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Predicting Pressure Injury Risk in Pediatric Patients: The Braden QD Scale
Martha A Q Curley1, Natalie R Hasbani2, Sandy M Quigley3
1Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA; Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Critical Care and Cardiovascular Nursing Program, Boston Children's Hospital, Boston, MA.
Insights
The Braden QD Scale effectively predicts pressure injury risk in hospitalized children, identifying both immobility-related and device-related risks. This tool aids in monitoring care and preventing hospital-acquired pressure injuries in pediatric patients.
Area of Science:
- Pediatric Nursing
- Patient Safety
- Clinical Assessment Tools
Background:
- Hospital-acquired pressure injuries (HAPIs) are a significant concern in pediatric care.
- Existing risk assessment tools may not adequately address the unique factors in pediatric patients, including device-related risks.
- Early identification of pressure injury risk is crucial for effective prevention strategies.
Purpose of the Study:
- To develop and evaluate the Braden QD Scale for predicting pressure injury risk in pediatric patients.
- To assess the scale's ability to identify both immobility-related and medical device-related pressure injuries.
- To provide a reliable tool for risk assessment in pediatric acute care settings.
Main Methods:
- A multicenter, prospective cohort study involving hospitalized pediatric patients (preterm to 21 years) on bedrest with a medical device.
- Data collection included patient demographics, medical devices, and pressure injury development.
- Receiver operating characteristic (ROC) curves were used to analyze the Braden QD Scale's predictive performance, calculating the area under the curve (AUC).
Main Results:
- The study enrolled 625 pediatric patients across eight centers.
- The Braden QD Scale demonstrated good performance in predicting both immobility-related and device-related pressure injuries, with an overall AUC of 0.78.
- At a cutoff score of 13, the scale showed a sensitivity of 0.86 and a negative predictive value of 0.98 for pressure injury prediction.
Conclusions:
- The Braden QD Scale reliably predicts immobility-related and device-related pressure injuries in pediatric acute care.
- The scale can assist healthcare providers in monitoring patient care and allocating resources for pressure injury prevention.
- Implementation of the Braden QD Scale is recommended for improving patient safety and reducing HAPIs in pediatric populations.
Objective:
To describe the development and initial testing of the Braden QD Scale to predict both immobility-related and medical device-related pressure injury risk in pediatric patients.
Study Design:
This was a multicenter, prospective cohort study enrolling hospitalized patients, preterm to 21 years of age, on bedrest for at least 24 hours with a medical device in place. Receiver operating characteristic curves using scores from the first observation day were used to characterize Braden QD Scale performance, including areas under the curve (AUC) with 95% CIs.
Results:
Eight centers enrolled 625 patients. A total of 86 hospital-acquired pressure injures were observed in 49 (8%) patients: 22 immobility-related pressure injuries in 14 (2%) patients and 64 medical device-related pressure injuries in 42 (7%) patients. The Braden QD Scale performed well in predicting immobility-related and medical device-related pressure injuries in the overall sample, with an AUC of 0.78 (95% CI 0.73-0.84). At a cutoff score of 13, the AUC was 0.72 (95% CI 0.67-0.78), providing a sensitivity of 0.86 (95% CI 0.76-0.92), specificity of 0.59 (95% CI 0.55-0.63), positive predictive value of 0.15 (95% CI 0.11-0.19), negative predictive value of 0.98 (95% CI 0.97-0.99), and a positive likelihood ratio of 2.09 (95% CI 0.95-4.58).
Conclusions:
The Braden QD Scale reliably predicts both immobility-related and device-related pressure injuries in the pediatric acute care environment and will be helpful in monitoring care and in guiding resource use in the prevention of hospital-acquired pressure injuries.
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