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The 2003 national pediatric pressure ulcer and skin breakdown prevalence survey: a multisite study
Kathleen M McLane1, Kimberly Bookout, Shannon McCord
1Texas Children's Hospital, Houston, TX 77042, USA. kmclane2001@yahoo.com
Insights
Hospitalized children had a low prevalence of pressure ulcers (4.0%), but a higher prevalence of other skin breakdown (14.8%), primarily excoriation and skin tears. Further research on prevention and treatment is recommended.
Area of Science:
- Pediatric Nursing
- Wound Care
- Hospital Acquired Conditions
Background:
- Pressure ulcers and skin breakdown are significant concerns in hospitalized patients.
- Limited data exists on the prevalence of these conditions in pediatric populations.
- Standardized assessment tools are crucial for accurate prevalence measurement.
Purpose of the Study:
- To determine the prevalence of pressure ulcers and other skin breakdown in hospitalized children.
- To identify common types and locations of skin breakdown in this demographic.
- To establish benchmark data for future research and prevention strategies.
Main Methods:
- A descriptive, multi-site study involving 1,064 pediatric inpatients across nine US children's hospitals.
- Utilized chart reviews, physical skin assessments, and validated risk assessment scales (Braden Q, Neonatal/Infant Braden Q).
- Data collected on a single day, with pressure ulcers staged per the National Pressure Ulcer Advisory Panel criteria.
Main Results:
- Pressure ulcer prevalence was 4.0%; other skin breakdown prevalence was 14.8%.
- Most pressure ulcers were partial thickness (92%) and facility-associated (66%).
- Common skin breakdown types included excoriation/diaper dermatitis, skin tears, and IV extravasation.
Conclusions:
- Pressure ulcer prevalence is low in hospitalized children, but other skin breakdown is more common.
- Excoriation, skin tears, and IV extravasation represent the majority of non-pressure ulcer wounds.
- Further studies on prevention and treatment are needed, with periodic multi-site studies to update benchmarks.
Objective:
The purpose of this study was to document the prevalence of pressure ulcers and other types of skin breakdown in hospitalized children.
Design:
This descriptive study included documentation of findings from chart reviews and physical assessments of children.
Setting And Subjects:
Nine children's hospitals from throughout the United States participated for a total sample of 1064 children. Subjects were inpatients in the children's hospitals between the ages of neonate to 17 years.
Instruments:
The data collection tools included the interrater reliability quiz, the patient data collection form, FAST data collection software, the Braden Q Risk Assessment Scale, and the Neonatal/Infant Braden Q Risk Assessment Scale.
Methods:
Prevalence of pressure ulcers and skin breakdown was measured on a predetermined day during an 8-hour period at each institution. Eight hospitals required a signed informed consent before study participation; 1 hospital's institutional review board waived consent. A physical skin assessment was done on each inpatient, and all pressure ulcers found were staged according to the National Pressure Ulcer Advisory Panel staging system. A chart review was done on all subjects to collect information on patient demographics and potential risk factors. The Neonatal/Infant Braden Q Risk Assessment was scored for infants younger than 1 year old, and the Braden Q Risk Assessment for children 1 year and older. Patient data collection forms were completed, and all data were entered into the FAST data collection software at the end of the study day. Analyses of data and reports were generated from a central site.
Results:
There were 1,064 children surveyed, with a pressure ulcer prevalence of 4.0% and other skin breakdown prevalence of 14.8%. Ninety-two percent of the pressure ulcers were partial thickness, Stages I and II. Sixty-six percent of the pressure ulcers were facility associated. Locations of pressure ulcers were predominately in the head area 31%, seat area 20%, and foot area 19%. The 3 most common types of skin breakdown were excoriation/diaper dermatitis, skin tear, and IV extravasation. Predominant locations for skin breakdown were seat area 35%, foot area 20%, and upper extremities 18%.
Conclusions:
The prevalence of pressure ulcers was low in the pediatric population studied, but skin breakdown prevalence (excluding pressure ulcers) was higher, with 74% of all wound types consisting of excoriation/diaper dermatitis, skin tears, and IV extravasation sites. Future studies are needed to evaluate prevention and treatment options for pressure ulcers and skin breakdown in this population. Repeating this multisite study at intervals may be beneficial to continue to build and modify the benchmark data.
