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Skin breakdown in acute care pediatrics

Elizabeth C Suddaby1, Scott D Barnett, Lorna Facteau

  • 1Inova Fairfax Hospital for Children, Falls Church, VA, USA.

Dermatology Nursing
|May 20, 2006
PubMed

Insights

A new tool, the Starkid SkinScale, effectively identifies hospitalized children at risk for skin breakdown. While sensitive for detecting all cases, it is highly specific for identifying true positive skin breakdown risks.

Area of Science:

  • Pediatric Nursing
  • Wound Care
  • Clinical Assessment Tools

Background:

  • Hospitalized children are susceptible to skin breakdown.
  • Existing assessment tools may not be optimized for pediatric populations.
  • Early identification of skin breakdown risk is crucial for prevention.

Purpose of the Study:

  • To develop and validate a simple, single-page tool (Starkid SkinScale) for assessing skin breakdown risk in pediatric patients.
  • To evaluate the tool's predictive ability for skin breakdown in acutely hospitalized children.

Main Methods:

  • A 15-month data collection involving 347 pediatric patients across four in-patient units.
  • Comparison of Starkid SkinScale scores with established AHCPR staging guidelines for skin breakdown.
  • Assessment of inter-rater reliability (r2 = 0.85) and internal reliability (0.71) of the Starkid SkinScale.

Main Results:

  • The overall prevalence of skin breakdown was 23%, with erythema being the most common form (77.5%).
  • The Starkid SkinScale demonstrated high specificity (98.5%) but low sensitivity (17.5%) for predicting skin breakdown.
  • Common breakdown sites included buttocks, perineum, and occiput, with variations based on patient acuity (PICU vs. medical-surgical).

Conclusions:

  • The Starkid SkinScale is a reliable and highly specific tool for identifying hospitalized children at risk of skin breakdown.
  • The tool's high specificity suggests it is effective in correctly identifying children who will not develop skin breakdown.
  • Further refinement may be needed to improve sensitivity, particularly for detecting early-stage skin breakdown.

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