Pediatric Pressure Ulcer Prevalence: A Multicenter, Cross-Sectional, Point Prevalence Study in Switzerland
- 1 Comments
- 4184 reads
The current study reveals a very high PU prevalence rate (35%) in the 14 pediatric hospitals. However, the prevalence rate of category 2 and higher PUs is only 3%. In particular, the age of the patients, the Braden risk score for PU development, and the institution in which the patients were hospitalized appear to be related to the development of PU.
In this study, the patients were assessed by a trained rater pair. From the good interrater reliability and data consistency in the pretest, one can assume the results presented are of sufficiently good quality. The prevalence rate of 35% is higher than previously found prevalence rates in worldwide pediatric care settings, which varied from 3% to 28%.8
The high prevalence rate demands critical appraisal. First, an already well-known problem is the diagnosis of category 1 pressure ulcers. This problem was first described in a study by Halfens et al.24 In a cross-sectional mail survey of coordinators of the Dutch National Pressure Ulcer Prevalence Survey in 1998, the authors distinguished several factors that have an impact on the assessment of PUs in institutions. One of these factors is the difficulty in diagnosing category 1 PUs. It should be noted that a category 1 PU can be misidentified because nurses might diagnose a blanchable erythema as a category 1 PU. This may lead to an overdiagnosis of PUs.26,27 Furthermore, according to the study by Halfens et al,24 most category 1 PUs are reversible. Therefore, several authors have recommended defining PU prevalence by starting the category system at category 2.26,27 The raters for this study were prepared and especially trained in diagnosing category 1 PUs. In the current study interrater pretest, 95% agreement was achieved, suggesting that findings are reliable. Also, even if category 1 PU is not defined as a PU, the presence of a category 1 PU can at least be considered the most important risk factor for PU,27 which subsequently can be interpreted for this study as meaning that a high percentage of pediatric patients are at high risk of developing PUs.
The prevalence of category 2 PUs and above accounts for 3% of the total. This is lower than the prevalence of PUs in the studies by Suddaby et al6 and Groene-veld et al16 (both 5.1%) and also lower than the PU prevalence in an earlier study by Schlüer et al8 (4.5%). In Groene-veld et al’s 2004 study,16 prevalence was assessed in 97 inpatients; prevalence among children was found to be 13.1% (including category 1). On the basis of Groene-veld et al’s16 and Schlüer et al’s8 results, one can conclude that while many patients are vulnerable to PU, the progression to a higher category occurs rather infrequently. Nevertheless, this implies that the diagnosis of a category 1 PU requires a related preventive intervention.
The data collection in all participating clinics took place on 1 day within the same time span from the morning (7:30 am) up to 3:00 pm in the afternoon. This is important insofar as it is known from adult patient populations that approximately 50% of all category 1 PUs disappear during the day, whereas approximately 22% of all category 1 PUs worsen during the day.24 No study related to this particular phenomenon has been undertaken so far for the pediatric setting.
The most widely affected patient group in this study involved very young patients in the PICU setting, who presented with mostly category 1 PUs. This is in line with results of Curley et al.13 The PU prevalence of nearly 45% in this patient group with 60% at risk is disconcerting and needs urgent attention. Patients in the NICU care setting had an overall prevalence of 43%.