Skin integrity in critically ill and injured children.
BACKGROUND
Skin breakdown increases the cost of care, may lead to increased morbidity, and has negative psychosocial implications because of secondary scarring or alopecia. The scope of this problem has not been widely studied in critically ill and injured children.


OBJECTIVE
To determine the incidence of skin breakdown in critically ill and injured children and to compare the characteristics of patients who experience skin breakdown with those of patients who do not.


METHODS
Admission and follow-up data for a 15-week period were collected retrospectively on children admitted to a large pediatric intensive care unit. The incidence of skin breakdown was calculated. The risk for skin breakdown associated with potential risk factors (relative risk) and 95% confidence intervals were determined.


RESULTS
The sample consisted of 401 distinct stays in the intensive care unit for 373 patients. During the 401 stays, skin breakdown occurred in 34 (8.5%), redness in 25 (6.2%), and breakdown and redness in 13 (3.2%); the overall incidence was 18%. Patients who had skin breakdown or redness were younger, had longer stays, and were more likely to have respiratory illnesses and require mechanical ventilatory support than those who did not. Patients who had skin breakdown or redness had a higher risk of mortality than those who did not.


CONCLUSIONS
Risk factors for skin breakdown were similar to those previously reported. Compared with children of other ages, children 2 years or younger are at higher risk for skin breakdown.
Schindler
Christine A
CA
Division of Pediatric Critical Care, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee 53201-1997, USA. cschindl@mcw.edu
Mikhailov
Theresa A
TA
Fischer
Kay
K
Lukasiewicz
Gloria
G
Kuhn
Evelyn M
EM
Duncan
Linda
L
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005076:Exanthema / Q000451:nursing / Q000517:prevention & control; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000592:standards / Q000706:statistics & numerical data*; D009731:Nursing Audit; D010371:Pediatric Nursing / Q000592:standards*; D003668:Pressure Ulcer / Q000451:nursing / Q000517:prevention & control; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017592:Skin Care / Q000451:nursing / Q000592:standards*; D012883:Skin Ulcer / Q000451:nursing / Q000517:prevention & control; D014922:Wisconsin