Pediatric Pressure Ulcer Prevalence: A Multicenter, Cross-Sectional, Point Prevalence Study in Switzerland
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PU prevalence and patient characteristics. Of the 412 patients taking part in this study, a total of 142 had one or more PUs on the day of the study, a PU prevalence rate of 35%. Of these 142 patients, 77 (54%) had one, 35 (25%) had two, 17 (12%) had three, six had four (4%), two had five (2%), three had six (1%), one had nine, and one patient had 10 PUs. This yields a total number of 269 PUs (see Table 3).
The most frequent type of PU was a category 1 PU (121, 94%). Sixteen patients (16, 3%) had category 2 and higher, three had category 3, and two had category 4 where assessed. The three children with a category 3 PU were all 16 years of age with multiple diagnoses and treatment for orthopedic surgery. One category 3 PU had occurred within the last 2 weeks on the ward where the patient was hospitalized, while the two other category 3 PUs had existed for a longer time. These two category 3 PUs had existed for 3 to 6 months and had developed in another hospital before these patients were transferred to the clinic where they were assessed. The two children with a category 4 PU were 9 and 16 years of age. The younger child was being treated in the surgery department after a multiple trauma incident and had developed the category 4 PU within the previous 2 weeks, while the other patient was being treated for an orthopedic surgery indication. The PU in this patient had already existed for more than 1 year and had developed in another care setting.
The PU prevalence differed between the departments (X2: 13.8, df: 5, P = 0.002), with the highest PU prevalence (44%) seen among patients in PICU (see Table 3).
The prevalence of PUs for patients with an external device was 40% (see Table 3). By age category, the PU prevalence for patients <1 year of age was 43%, followed by 31% for patients >12 years of age. In terms of length of stay before measurement, patients with a PU had been in the hospital slightly longer than patients without a PU (P = 0.036) (see Table 3).
Within the group found to be at risk for PUs (ie, patients with a Braden Scale score ≤20), 93 patients presented with a PU (49%), whereas among patients not at risk 46 (24%) had a PU (X2: 26.4; df: 1; P <0.001). Classified by departments, the PU prevalence for patients at risk was 50% for a patient after a surgical intervention as well as for neonates, 46% for pediatric medical patients, 25% for patients in a rehabilitation setting, and 60% for patients in the PICU. Of all patients with at least one PU, 76% were assessed as being at risk (sensitivity 67%). The number of patients assessed as being at risk who did not have a PU (specificity) was 95 (40%).
PU influencing factors. The risk factors age, gender, surgery (ie, the patient had at least one surgical intervention during the present hospitalization), BMI, preventive intervention, Braden scale score, institution, and department were examined with a multiple logistic regression analysis. The factors department, age, Braden score, and institution contributed significantly to fit in the model. The Hosmer Lemeshow test showed an adequate goodness of fit for this model (Nagelkerke R2 = 0.248) (see Table 4). This means that those remaining four variables explain 25% of the variance when PUs are the dependent variable.