Prevalence, incidence, length of stay and cost of healthcare-acquired pressure ulcers in pediatric populations: A systematic review and meta-analysis

Triantafyllou, Christos; Chorianopoulou, Evangelia; Kourkouni, Εleni; Zaoutis, Theoklis E.; Kourlaba, Georgia

doi:10.1016/j.ijnurstu.2020.103843

Cited by 31 publications

(31 citation statements)

References 35 publications

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“…Despite increased attention over the past 20 years, formalised in international and national safety and quality health service standards [4][5][6][7], the prevalence of PU in Portugal has largely remained unchanged, while the associated costs of care continue to grow [8,9]. Reducing PU prevalence is a complex issue, requiring interventions that include education, evidence-based practice, enthusiastic implementation and auditing, resources, and multidisciplinary team involvement.…”

Section: Introductionmentioning

confidence: 99%

Content Validity and Reliability of the Pressure Ulcer Knowledge Test and the Knowledge Level of Portuguese Nurses at Long-Term Care Units: A Cross-Sectional Survey

Furtado

Lopes

Afonso

et al. 2022

JCM

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(1) Background: Improvement in pressure ulcer care depends both on the dissemination of knowledge and its implementation. This study aims to translate the Pressure Ulcer Knowledge Test into Portuguese from Portugal and evaluate the internal consistency of the questionnaire. The second aim is to assess nurses’ pressure ulcer knowledge level. (2) Methods: The Pressure Ulcer Knowledge Test was translated into Portuguese, and the translated test’s internal consistency and content validity were assessed. Further, the authors conducted a cross-sectional survey using the test among 221 nurses working in long-term care units. (3) Results: The Cronbach’s alpha internal coefficient of reliability recorded for the 47 items was 0.738, which is higher than the minimum acceptable level of 0.7. The Cronbach’s alpha for the subscales was 0.709 for prevention/risk and less than 0.5 for staging and wound description. Only two of the 221 nurses achieved a score of 90% correct answers or more. The nurses scored lower in questions related to prevention/risk (Me = 67.4%, IQR = 60.6–75.8% vs. staging: ME = 85.7%, IQR = 71.4–85.7%, description: ME = 85.7%, IQR = 71.4–85.7%, p < 0.001). (4) Conclusion: The internal consistency of the instrument was acceptable. The instrument can accurately measure Portuguese nurses’ knowledge of pressure ulcers, and its information can help improve education and implementation of best practices.

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Section: Introductionmentioning

confidence: 99%

Content Validity and Reliability of the Pressure Ulcer Knowledge Test and the Knowledge Level of Portuguese Nurses at Long-Term Care Units: A Cross-Sectional Survey

Furtado

Lopes

Afonso

et al. 2022

JCM

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“…PIs are often correlated with advanced age and many studies concerning adult populations identified age as a factor increasing PI prevalence (Amlung, Miller & Bosley, 2001;Manzano et al, 2010;Cox, 2011;Nassaji, Askari & Ghorbani, 2014;O'Brien et al, 2014;Tayyib, Coler & Lewis, 2016;Labeau et al, 2021). Fewer data are available for the paediatric population (Bernabe, 2012;Luton et al, 2017;Triantafyllou et al, 2021) and they show highly variable results depending on the study (Jackson et al, 2019;Triantafyllou et al, 2021), although some data suggest that PI prevalence is age dependent with the observed prevalence higher for the youngest children. For example, Fujii et al (2010) reported a prevalence of 16% for children under 1 month old, also called newborns or neonates according to the National Library of Medicine, versus 2.5% for all ages in Japanese hospitals.…”

Section: Introductionmentioning

confidence: 99%

“…For example, Fujii et al (2010) reported a prevalence of 16% for children under 1 month old, also called newborns or neonates according to the National Library of Medicine, versus 2.5% for all ages in Japanese hospitals. Schlüer, Halfens & Schols (2012) found in paediatric ICUs (PICUs) a prevalence of 43% for children under 1 year old, also called infants, versus 31% for children of more than 12 years and Triantafyllou et al (2021) reported an estimated pooled prevalence of 27% among neonates, 19.2% among infants and 12.3% for children older than 1 year. In neonatal ICUs (NICUs), incidence and severity are inversely proportional to birth weight and gestational age (Fischer et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Newborn and elderly skin: two fragile skins at higher risk of pressure injury

Bengy¹,

Lamartine

Sigaudo‐Roussel

et al. 2021

Biological Reviews

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Skin is a key organ maintaining internal homeostasis by performing many functions such as water loss prevention, body temperature regulation and protection from noxious substance absorption, microorganism intrusion and physical trauma. Skin ageing has been well studied and it is well known that physiological changes in the elderly result in higher skin fragility favouring the onset of skin diseases. For example, prolonged and/or high‐intensity pressure may suppress local blood flow more easily, disturbing cell metabolism and inducing pressure injury (PI) formation. Pressure injuries (PIs) represent a significant problem worldwide and their prevalence remains too high. A higher PI prevalence is correlated with an elderly population. Newborn skin evolution has been less studied, but some data also report a higher PI prevalence in this population compared to older children, and several authors also consider this skin as physiologically fragile. In this review, we compare the characteristics of newborn and elderly skin in order to determine common features that may explain their fragility, especially regarding PI risk. We show that, despite differences in appearance, they share many common features leading to higher fragility to shear and pressure forces, not only at the structural level but also at the cellular and molecular level and in terms of physiology. Both newborn and elderly skin have: (i) a thinner epidermis; (ii) a thinner dermis containing a less‐resistant collagen network, a higher collagen III:collagen I ratio and less elastin; (iii) a flatter dermal–epidermal junction (DEJ) with lower anchoring systems; and (iv) a thinner hypodermis, resulting in lower mechanical resistance to skin damage when pressure or shear forces are applied. At the molecular level, reduced expression of transforming growth factor β (TGFβ) and its receptor TGFβ receptor II (TβRII) is involved in the decreased production and/or increased degradation of various dermal extracellular matrix (ECM) components. Epidermal fragility also involves a higher skin pH which decreases the activity of key enzymes inducing ceramide deficiency and reduced barrier protection. This seems to be correlated with higher PI prevalence in some situations. Some data also suggest that stratum corneum (SC) dryness, which may disturb cell metabolism, also increases the risk of PI formation. Besides this structural fragility, several skin functions are also less efficient. Low applied pressures induce skin vessel vasodilation via a mechanism called pressure‐induced vasodilation (PIV). Individuals lacking a normal PIV response show an early decrease in cutaneous blood flow in response to the application of very low pressures, reflecting vascular fragility of the skin that increases the risk of ulceration. Due to changes in endothelial function, skin PIV ability decreases during skin ageing, putting it at higher risk of PI formation. In newborns, some data lead us to hypothesize that the nitric oxide (NO) pathway is not fully functional at birth, which m...

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“…Standard treatments for PI cost approximately $10,100–$10,708 (Mervis & Phillips, 2019; Padula & Delarmente, 2019), while preventative interventions have been analyzed to cost $7300 (Mervis & Phillips, 2019). A systematic review reported attributable costs ranged from $894.69 to $ 98,730.24 per patient with hospital‐acquired pressure ulcers (Triantafyllou et al, 2021). Therefore, a focus on PI prevention rather than treatment would be more important.…”

Section: Introductionmentioning

confidence: 99%

Effects of alternating pressure air mattresses on pressure injury prevention: A systematic review of randomized controlled trials

Kim

et al. 2022

Worldviews Ev Based Nurs

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Background Pressure injury (PI) is a significant health problem among inpatients that affects their health, quality of life, and expenses. Aim This systematic review aimed to compare effects of alternating pressure air mattresses (APMs) with other types of supporting surfaces as a tool for PI prevention. Methods The literature published between 2009 and 2020 was searched using the databases PubMed, EMBASE, CINAHL, and Cochrane. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses process was followed, including independent study selection and data extraction. Quality appraisal was conducted using the Cochrane Risk of Bias Tool (RoB 2.0). Results A total of six randomized controlled trials (RCTs) were analyzed. The incidence of hospital‐acquired PIs at stage 1 or higher was reported in the APM group from 0.3% to 25%. In one study, APMs were found to be less effective than static air mattresses (SAMs); in contrast, two studies found no difference. In one study, the APM was reported to be more effective than the viscoelastic foam mattress (VFM). On the contrary, in a more recent study, the APM was reported to be less effective than the VFM, and there was no difference compared with high‐specification foam mattresses in another study. Using the RoB 2.0 tool, one study was evaluated at “low risk of bias,” another as “some concern,” and four as “high risk.” Linking Evidence to Action There is insufficient evidence to suggest that APM is more effective in preventing PIs than other supporting surfaces. Evidence to date suggests that APM can be used in patients at risk for PIs. It is important to change position regardless of the type of support surface used. Highly controlled RCTs with low risk of bias are needed to provide strong evidence for identifying the most effective PI prevention support surfaces.

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Prevalence, incidence, length of stay and cost of healthcare-acquired pressure ulcers in pediatric populations: A systematic review and meta-analysis

Cited by 31 publications

References 35 publications

Content Validity and Reliability of the Pressure Ulcer Knowledge Test and the Knowledge Level of Portuguese Nurses at Long-Term Care Units: A Cross-Sectional Survey

Content Validity and Reliability of the Pressure Ulcer Knowledge Test and the Knowledge Level of Portuguese Nurses at Long-Term Care Units: A Cross-Sectional Survey

Newborn and elderly skin: two fragile skins at higher risk of pressure injury

Effects of alternating pressure air mattresses on pressure injury prevention: A systematic review of randomized controlled trials

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