Pressure ulcers in pediatric intensive care: incidence and associated factors.
OBJECTIVE
To describe the incidence, location, and factors associated with the development of pressure ulcers in patients cared for in the pediatric intensive care unit (PICU).


METHODS
Multisite prospective cohort study.


METHODS
Three PICUs contained within freestanding children's hospitals.


METHODS
A total of 322 patients, 21 days to 8 yrs of age, on bed rest in the PICU for at least 24 hrs without preexisting pressure ulcers or congenital heart disease.


METHODS
Patients were observed up to three times a week for 2 wks, then once a week until PICU discharge for a median of two observation periods (interquartile range, 1-4), reflecting 877 skin assessments. Skin assessments were independently rated, and data collectors were blinded to the assessments of the others.


RESULTS
Pressure ulcers were staged according to the American National Pressure Ulcer Advisory Panel Consensus Development Conference recommendations. Eighty-six patients (27%) developed 199 pressure ulcers; 139 (70%) were Stage I, 54 (27%) were Stage II, and 6 (3%) were Stage III. Of the 60 Stage II/III pressure ulcers, 19 (32%) involved the head. Stage III pressure ulcers involved the occiput, ear, chest, and coccyx. An additional 27 pressure-related injuries were caused by medical devices. Statistically significant Stage I pressure ulcer predictor variables include the use of mechanical ventilation, mean arterial pressures < or =50 mm Hg, and lower Braden Q scores.


CONCLUSIONS
PICU patients at risk include those supported on mechanical ventilation, those with hypotension, and those who have low Braden Q scores. This study provides unique benchmark data for the general PICU population from which pediatric interventional studies can be designed to reduce the incidence of pressure ulcers in this vulnerable patient population.
Curley
Martha A Q
MA
Critical Care and Cardiovascular Program, Children's Hospital of Boston, Newton Centre, MA, USA.
Quigley
Sandy M
SM
Lin
Ming
M
D000367:Age Factors; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003625:Data Collection; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors