Validation and clinical impact of paediatric pressure ulcer risk assessment scales: A systematic review

BackgroundPressure ulcer risk assessment using an age-appropriate, valid and reliable tool is recommended for clinical paediatric practice.Objectives(1) What PU risk scales for children currently exist? (2) What is the diagnostic accuracy of their scores? (3) Are the scores reliable and what is the degree of agreement? (4) What is the clinical impact of risk scale scores in paediatric practice?DesignSystematic review.Data sourcesMEDLINE (1950 to December 2010), EMBASE (1989 to December 2010), CINAHL (1982 to December 2010), reference lists.Review methodsTwo reviewers independently screened databases, selected and evaluated articles and studies. Diagnostic accuracy, reliability/agreement, and experimental studies investigating the performance and clinical impact of PU risk scale scores in the paediatric population (0–18 years) were included. PU development was used as reference standard for diagnostic accuracy studies. Methodological quality of the validity and reliability studies was assessed based on the QUADAS and QAREL checklists.ResultsThe search yielded 1141 hints. Finally, 15 publications describing or applying 12 paediatric pressure ulcer risk scales were included. Three of these scales (Neonatal Skin Risk Assessment Scale for Predicting Skin Breakdown, Braden Q Scale, Burn Pressure Skin Risk Assessment Scale) were investigated in prospective validation studies. Empirical evidence about interrater reliability and agreement is available for four instruments (Neonatal Skin Risk Assessment Scale for Predicting Skin Breakdown, Starkid Skin Scale, Glamorgan Scale, Burn Pressure Ulcer Risk Assessment Scale). No studies were identified investigating the clinical impact.ConclusionsSound empirical evidence about the performance of paediatric pressure ulcer risk assessment scales is lacking. Based on the few results of this review no instrument can be regarded as superior to the others. Whether the application of pressure ulcer risk assessment scales reduces the pressure ulcer incidence in paediatric practice is unknown. Maybe clinical judgement is more efficient in evaluating pressure ulcer risk than the application of risk scale scores.