The 2003 National Pediatric Pressure Ulcer and Skin Breakdown Prevalence Survey: A Multisite Study

Abstract

OBJECTIVE: The purpose of this study was to document the prevalence of pressure ulcers and other types of skin breakdown in hospitalized children. DESIGN: This descriptive study included documentation of findings from chart reviews and physical assessments of children. SETTING AND SUBJECTS: Nine children's hospitals from throughout the United States participated for a total sample of 1064 children. Subjects were inpatients in the children's hospitals between the ages of neonate to 17 years. INSTRUMENTS: The data collection tools included the interrater reliability quiz, the patient data collection form, FAST data collection software, the Braden Q Risk Assessment Scale, and the Neonatal/Infant Braden Q Risk Assessment Scale. METHODS: Prevalence of pressure ulcers and skin breakdown was measured on a predetermined day during an 8-hour period at each institution. Eight hospitals required a signed informed consent before study participation; 1 hospital's institutional review board waived consent. A physical skin assessment was done on each inpatient, and all pressure ulcers found were staged according to the National Pressure Ulcer Advisory Panel staging system. A chart review was done on all subjects to collect information on patient demographics and potential risk factors. The Neonatal/Infant Braden Q Risk Assessment was scored for infants younger than 1 year old, and the Braden Q Risk Assessment for children 1 year and older. Patient data collection forms were completed, and all data were entered into the FAST data collection software at the end of the study day. Analyses of data and reports were generated from a central site. RESULTS: There were 1,064 children surveyed, with a pressure ulcer prevalence of 4.0% and other skin breakdown prevalence of 14.8%. Ninety-two percent of the pressure ulcers were partial thickness, Stages I and II. Sixty-six percent of the pressure ulcers were facility associated. Locations of pressure ulcers were predominately in the head area 31%, seat area 20%, and foot area 19%. The 3 most common types of skin breakdown were excoriation/diaper dermatitis, skin tear, and IV extravasation. Predominant locations for skin breakdown were seat area 35%, foot area 20%, and upper extremities 18%. CONCLUSIONS: The prevalence of pressure ulcers was low in the pediatric population studied, but skin breakdown prevalence (excluding pressure ulcers) was higher, with 74% of all wound types consisting of excoriation/diaper dermatitis, skin tears, and IV extravasation sites. Future studies are needed to evaluate prevention and treatment options for pressure ulcers and skin breakdown in this population. Repeating this multisite study at intervals may be beneficial to continue to build and modify the benchmark data.