Risk Tool Predicts Pressure Injuries in Pediatric Patients

A new study describes how a patient assessment tool predicts both immobility-related and device-related pressure injuries in hospitalized pediatric patients.

Researchers at the University of Pennsylvania (Penn; Philadelphia, USA), Boston Children’s Hospital (BCH; MA, USA), and other organizations conducted a multicenter, prospective cohort study that details the design and initial testing of the Braden QD Scale tool. Developed from the current pediatric Braden Q scale, the QD scale was amplified to include patients between eight and 21 years of age, including those with congenital heart defects. The study enrolled 625 hospitalized pediatric patients on bed rest for at least 24 hours, with a medical device in place.

In all, 86 hospital-acquired pressure injures were observed: 22 immobility-related pressure injuries in 2% of patients, and 64 medical device-related pressure injuries in another 7%. First day observation scores were used to characterize Braden QD Scale performance, including areas under the curve (AUC) with 95% confidence interval (CI). The results revealed that the Braden QD Scale performed well in predicting immobility-related and medical device–related pressure injuries in the overall sample, with an AUC of 0.78. The study was published in the January 2018 issue of Journal of Pediatrics.

“The prevention of pressure injuries requires the accurate identification of patients at risk and the reliable implementation of prevention strategies on patients identified as being at risk, “ concluded lead author Martha Curley, RN, PhD, of the University of Pennsylvania, and colleagues. “The Braden QD Scale reliably predicts both immobility-related and device-related pressure injuries in the pediatric acute care environment, and will be helpful in monitoring care and in guiding resource use in the prevention of hospital-acquired pressure injuries.”

The Braden scale assesses a patient's risk of developing a pressure ulcer by examining six criteria, which include sensory perception; the degree of moisture the skin is exposed to; the patient's level of physical activity; physical competency to move; assessment of the patients nutritional status; and friction and shear on beds or chairs, as the sliding motion can cause breakdown of cell membranes and capillaries. Moisture enhances the susceptibility of friction.

Related Links:
University of Pennsylvania
Boston Children’s Hospital