Pediatric Pressure Ulcer Prevalence: A Multicenter, Cross-Sectional, Point Prevalence Study in Switzerland
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Index: Ostomy Wound Manage. 2012;58(7):18–31.
Pressure ulcers (PUs) are a common concern for hospitalized children and adults, but knowledge about PU risk factors, prevalence, and incidence rates among children remains limited. To assess the prevalence of and risk factors for PUs in pediatric care settings, a 1-day cross-sectional study was conducted among all hospitalized children ages 0 to 18 years in all 14 pediatric hospitals in the German-speaking part of Switzerland. Data collection involved a direct systematic inspection and assessment of the skin. A standardized data collection instrument was used, and each patient was assessed by a previously instructed rater pair. The total number of participating children was 412 (75% of all hospitalized children).
An overall PU prevalence of 35% (including European Pressure Ulcer Advisory Panel category 1 ulcers) was observed. Most patients with PUs (80%) had category 1 ulcers. The prevalence rate was highest among patients in the pediatric intensive care unit (PICU) (16/36, 44%), followed by the department of neonatology (47/109, 43%). The presence of a PU was significantly higher among patients with a medical device, who were young (<1 year old), had a longer length of stay, and low Braden scale score (P <0.05). Rates also varied by institution (P <0.05). Department, patient age, Braden scale score, and institution explained 25% of the variance in PU prevalence. The prevalence of PUs in pediatric patients is higher than expected, and the rate of category 1 PUs suggests that interventions to prevent PUs are needed, especially in the high-risk patients identified. Future studies are needed to further assess these risk factors, especially for patients in PICUs.
Keywords: pressure ulcer, prevalence, PICU, pediatric nursing
Potential Conflicts of Interest: none disclosed
A pressure ulcer (PU) is a localized injury to the skin and/or underlying tissue as a result of pressure or pressure in combination with shear forces.1 Although this care problem has gained a great deal of attention in adults, far less is known about PUs in children and neonates.2 Multimorbidity is limited to a small percentage of children only. Because survival rates of both critically and chronically ill infants and children have improved dramatically in recent years, new challenges for medical and nursing care have been introduced; one of these is an increase in PU risk.3 In a retrospective, exploratory study of 50 children by Samaniego,4 as well as in a systematic literature review aimed at identifying factors contributing to the development of PUs in pediatric patients by Cockett,5 several additional PU risk factors in children are described, including the use of additional medical and therapeutic aids, such as wheelchairs, unadjusted ortheses, and prostheses. The consequences of immobility and decreased skin sensitivity are described in a prospective study of 347 pediatric patients by Suddaby et al,6 as well as in a multicenter survey by Willock et al7 that included 54 children ages 0 to 18 years, conducted over 18 months. The latter study’s goal was to identify characteristics of children with PUs. In an earlier prevalence study by Schlüer et al8 in 155 pediatric patients, as well as in a prospective matched case-control study of 271 consecutive admission patients in a pediatric intensive care unit (PICU) setting by Zollo et al,9 risk factors related to equipment such as tubes, IV catheterization, and airway devices were described.