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Factors Associated With Occipital Pressure Ulcers in Hospitalized Infants and Children
Mary-Jeanne Manning1, Kimberlee Gauvreau2, Martha A Q Curley2
1Mary-Jeanne Manning is a clinical nurse specialist in the medical-surgical intensive care unit at Boston Children's Hospital, Boston, Massachusetts. Kimberlee Gauvreau is a senior biostatistician, Department of Cardiology, Boston Children's Hospital, and an associate professor in pediatrics, Harvard Medical School, Boston, Massachusetts. Martha A.Q. Curley is the Ellen and Robert Kapito Professor in Nursing Science, School of Nursing, Anesthesia and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, and a nurse scientist at Boston Children's Hospital. mary-jeanne.manning@childrens.harvard.edu.
Insights
Occipital pressure ulcers are common in critically ill infants and children. Key risk factors include mechanical ventilation, sedation, agitation, and neck vascular access devices restricting head movement.
Area of Science:
- Pediatric critical care medicine
- Nursing science
- Wound prevention
Background:
- Occipital pressure ulcers frequently affect hospitalized infants and children.
- Risk factors for these ulcers remain incompletely understood.
Purpose of the Study:
- To identify factors associated with the development of occipital pressure ulcers in acutely ill pediatric patients.
Main Methods:
- Retrospective review of patient charts with reported occipital pressure ulcers.
- Inclusion of cases from a computerized safety event reporting system and skin care group recalls.
Main Results:
- 60 cases identified over 4 years; ulcers ranged from Stage I to unstageable/deep tissue injury.
- Patients were typically infants (<1 year), critically ill (ICU, cardiovascular/pulmonary issues), with comorbidities (68%).
- Commonly associated factors included mechanical ventilation (83%), sedation (74%), agitation (42%), vasoactive medications (50%), and neck vascular access devices (45%).
Conclusions:
- Infants and children at risk for occipital pressure ulcers can be identified prospectively.
- Proactive identification enables targeted nursing interventions to prevent ulcer development.
Background:
The occiput is a common location for development of pressure ulcers in hospitalized infants and young children. However, risk factors associated with occurrence of the ulcers have not been fully described.
Objective:
To identify factors associated with development of occipital pressure ulcers in acutely ill infants and children.
Methods:
Charts of all patients with occipital pressure ulcers reported in a computerized safety event reporting system since its implementation in 2005 and of any patients with such ulcers recalled by members of the skin care special interest group were reviewed retrospectively.
Results:
During a 4-year period, 60 cases of occipital pressure ulcers were identified: 40% stage I, 12% stage II, 30% unstageable, and 18% deep tissue Injury. The median age of the sample was 12 months. Among the patients, 86% were in the intensive care unit with cardiovascular or pulmonary problems. A total of 68% had comorbid conditions. Most of the patients were less than 1 year old; were critically ill, requiring high-risk therapies; and had multiple medical devices in place. Patients with the ulcers were commonly treated with mechanical ventilation (83%) and sedation (74%) and were described as agitated (42%). Many of these patients were receiving vasoactive medications (50%) and had vascular access devices in the neck that restricted head movement (45%). When documented, the median Braden Q score was 16.
Conclusions:
Infants and children at risk for occipital pressure ulcers can be prospectively identified, allowing implementation of nursing interventions to prevent these ulcers.
