title: SIRA+P: Development and Testing.
abstract: OBJECTIVE
  To describe the development of a new skin risk assessment scale called Skin Injury Risk Assessment and Prevention (SIRA+P) and to establish initial reliability and validity of the scale among patients ranging in age from birth, including pre-term, to adulthood, regardless of age or acuity of illness.
  
  
  METHODS
  The single-site study was a retrospective chart review to evaluate the measurement properties of SIRA+P. Charts of 385 patients of all ages and in all units (including the neonatal and pediatric intensive care units) of a free-standing children's hospital were included. Concurrent validity was assessed with scales having previously established reliability and validity. For subjects <30days of age, the comparison scale was the Neonatal Skin Risk Assessment Scale (NSRAS); for subjects 31days through 17years, the Braden Q Scale (Braden Q) was used; and for subjects 18years and older, the Braden Scale (Braden) was used. Interrater reliability was examined using Intraclass Correlation Coefficients (ICC). Concurrent validity procedures compared SIRA+P with NSRAS, Braden Q, and Braden using Pearson Correlation Coefficients.
  
  
  RESULTS
  Interrater reliability for SIRA+P was very high (0.878). SIRA+P strongly correlated with the NSRAS (0.725), the Braden Q (-0.634), and the Braden (-0.778).
  
  
  CONCLUSIONS
  SIRA+P is designed to be used within the EHR and includes nursing decision support to guide pressure injury prevention interventions for specific skin integrity risks. SIRA+P has good interrater reliability, is valid across all age groups and accounts for device-related pressure.
authors.affiliation: Lucile Packard Children's Hospital Stanford, 725 Welch Rd, Palo Alto, CA 94304, United States. Electronic address: fosterkristina@gmail.com.
authors.forename: Kristina L
authors.initials: KL
authors.lastname: Foster
authors.affiliation: Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States.
authors.forename: Lacey D
authors.initials: LD
authors.lastname: Bergerhofer
authors.affiliation: Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States.
authors.forename: Janis B
authors.initials: JB
authors.lastname: Smith
authors.affiliation: Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Fix
authors.affiliation: Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Olney
authors.affiliation: Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States.
authors.forename: Ashley
authors.initials: A
authors.lastname: Sherman
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009730:Nursing Assessment; D015588:Observer Variation; D010371:Pediatric Nursing / Q000458:organization & administration; D010808:Physical Examination / Q000379:methods; D003668:Pressure Ulcer / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D017678:Sex Distribution; D012867:Skin / Q000293:injuries*; D017592:Skin Care / Q000379:methods*
keywords: Decision support; Pressure injury; Pressure ulcer; Risk assessment; Skin injury