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Pressure ulcers in pediatric intensive care: incidence and associated factors
Martha A Q Curley1, Sandy M Quigley, Ming Lin
1Critical Care and Cardiovascular Program, Children's Hospital of Boston, Newton Centre, MA, USA.
Insights
Pediatric intensive care unit (PICU) patients on mechanical ventilation or with hypotension are at higher risk for developing pressure ulcers. Lower Braden Q scores also predict pressure ulcer development in this vulnerable population.
Area of Science:
- Pediatric critical care medicine
- Wound care and prevention
- Patient safety in intensive care
Background:
- Pressure ulcers are a significant concern in pediatric intensive care units (PICUs).
- Understanding the incidence and risk factors is crucial for prevention strategies.
Purpose of the Study:
- To determine the incidence, location, and associated factors of pressure ulcer development in PICU patients.
- To identify patient characteristics that predict the occurrence of pressure ulcers.
Main Methods:
- A multisite prospective cohort study was conducted in three freestanding children's hospitals.
- 322 pediatric patients (21 days to 8 years) on bed rest for at least 24 hours were monitored.
- Skin assessments were performed regularly by blinded data collectors over a median of two observation periods.
Main Results:
- 27% of patients developed 199 pressure ulcers; most were Stage I (70%) or Stage II (27%).
- Stage III ulcers occurred on the head, occiput, ear, chest, and coccyx.
- Mechanical ventilation, mean arterial pressures ≤50 mm Hg, and lower Braden Q scores were significant predictors of Stage I pressure ulcers.
Conclusions:
- Patients requiring mechanical ventilation, experiencing hypotension, or with low Braden Q scores are at increased risk for pressure ulcers in the PICU.
- This study provides benchmark data to inform the design of pediatric interventional studies aimed at reducing pressure ulcer incidence.
- Identifying at-risk populations is key to developing targeted prevention strategies for vulnerable pediatric patients.
Objective:
To describe the incidence, location, and factors associated with the development of pressure ulcers in patients cared for in the pediatric intensive care unit (PICU).
Design:
Multisite prospective cohort study.
Setting:
Three PICUs contained within freestanding children's hospitals.
Patients:
A total of 322 patients, 21 days to 8 yrs of age, on bed rest in the PICU for at least 24 hrs without preexisting pressure ulcers or congenital heart disease.
Intervention:
Patients were observed up to three times a week for 2 wks, then once a week until PICU discharge for a median of two observation periods (interquartile range, 1-4), reflecting 877 skin assessments. Skin assessments were independently rated, and data collectors were blinded to the assessments of the others.
Measurements And Main Results:
Pressure ulcers were staged according to the American National Pressure Ulcer Advisory Panel Consensus Development Conference recommendations. Eighty-six patients (27%) developed 199 pressure ulcers; 139 (70%) were Stage I, 54 (27%) were Stage II, and 6 (3%) were Stage III. Of the 60 Stage II/III pressure ulcers, 19 (32%) involved the head. Stage III pressure ulcers involved the occiput, ear, chest, and coccyx. An additional 27 pressure-related injuries were caused by medical devices. Statistically significant Stage I pressure ulcer predictor variables include the use of mechanical ventilation, mean arterial pressures < or =50 mm Hg, and lower Braden Q scores.
Conclusions:
PICU patients at risk include those supported on mechanical ventilation, those with hypotension, and those who have low Braden Q scores. This study provides unique benchmark data for the general PICU population from which pediatric interventional studies can be designed to reduce the incidence of pressure ulcers in this vulnerable patient population.