Related Experiment Video
Updated: Aug 31, 2025
Mouse Model of Pressure Ulcers After Spinal Cord Injury
Published on: March 9, 2019
Determining Incidence and Risk Factors of Pressure Injury After Orthopaedic Surgery in Children and Adolescents With
Aneesh V Samineni1, Patricia E Miller1, Christopher Hopkinson1
1Boston Children's Hospital, Department of Orthopaedics.
Insights
Pressure injuries affect 7.6% of pediatric patients with complex chronic conditions after orthopedic surgery. Key risk factors include non-ambulatory status and medical devices, highlighting the need for targeted prevention strategies.
Area of Science:
- Pediatric Orthopaedics
- Wound Care
- Clinical Nursing
Background:
- Pressure injuries are preventable skin integrity issues common in pediatric orthopaedics.
- Children with neuromuscular complex chronic conditions (NCCC) are particularly vulnerable.
Purpose of the Study:
- Estimate pressure injury incidence post-orthopaedic surgery in children with NCCC.
- Identify risk factors for pressure injury development.
- Describe pressure injury severity and location.
Main Methods:
- Retrospective case-control study of children (<22 years) with NCCC undergoing orthopaedic surgery (2016-2020).
- 1:1 matching of patients with and without pressure injuries based on diagnosis, age, sex, and surgery type.
- Comparison of patient characteristics, comorbidities, and Braden QD scale scores.
Main Results:
- 43 of 564 children (7.6%) developed postoperative pressure injuries.
- Common locations: heel, sacral/groin/buttocks, knee.
- Higher risk in non-ambulatory patients (GMFCS IV/V), those with seizure disorders, g-tube, nonverbal status, wheelchair use, and medical devices.
- Median Braden QD score ≥12 predicted pressure injury development.
Conclusions:
- Postoperative pressure injuries are a significant concern in pediatric NCCC patients undergoing orthopaedic surgery.
- Cerebral palsy with neuromuscular scoliosis, seizure disorder, nonverbal status, g-tube, and multiple medical devices are key risk factors.
- Implementing evidence-based prevention guidelines for high-risk children can reduce pressure injury incidence and improve outcomes.
Background:
Pressure injuries are serious yet often preventable alterations in skin integrity prevalent in orthopaedics, especially in pediatric patients with neuromuscular complex chronic conditions (NCCC). The aims of this study were to (1) estimate incidence of pressure injury in children with NCCC after orthopaedic surgery; (2) determine risk factors for pressure injury development; and (3) describe severity and location of pressure injuries.
Methods:
Children and adolescents (<22 y old) with NCCC who underwent orthopaedic surgery at a single tertiary-care children's hospital between 2016 and 2020 were retrospectively identified. A matched case-control design was used to match patients who developed a pressure injury within 1.5 months after surgery to subjects who did not develop a pressure injury using a 1:1 matching based on neuromuscular diagnosis, age, sex, and type of surgery. Patient characteristics, comorbidities, pressure injury characteristics, and a pressure injury risk assessment score utilizing the Braden QD scale were compared across pressure injury groups.
Results:
Of 564 children with NCCC who underwent orthopaedic surgery, 43 (7.6%) developed a postoperative pressure injury. Pressure injuries were primarily located on the heel, followed by sacral/groin/buttocks, then knee. The most common diagnosis was cerebral palsy with associated neuromuscular scoliosis, and hip reconstruction was the most common surgical procedure. The pressure injury cohort had significantly more patients who were non-ambulatory (GMFCS IV/V), with a seizure disorder, g-tube, nonverbal status, wheelchair usage, and had additional medical devices. Median Braden QD risk score was higher in the injury cohort and a cutoff ≥12 was optimal for predicting pressure injury development.
Conclusions:
Pressure injuries after orthopaedic surgery are not uncommon in children with NCCC. The entire care team should be aware of additional risk factors associated with pressure injury development, including the diagnosis of cerebral palsy with neuromuscular scoliosis, seizure disorder, nonverbal status, g-tube, and the presence of multiple medical devices. Implementation of evidence-based pressure injury prevention guidelines on identified high-risk children with NCCC may reduce pressure injury risk and improve the postoperative course.
Level Of Evidence:
Level III.
Related Concept Videos
01:28Disorders of the Skeletal Muscle
Musculoskeletal disorders
Musculoskeletal disorders involve injuries and conditions affecting the skeletal muscles and associated connective tissues. These disorders can arise from acute biomechanical stresses or chronic overuse and can occur across different age groups. Common injuries include sprains, fractures, and muscular strains, often resulting from...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:22Burn Injuries
The damage results in the death of skin cells, which can lead to a massive loss of fluid. Dehydration, electrolyte imbalance, and renal and circulatory failure follow, which can be fatal. Burn patients are treated with intravenous fluids to offset...