Vol. 3 No. 4 (2024): caring for nurses
Articles

Risk Factors for Skin Injuries in Hospitalized Children: a Retrospective Study

PDF
  • Biagio Nicolosi,
  • Eustachio Parente,
  • Irene Fontani,
  • Sabina Idrizaj,
  • Daiana Stringi,
  • Claudia Bamonte,
  • Yari Longobucco,
  • Emanuele Buccione,
  • Marina Maffeo,
  • Valentina Granai,
  • Mirco Gregorini,
  • Daniele Ciofi
Biagio Nicolosi
Department of Health Care Professions, Meyer Children’s Hospital IRCCS, Florence, Italy
Eustachio Parente
Department of Health Care Professions, Meyer Children’s Hospital IRCCS, Florence, Italy
Irene Fontani
School of Human Health Science. University of Florence, Florence, Italy
Sabina Idrizaj
School of Human Health Science. University of Florence, Florence, Italy
Daiana Stringi
School of Human Health Science. University of Florence, Florence, Italy
Claudia Bamonte
Emergency and Traumatic Intensive and Sub-intensive Care Unit, University Hospital of Careggi, Florence, Italy
Yari Longobucco
Department of Health Sciences, University of Florence, Florence, Italy
Emanuele Buccione
Local Health Authority of Pescara, Pescara, Italy; Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
Marina Maffeo
Pediatric Intensive Care Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
Valentina Granai
Pediatric Intensive Care Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
Mirco Gregorini
Department of Health Care Professions, Meyer Children’s Hospital IRCCS, Florence, Italy
Daniele Ciofi
Department of Health Care Professions, Meyer Children’s Hospital IRCCS, Florence, Italy
DOI: https://doi.org/10.36253/if-3159

Published 2024-12-31

Keywords

  • Pediatric Skin Injuries,
  • Hospitalization,
  • Risk Factors,
  • Pressure Injuries,
  • Comorbidities,
  • Medical Devices
    • ...More
    Less

Copyright (c) 2024 Biagio Nicolosi, Eustachio Parente, Irene Fontani, Sabina Idrizaj, Daiana Stringi, Claudia Bamonte, Yari Longobucco, Emanuele Buccione, Marina Maffeo, Valentina Granai, Mirco Gregorini, Daniele Ciofi

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Background. Skin injuries in hospitalized pediatric patients can slow recovery, increase infection risk, pain, stress, length of stay, and healthcare costs, while reducing family quality of life. The prevalence and incidence of these injuries vary by environment, comorbidities, and specific pathologies.

Objective. To identify the main risk factors related to skin lesions in hospitalized children

Methods. This retrospective, observational, monocentric study aims to identify the main risk factors for skin injuries in hospitalized children.

Results. A study of 880 hospitalized children aged 0-17 from January 2019 to December 2020 found that 133 developed skin injuries. Factors increasing risk included longer hospital stays, comorbidities, forced bed rest, and the number of medical devices. Each additional hospitalization day and lower weight raised the risk. Continence was protective. Injuries mainly affected the perineum, upper limbs, face, lower limbs, abdomen, and occiput. These findings emphasize the need for tailored prevention strategies for pediatric patients due to their unique characteristics.

Conclusions. This study underscores the need for further research to develop effective prevention protocols specifically for pediatric populations, emphasizing the role of comprehensive risk factor assessment and resource allocation to mitigate skin injury risks in hospitalized children.

PDF

References

  1. Dealey C. Skin care and pressure ulcers. Adv Skin Wound Care. 2009;22(9):421–8; quiz 429–30.
  2. Kim HK, Kim Y, Son HM. [Characteristics Influencing the Occurrence of Respiratory Medical Device-related Pressure Ulcers in the Pediatric Intensive Care Unit]. Child Health Nurs Res. 2019;25(2):133–42.
  3. Chung SC, Mueller S, Green K, Chang WH, Hargrave D, Lai AG. Multimorbidity patterns and risk of hospitalisation in children: A population cohort study of 3.6 million children in England, with illustrative examples from childhood cancer survivors. Lancet Reg Health Eur. 2022;20:100433.
  4. Schlüer AB, Schols JMGA, Halfens RJG. Risk and associated factors of pressure ulcers in hospitalized children over 1 year of age. J Spec Pediatr Nurs. 2014;19(1):80–9.
  5. Nie AM, Johnson D, Reed RC. Neonatal Skin Structure: Pressure Injury Staging Challenges. Adv Skin Wound Care. 2022;35(3):149–54.
  6. Oranges T, Dini V, Romanelli M. Skin Physiology of the Neonate and Infant: Clinical Implications. Adv Wound Care (New Rochelle). 2015;4(10):587–95.
  7. Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, et al. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care. 2022;31(Sup3a):S1–72.
  8. Visscher MO. Update on the Use of Topical Agents in Neonates. Newborn Infant Nurs Rev. 2009;9(1):31–47.
  9. Beeckman D, Van Damme N, Schoonhoven L, Van Lancker A, Kottner J, Beele H, et al. Interventions for preventing and treating incontinence-associated dermatitis in adults. Cochrane Database Syst Rev. 2016;11(11):CD011627.
  10. Allaway R, Gardiner C, Hanson J, Murphy J, Sharma A, Rodgers A, et al. BEST PRACTICE STATEMENT: PRINCIPLES OF WOUND MANAGEMENT IN PAEDIATRIC PATIENTS (SECOND EDITION).
  11. Sánchez-Lorente MM, Sanchis-Sánchez E, García-Molina P, Balaguer-López E, Blasco JM. Prevalence of pressure ulcers in the paediatric population and in primary health care: An epidemiological study conducted in Spain. J Tissue Viability. 2018;27(4):221–5.
  12. Agenzia regionale di sanità della Toscana. (2018). Accessi in pronto soccorso e ricoveri pediatrici. Anno 2016. Serie In cifre - N. 14. Firenze: ARS Toscana. Available on: www.ars.toscana.it.
  13. Fujii K, Sugama J, Okuwa M, Sanada H, Mizokami Y. Incidence and risk factors of pressure ulcers in seven neonatal intensive care units in Japan: a multisite prospective cohort study. Int Wound J. 2010;7(5):323–8.
  14. Fischer C, Bertelle V, Hohlfeld J, Forcada-Guex M, Stadelmann-Diaw C, Tolsa JF. Nasal trauma due to continuous positive airway pressure in neonates. Arch Dis Child Fetal Neonatal Ed. 2010;95(6):F447-451.
  15. García-Molina P, Balaguer-López E, García-Fernández FP, Ferrera-Fernández M de LÁ, Blasco JM, Verdú J. Pressure ulcers’ incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units. Int Wound J. 2018;15(4):571–9.
  16. McCord S, McElvain V, Sachdeva R, Schwartz P, Jefferson LS. Risk factors associated with pressure ulcers in the pediatric intensive care unit. J Wound Ostomy Continence Nurs. 2004;31(4):179–83.
  17. Schlüer AB, Schols JMGA, Halfens RJG. Risk and associated factors of pressure ulcers in hospitalized children over 1 year of age. J Spec Pediatr Nurs. 2014;19(1):80–9.
  18. Cockett A. A research review to identify the factors contributing to the development of pressure ulcers in paediatric patients. J Tissue Viability. 2002;12(1):16–7, 20–3.
  19. García-Molina P, Balaguer-López E, García-Fernández FP, Ferrera-Fernández M de los Á, Blasco JM, Verdú J. Pressure ulcers’ incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units. Int Wound J. 2018;15(4):571–9.
  20. Makori OLS, Olayo R, Wamukoya EK. Intrinsic and Extrinsic Risk Factors for Nosocomial Pressure Injury among Hospitalized Adults at a Tertiary Hospital in Western Kenya. African J Empir Res. 2023.
  21. Alipoor E, Mehrdadi P, Yaseri M, Hosseinzadeh-Attar MJ. Association of overweight and obesity with the prevalence and incidence of pressure ulcers: A systematic review and meta-analysis. Clin Nutr. 2021;40(9):5089–98.
  22. Hyun S, Li X, Vermillion B, Newton C, Fall M, Kaewprag P, et al. Body Mass Index and Pressure Ulcers: Improved Predictability of Pressure Ulcers in Intensive Care Patients. Am J Crit Care. 2014;23(6):494–501.
  23. VanGilder C, MacFarlane G, Meyer S, Lachenbruch C. Body mass index, weight, and pressure ulcer prevalence: an analysis of the 2006-2007 International Pressure Ulcer Prevalence Surveys. J Nurs Care Qual. 2009;24(2):127–35.
  24. Tschannen D, Bates O, Talsma A, Guo Y. Patient-specific and surgical characteristics in the development of pressure ulcers. Am J Crit Care. 2012;21(2):116–25.
  25. Lindgren M, Unosson M, Fredrikson M, Ek AC. Immobility–a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study. Scand J Caring Sci. 2004;18(1):57–64.
  26. Jaul E, Barron J, Rosenzweig JP, Menczel J. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatr. 2018;18:305.
  27. Schlüer AB, Halfens RJ, Schols JMGA. Pediatric pressure ulcer prevalence: a multicenter, cross-sectional, point prevalence study in Switzerland. Ostomy Wound Manage. 2012;58(7):18–31.
  28. Anders J, Heinemann A, Leffmann C, Leutenegger M, Pröfener F, von Renteln-Kruse W. Decubitus Ulcers: Pathophysiology and Primary Prevention. Dtsch Arztebl Int. 2010;107(21):371–82.
  29. Moore ZE, Cowman S. Repositioning for treating pressure ulcers. Cochrane Database Syst Rev. 2009;(2):CD006898.
  30. Moore ZEH, Cowman S. Repositioning for treating pressure ulcers. Cochrane Database Syst Rev. 2015;1(1):CD006898.
  31. Baharestani MM, Ratliff CR. Pressure ulcers in neonates and children: an NPUAP white paper. Adv Skin Wound Care. 2007;20(4):208, 210, 212, 214, 216, 218–20.
  32. Willock J, Anthony D, Richardson J. Inter-rater reliability of Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale. Paediatr Nurs. 2008;20(7):14–9.
  33. Tomova-Simitchieva T, Akdeniz M, Blume-Peytavi U, Lahmann N, Kottner J. [The Epidemiology of Pressure Ulcer in Germany: Systematic Review]. Gesundheitswesen. 2019;81(6):505–12.
  34. Kottner J, Wilborn D, Dassen T. Frequency of pressure ulcers in the paediatric population: A literature review and new empirical data. Int J Nurs Stud. 2010;47(10):1330–40.
  35. García-Fernández FP, Soldevilla Agreda JJ, Pancorbo-Hidalgo PL, Verdu-Soriano J, López Casanova P, Rodríguez-Palma M. Classification of dependence-related skin lesions: a new proposal. J Wound Care. 2016;25(1):26–32.
  36. Berke CT. Pathology and clinical presentation of friction injuries: case series and literature review. J Wound Ostomy Continence Nurs. 2015;42(1):47–61.
  37. Mahoney M, Rozenboom B, Doughty D. Challenges in classification of gluteal cleft and buttocks wounds: consensus session reports. J Wound Ostomy Continence Nurs. 2013;40(3):239–45.
  38. Shoham N, Gefen A. Mechanotransduction in adipocytes. J Biomech. 2012;45(1):1–8.
  39. Kottner J, Dobos G, Andruck A, Trojahn C, Apelt J, Wehrmeyer H, et al. Skin response to sustained loading: A clinical explorative study. J Tissue Viability. 2015;24(3):114–22.
  40. Coleman S, Gorecki C, Nelson EA, Closs SJ, Defloor T, Halfens R, et al. Patient risk factors for pressure ulcer development: Systematic review. Int J Nurs Stud. 2013;50(7):974–1003.
  41. Visscher M, Odio M, Taylor T, White T, Sargent S, Sluder L, et al. Skin care in the NICU patient: effects of wipes versus cloth and water on stratum corneum integrity. Neonatology. 2009;96(4):226–34.
  42. Nikolovski J, Stamatas GN, Kollias N, Wiegand BC. Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. J Invest Dermatol. 2008;128(7):1728–36.
  43. Visscher MO, Chatterjee R, Munson KA, Pickens WL, Hoath SB. Changes in diapered and nondiapered infant skin over the first month of life. Pediatr Dermatol. 2000;17(1):45–51.
  44. Eichenfield LF, Hardaway CA. Neonatal dermatology. Curr Opin Pediatr. 1999;11(5):471–4.
  45. Kottner J, Black J, Call E, Gefen A, Santamaria N. Microclimate: A critical review in the context of pressure ulcer prevention. Clin Biomech (Bristol, Avon). 2018;59:62–70.
  46. Visscher M, Taylor T. Pressure ulcers in the hospitalized neonate: rates and risk factors. Sci Rep. 2014;4:7429.
  47. Gorecki C, Nixon J, Madill A, Firth J, Brown JM. What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors. J Tissue Viability. 2012;21(1):3–12.
  48. Schubart J. An e-learning program to prevent pressure ulcers in adults with spinal cord injury: a pre- and post- pilot test among rehabilitation patients following discharge to home. Ostomy Wound Manage. 2012;58(10):38–49.