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Predicting pressure ulcer risk in pediatric patients: the Braden Q Scale
Martha A Q Curley1, Ivy S Razmus, Kathryn E Roberts
1Critical Care and Cardiovascular Nursing Research, Children's Hospital, Boston, Massachusetts 02115, USA. Martha.Curley@TCH.Harvard.edu
Insights
The Braden Q Scale effectively predicts pressure ulcers in acutely ill children, similar to the adult Braden Scale. A modified 3-subscale version offers a shorter, comparable risk assessment tool.
Area of Science:
- Pediatric critical care medicine
- Nursing research
- Patient safety
Background:
- No validated pressure ulcer risk assessment tools existed for pediatric patients.
- The Braden Scale was adapted for pediatric use, creating the Braden Q Scale.
Purpose of the Study:
- Establish predictive validity of the Braden Q Scale in acutely ill children.
- Determine optimal cutoff scores for risk classification.
- Identify the best timing for risk assessment.
Main Methods:
- A prospective cohort study enrolled 322 pediatric intensive care unit (PICU) patients.
- The Braden Q Scale and skin assessments were independently rated by blinded data collectors.
- Patients were observed for a median of 2 assessments over 2 weeks, totaling 887 skin assessments.
Main Results:
- 27% of patients developed pressure ulcers, most commonly Stage I or II.
- The Braden Q Scale demonstrated good predictive validity (AUC=0.83) with a cutoff of 16 (sensitivity 0.88, specificity 0.58).
- A Modified Braden Q Scale (3 subscales) maintained high validity (AUC=0.84) with a cutoff of 7 (sensitivity 0.92, specificity 0.59).
Conclusions:
- The Braden Q Scale performs comparably to the adult Braden Scale in pediatric populations.
- The Modified Braden Q Scale offers a concise and effective alternative for pediatric pressure ulcer risk assessment.
Background:
While there are valid and reliable pressure ulcer risk assessment tools available for adult patients, none exist for infants and children. To remedy this, the Braden Scale was adapted for use in pediatrics, calling it the Braden Q Scale.
Objective:
The purpose of this study was to: (a) establish the predictive validity of the Braden Q Scale in an acutely ill pediatric population; (b) determine the critical cutoff point for classifying patient risk; and (c) determine the best time to assess patient risk.
Methods:
A multisite prospective cohort descriptive study with a convenience sample of 322 patients on bedrest for at least 24 hours without pre-existing pressure ulcers or congenital heart disease were enrolled from three pediatric intensive care units (PICU). The Braden Q score and skin assessment were independently rated and data collectors were blind to the other measures. Patients were observed up to 3 times per week for 2 weeks and then once a week until PICU discharge for a median of 2 observations reflecting 887 skin assessments.
Results:
Eighty-six patients (27%) developed 199 pressure ulcers; 139 (70%) were Stage I pressure ulcers, 54 (27%) were Stage II pressure ulcers, and 6 (3%) were Stage III pressure ulcers. Most pressure ulcers (57%) were present at the first observation. Using Stage II+ pressure ulcer data obtained during the first observation, a Receiver Operator Characteristic (ROC) curve for each possible score of the Braden Q Scale was constructed. The area under the curve (AUC) was 0.83. At a cutoff score of 16, the sensitivity was 0.88 and the specificity was 0.58. The Braden Q Scale was then modified to eliminate 4 subscales with an AUC <0.7. With 3 subscales (mobility, sensory perception, tissue perfusion/oxygenation) the AUC of this Modified Braden Q Scale was maintained at 0.84. At a cutoff score of 7, the sensitivity was 0.92 and the specificity was 0.59.
Conclusions:
The performance of the Braden Q Scale in a pediatric population is similar to that consistently reported for the Braden Scale in adult patients. The Modified Braden Q Scale, with 3 subscales, provides a shorter yet comparable tool.
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