Predictive risk scales for development of pressure ulcers in pediatric patients admitted to general ward and intensive care unit

Abstract

BACKGROUND More than ten special scales are available to predict the risk of pressure ulcers inchildren. However, the performances of those scales have not yet been comparedin China.AIMTo compare the Waterlow, Braden Q, and Glamorgan scales, and identify moresuitable pressure ulcer evaluation scale for the pediatric intensive care unit(PICU).METHODS Trained nurses used the Waterlow, Braden Q, and Glamorgan scales to assesspediatric patients at Sun Yat-sen Memorial Hospital (China) within 24 h ofadmission from May 2017 to December 2020 in two stages. Skin examination wascarried out to identify pressure ulcers every 3 d for 3 wk.RESULTS The incidence of pressure ulcers was 3/28 (10.7%) in the PICU and 5/314 (1.6%) inthe general pediatric ward. For children in the general ward, the Waterlow,Braden Q, and Glamorgan scales had comparable area under the operatingcharacteristic curve (AUC) of 0.870, 0.924, and 0.923, respectively, and optimalcut-off values of 14, 14, and 29 points. For PICU, the Waterlow, Braden Q, andGlamorgan scales had slightly lower AUC of 0.833, 0.733, and 0.800, respectively,and optimal cut-off values of 13, 16, and 27 points. Braden Q demonstrated asatisfactory specificity, and during the second stage of the study for PICUpatients, the AUC of the Braden Q scale was 0.810, with an optimal cut-off valueof 18.35 points.CONCLUSION The Waterlow, Braden Q, and Glamorgan scales have comparable performance,while the Braden Q scale demonstrates a better specificity and can be successfullyused by pediatric nurses to identify patients at high risk of pressure ulcers in PICU.