursing journal homepage: www.pediatricnursing.org