Predicting Pressure Ulcer Risk in Pediatric Patients
- 1 January 2003
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Nursing Research
- Vol. 52 (1), 22-33
- https://doi.org/10.1097/00006199-200301000-00004
Abstract
While there are valid and reliable pressure ulcer risk assessment tools available for adult patients, none exist for infants and children. To remedy this, the Braden Scale was adapted for use in pediatrics, calling it the Braden Q Scale. The purpose of this study was to: (a) establish the predictive validity of the Braden Q Scale in an acutely ill pediatric population; (b) determine the critical cutoff point for classifying patient risk; and (c) determine the best time to assess patient risk. A multisite prospective cohort descriptive study with a convenience sample of 322 patients on bedrest for at least 24 hours without pre-existing pressure ulcers or congenital heart disease were enrolled from three pediatric intensive care units (PICU). The Braden Q score and skin assessment were independently rated and data collectors were blind to the other measures. Patients were observed up to 3 times per week for 2 weeks and then once a week until PICU discharge for a median of 2 observations reflecting 887 skin assessments. Eighty-six patients (27%) developed 199 pressure ulcers; 139 (70%) were Stage I pressure ulcers, 54 (27%) were Stage II pressure ulcers, and 6 (3%) were Stage III pressure ulcers. Most pressure ulcers (57%) were present at the first observation. Using Stage II+ pressure ulcer data obtained during the first observation, a Receiver Operator Characteristic (ROC) curve for each possible score of the Braden Q Scale was constructed. The area under the curve (AUC) was 0.83. At a cutoff score of 16, the sensitivity was 0.88 and the specificity was 0.58. The Braden Q Scale was then modified to eliminate 4 subscales with an AUC <0.7. With 3 subscales (mobility, sensory perception, tissue perfusion/oxygenation) the AUC of this Modified Braden Q Scale was maintained at 0.84. At a cutoff score of 7, the sensitivity was 0.92 and the specificity was 0.59. The performance of the Braden Q Scale in a pediatric population is similar to that consistently reported for the Braden Scale in adult patients. The Modified Braden Q Scale, with 3 subscales, provides a shorter yet comparable tool.Keywords
This publication has 13 references indexed in Scilit:
- The 1999 National Pressure Ulcer Prevalence Survey: A Benchmarking ApproachAdvances in Skin & Wound Care, 2001
- Predicting Pressure Ulcer RiskNursing Research, 1998
- The pediatric risk of mortality III— Acute physiology score (PRISM III-APS): A method of assessing physiologic instability for pediatric intensive care unit patientsThe Journal of Pediatrics, 1997
- The Neonatal Skin Risk Assessment Scale for Predicting Skin Breakdown in NeonatesIssues in Comprehensive Pediatric Nursing, 1997
- PRISM IIICritical Care Medicine, 1996
- Practice guidelines for the prediction and prevention of pressure ulcers: evaluating the evidenceApplied Nursing Research, 1996
- Predictive validity of the braden scale for pressure sore risk in a nursing home populationResearch in Nursing & Health, 1994
- The development of a pressure area scoring system for critically ill patients: a pilot studyIntensive and Critical Care Nursing, 1993
- Assessing the outcome of pediatric intensive careThe Journal of Pediatrics, 1992
- A Conceptual Schema for the Study of the Etiology of Pressure SoresRehabilitation Nursing Journal, 1987