Incidence density and device-related pressure injury patterns in paediatric intensive care

To determine pressure injury (PI) incidence density in a paediatric intensive care unit (PICU) over five years and describe diagnosis-specific anatomical and device-related PI (DRPI) patterns.

This single-centre retrospective study included patients with stage 2 or higher PIs recorded in a tertiary hospital PICU incidence report from January 2021 to December 2025, using de-identified quality-indicator data. The incidence density was calculated per 1000 patient days. PIs were grouped as superficial (stage 2), severe (deep tissue PI, unstageable, stage 3-4) or mucosal. Patient variables were analysed per patient and injury variables per PI, using Mann-Whitney U and Kruskal-Wallis tests.

The study cohort comprised 94 patients. During 12,371 patient days, 107 PIs occurred, giving an incidence density of 8.65 per 1000 patient days. Patients with cardiovascular illness (n=41, 43.6%; median age 15 months) were younger than other groups (U=750.0; p=0.010). The head/neck was the most common site overall, but pelvic/gluteal PIs were more frequent in patients with cardiovascular illness (37.0%), whereas 83.3% of PIs in patients with respiratory and neurological illness occurred at the head/neck. At least one device was in place for every PI (median 5), and 51 PIs (47.7%) were classified as DRPIs. DRPIs accounted for 71.2% of head/neck PIs, of which 95.7% involved respiratory devices. Risk scores did not differ across severity groups (Braden Scale H=2.40; p=0.301, Braden Q H=1.68; p=0.431, Neonatal/Infant Braden Q H=0.70; p=0.705).

In this study PI patterns differed by diagnostic group, supporting pelvic/gluteal protection for patients with cardiovascular illness and device-related head/neck prevention for patients with respiratory and neurological illness. A risk-assessment tool reflecting device-related risk should be considered.