Skin breakdown in acute care pediatrics.
OBJECTIVE
To develop a simple, single-page measurement tool that evaluates risk of skin breakdown in the pediatric population and apply it to the acutely hospitalized child.


METHODS
Data were collected over a 15-month period from 347 patients on four in-patient units (PICU, medical-surgical, oncology, and adolescents) on skin breakdown using the AHCPR staging guidelines and compared to the total score on the Starkid SkinScale in order to determine its ability to predict skin breakdown.


RESULTS
The inter-rater reliability of the Starkid Skin Scale was r2 = 0.85 with an internal reliablity of 0.71. The sensitivity of the total score was low (17.5%) but highly specific (98.5%). The prevalence of skin breakdown in the acutely hospitalized child was 23%, the majority (77.5%) occurring as erythema of the skin. Buttocks, perineum, and occiput were the most common locations of breakdown. Occiput breakdown was more common in critically ill (PICU) patients while diaper dermatitis was more common in the general medical-surgical population.


CONCLUSIONS
The Starkid Skin Scale may be useful to pediatric nurses in assessing which patients require intensive prevention measures. Further research is needed as to which of these specific techniques are effective in the prevention of skin breakdown in children.
Suddaby
Elizabeth C
EC
Inova Fairfax Hospital for Children, Falls Church, VA, USA.
Barnett
Scott
S
Facteau
Lorna
L
D000208:Acute Disease; D000293:Adolescent; D001835:Body Weight; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D016015:Logistic Models; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D015403:Nursing Evaluation Research; D015588:Observer Variation; D010371:Pediatric Nursing / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017592:Skin Care / Q000379:methods / Q000451:nursing