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

Table 1 Baseline demographic and clinical characteristics of the study participants (first stage of the study, May 2017-August 2017)

Characteristic	Intensive care unit (n = 28)	General pediatric ward (n = 314)
Age (mo)	78.3 ± 15.3	56.7 ± 19.4
Male, n	13 (46.4%)	197 (62.7%)
Waterlow scale score	10.9 ± 6.0	4.6 ± 2.7
Braden Q scale score	17.8 ± 4.3	24.6 ± 3.5
Glamorgan scale score	26.9 ± 5.6	7.5 ± 9.2
Patients with squeezing or rubbing of the skin, n	28 (100%)	57 (18.2%)
Patients with pain at admission, n	8 (28.6%)	11 (3.5%)
Patients with mechanical ventilation, n	19 (67.9%)	7 (2.3%)
Patients with blood tumor, n	18 (64.3%)	133 (42.4%)
Death, n	4 (14.2%)	1 (0.3%)

Data are presented as the mean ± SD.

Table 2 Baseline demographic and clinical characteristics of the study participants (second stage, from January 2018-2020)

Characteristic	Intensive care unit (n = 342)
Age (mo)	70.3 ± 49.8
Male, n	188 (55.0%)
Length of stay > 1 d ≤ 10 d, n	291 (85.0%)
Length of stay > 10 d, n	51 (14.9%)
Braden Q scale score	26.9 ± 5.6
Patients with blood tumor, n	210 (61.4%)
Patients with immune system diseases, n	30 (8.77%)
Patients with respiratory diseases, n	41 (12.0%)
Postoperative patients, n	48 (14.0%)
Other patients, n	13 (3.8%)
Pressure ulcer incidence, n	13 (3.8%)
Patients with mechanical ventilation, n	19 (67.9%)
Transfer out	281 (82.2%)
Leave hospital	39 (11.41%)
Death, n	22 (6.43%)

Table 3 Pressure ulcer incidence, stage, and location (first stage of the study, May 2017-August 2017)

Characteristic	Intensive care unit (n = 28)	General pediatric ward (n = 314)
Pressure ulcer incidence	3 (10.7%)	5 (1.6%)
NPUAP stage
Stage 1	1 (3.6%)	3 (1.0%)
Stage 2	2 (7.1%)	2 (0.6%)
Location of pressure ulcer
Scalp	1 (33.3%)	0
Nose	1 (33.3%)	0
Face	0	2 (40%)
Toe	0 (0%)	2 (40%)
Thumb	0	1 (20%)
Ankle	1 (33.3%)	0
Patients with mechanical ventilation, n	0 (0%)	5 (100%)

NPUAP: National Pressure Ulcer Advisory Panel.

Table 4 Pressure ulcer incidence, stage, and location (second stage of the study, January 2018-2020)

Characteristic	Intensive care unit (n = 13)
Pressure ulcer incidence, n	13 (3.8%)
Patients with mechanical ventilation, n	12 (92.3%)
Patients with blood tumor, n	7 (61.4%)
Postoperative patients, n	6 (14.0%)
NPUAP stage
Stage 1	9 (69.2%)
Stage 2	4 (30.8%)
Location of pressure ulcer
Occiput	3
Nose	3
Buttocks	2
Ear	1
Head	1
Cervix	1
Heel	1
Toe	1
Transfer out	11 (84.6%)
Leave hospital	1 (7.7%)
Death, n	1 (7.7%)

Table 5 Diagnosis, self-care ability score, nutrition score, and related information of patients with pressure ulcer (second stage of the study, from January 2018 to 2020)

Inpatient number	Sex (M/F)	Age (mo)	Weight (kg)	Main diagnosis	Other diagnosis	Time of staying in PICU (d)	Branden Q score	Barthel score	BMI score
1047089	F	60	18.5	Primary lymphoma of bone (stage IV)	After resection of left occipital tumor	4	14	10	18.5
1093493	F	60	21	T1-7 mixed intraspinal and extraspinal ganglioneuroblastoma (low risk)		2	13	10	20
632852	F	108	33	Severe aplastic anemia after hematopoietic stem cell transplantation	Intracranial hemorrhage; graft versus host disease	26	18	20	21.1
1116677	F	133	32	Left thalamic and intraventricular variant astrocytoma (WHO stage III)		6	15	10	15
1126874	F	6	6.5	Postoperative complications of resection of right skull base myofibroblastoma	Bronchopneumonia	15	13	10	15.4
1066251	M	144	25	Acute lymphoblastic leukemia after hematopoietic stem cell transplantation	Severe pneumonia; hyperacute graft versus host disease	19	18	25	11.3
831463	M	156	45	Cervical spinal cord injury	Multiple cervical fractures	40	13	10	15.9
829101	M	48	17.7	Severe aplastic anemia after hematopoietic stem cell transplantation	Acute graft versus host disease (stage IV)	42	10	10	18.1
850224	F	110	24	Postoperative complications of resection of ameloblastoma of left mandible		3	14	10	13.2
825633	M	36	10	Acute lymphoblastic leukemia after hematopoietic stem cell transplantation	Severe pneumonia; hyperacute graft versus host disease (stage IV)	11	16	10	11.8
868274	F	8	5	Postoperative complications of right submandibular gland cyst resection	Protein energy malnutrition	5	16	10	11.1
858433	F	121	25	Right mandible osteosarcoma after surgery and chemotherapy	Abnormal liver function	7	16	10	14.8
852006	M	24	12.4	Acute lymphoblastic leukemia after hematopoietic stem cell transplantation	Severe pneumonia; acute graft versus host disease	37	12	10	17.2

PICU: Pediatric intensive care unit; BMI: Body mass index; WHO: World Health Organization.

Table 6 Test results on the day of pressure ulcer diagnosis for pediatric intensive care unit patients (second stage of the study, from January 2018 to 2020)

Inpatient number	White blood cell count	Red blood cell count	Hemoglobin value	Platelet calculation	Blood pH value	CRP	D-Dimer (0-0.55)
1047089	2.92	3.09	88	594	7.314	9.3	4.1
1093493	12.11	3.65	114	227	7.401	< 5	1.35
632852	1.57	2.57	71	43	7.438	102.3	2.37
1116677	13.71	3.23	97	194	7.435	75.1	2.77
1126874	6.24	3.37	91	247	7.301	62	0.23
1066251	9.56	2.86	108	66	7.374	< 5	0.33
831463	9.56	2.86	108	66	7.385	< 5	0.33
829101	13.8	2.97	87	375	7.392	< 5	7.85
850224	9.66	2.48	75	28	7.331	57.9	2.59
825633	11.7	2.69	78	220	7.439	58.7	1.27
868274	5.68	3.63	101	67	7.441	18.3	7.8
858433	9.93	4.45	110	643	7.35	23.9	1.48
852006	5.61	2.88	89	239	7.402	72.2	2.65

CRP: C-reactive protein.

Table 7 Receiver operating characteristic curve analysis of abilities of Waterlow, Braden Q, and Glamorgan risk assessment scales to predict development of pressure ulcers in pediatric patients (first stage of the study, between May 2017 and August 2017)

Scale	AUC (95%CI)	Optimal cut-off	Sensitivity	Specificity	PPV	NPV
Intensive care unit
Waterlow	0.833 (0.653-1.000)	≤ 13	0.667	0.720	0.100	0.900
Braden Q	0.733 (0.508-0.959)	≤ 16	0.667	0.840	0.090	0.910
Glamorgan	0.800 (0.629-0.971)	≤ 27	0.667	0.720	0.100	0.900
General ward
Waterlow	0.870 (0.718-1.000)	≤ 14	0.600	0.990	0.010	0.990
Braden Q	0.924 (0.838-1.000)	≤ 14	0.600	0.980	0.010	0.990
Glamorgan	0.923 (0.839-1.000)	≤ 29	0.600	0.790	0.013	0.987

95%CI: 95% confidence interval; AUC: Area under the receiver operating characteristic curve; NPV: Negative predictive value; PPV: Positive predictive value.

Table 8 Score of each item of Branden Q score for pediatric intensive care unit patients (second stage of the study, from January 2018 to 2020)

Inpatient number	Mobility	Activity	Sensory perception	Moisture	Friction-shear	Nutrition	Tissue perfusion and oxygenation	Total score
1047089	1	1	1	3	2	2	4	14
1093493	1	1	1	3	2	1	4	13
632852	3	1	4	4	3	1	2	18
1116677	1	1	1	4	2	2	4	15
1126874	1	1	2	3	1	2	3	13
1066251	3	1	4	4	2	2	2	18
831463	1	1	1	4	2	2	3	13
829101	2	1	3	4	1	1	2	10
850224	1	1	1	4	2	2	3	14
825633	3	1	3	2	3	1	3	16
868274	1	1	3	2	3	2	4	16
858433	1	1	1	4	3	3	3	16
852006	1	1	1	4	2	1	2	12