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Validation and clinical impact of paediatric pressure ulcer risk assessment scales: A systematic review
Jan Kottner1, Armin Hauss, Anna-Barbara Schlüer
1Quality Management, Charité Universitätsmedizin Berlin, Berlin, Germany. jan.kottner@email.de
Insights
Evidence for pediatric pressure ulcer (PU) risk assessment scales is limited. This systematic review found no single scale superior to others, and the clinical impact remains unknown, suggesting clinical judgment may be more effective.
Area of Science:
- Pediatric Nursing
- Clinical Risk Assessment
- Evidence-Based Practice
Background:
- Pressure ulcer (PU) risk assessment is recommended in pediatric clinical practice.
- Validated and reliable tools are needed for accurate pediatric PU risk assessment.
Purpose of the Study:
- To identify existing pediatric PU risk assessment scales.
- To evaluate the diagnostic accuracy, reliability, and agreement of these scales.
- To determine the clinical impact of PU risk scale scores in pediatric care.
Main Methods:
- Systematic review of MEDLINE, EMBASE, and CINAHL databases (up to December 2010).
- Inclusion of studies on diagnostic accuracy, reliability, agreement, and clinical impact of PU risk scales in children (0-18 years).
- Quality assessment using QUADAS and QAREL checklists.
Main Results:
- 15 publications on 12 pediatric PU risk scales were identified.
- Three scales underwent prospective validation; four had reliability/agreement data.
- No studies investigated the clinical impact of these scales.
Conclusions:
- Empirical evidence for pediatric PU risk assessment scale performance is insufficient.
- No single scale is demonstrably superior; clinical judgment may be more effective.
- The impact of PU risk scales on reducing PU incidence in pediatrics is unknown.
Background:
Pressure ulcer risk assessment using an age-appropriate, valid and reliable tool is recommended for clinical paediatric practice.
Objectives:
(1) What PU risk scales for children currently exist? (2) What is the diagnostic accuracy of their scores? (3) Are the scores reliable and what is the degree of agreement? (4) What is the clinical impact of risk scale scores in paediatric practice?
Design:
Systematic review.
Data Sources:
MEDLINE (1950 to December 2010), EMBASE (1989 to December 2010), CINAHL (1982 to December 2010), reference lists.
Review Methods:
Two reviewers independently screened databases, selected and evaluated articles and studies. Diagnostic accuracy, reliability/agreement, and experimental studies investigating the performance and clinical impact of PU risk scale scores in the paediatric population (0-18 years) were included. PU development was used as reference standard for diagnostic accuracy studies. Methodological quality of the validity and reliability studies was assessed based on the QUADAS and QAREL checklists.
Results:
The search yielded 1141 hints. Finally, 15 publications describing or applying 12 paediatric pressure ulcer risk scales were included. Three of these scales (Neonatal Skin Risk Assessment Scale for Predicting Skin Breakdown, Braden Q Scale, Burn Pressure Skin Risk Assessment Scale) were investigated in prospective validation studies. Empirical evidence about interrater reliability and agreement is available for four instruments (Neonatal Skin Risk Assessment Scale for Predicting Skin Breakdown, Starkid Skin Scale, Glamorgan Scale, Burn Pressure Ulcer Risk Assessment Scale). No studies were identified investigating the clinical impact.
Conclusions:
Sound empirical evidence about the performance of paediatric pressure ulcer risk assessment scales is lacking. Based on the few results of this review no instrument can be regarded as superior to the others. Whether the application of pressure ulcer risk assessment scales reduces the pressure ulcer incidence in paediatric practice is unknown. Maybe clinical judgement is more efficient in evaluating pressure ulcer risk than the application of risk scale scores.
