A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominance, as a result of pressure, or pressure in combination with shear and/or friction. Pressure ulcer risk assessment scales are used to identify patient risk, level of risk and type of risk. Most paediatric pressure ulcer risk assessment scales have been derived either from adult risk assessment scales, clinical observation or literature review. Detailed questionnaires were developed based on a review of pressure ulcer literature and discussion with experienced paediatric nurses. These were used to collect detailed data on the characteristics of 336 children (61 with pressure ulcers, 275 without pressure ulcers) who were inpatients in 11 hospitals in England and Wales. Using chi-square analysis, the significance of the children's characteristics in relation to the presence of pressure ulceration was calculated. Eleven patient characteristics had a significant level of pandlt;0.01. A paediatric pressure ulcer risk assessment scale (the Glamorgan Scale) was developed using the results of the analysis. Weightings for risk characteristics were devised using the signifiance values as a guide. Using the same data set, the sensitivity and specificity of the Glamorgan scale were calculated to be 98.4% sensitive and 67.4% specific at a cut off score of 15. With this data set, the Glamorgan scale was demonstrated to out perform the Braden Q scale paediatric pressure ulcer risk assessment scale. However, more work needs to be done with a new data set. The inter-rater reliability of the Glamorgan scale also needs to be determined.
- pressure ulcer
- risk assessment
- receiver operating characteristics