Skin breakdown in acute care pediatrics.

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.