The prevalence and risk factors for foot pressure ulcers in ambulatory pediatric patients with spina bifida

Rethlefsen, Susan A.; Mueske, Nicole M.; Wren, Tishya A. L.; Murgai, Rajan; Bent, Melissa A.

doi:10.1080/09638288.2019.1660915

Cited by 4 publications

(9 citation statements)

References 14 publications

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“…Previous literature has reported the incidence of pressure injuries in children to be around 10% in various hospital settings, namely 11.7% in the pediatric intensive care unit, 10% in spina bifida patients (specifically those of the foot), and 9.7% in pediatric patients with congenital heart disease. [13][14][15][16][17] Our study reports an incidence of 7.6% in pediatric patients with NCCC, similar to the reported rates of pediatric pressure injuries in other studies.…”

Section: Discussionsupporting

confidence: 90%

“…Children can develop pressure injuries in a variety of locations. In spina bifida, heel pressure injuries were reported to be the most common location for pressure injuries; whereas in the pediatric intensive care unit, pressure injuries were most common on the scalp and face area; in children with congenital heart disease, pressure injury occurred most commonly at the sacrum, buttocks, or coccyx 14,15,17,18. The variable pressure injury locations seen in hospitalized children reflect the different patient specific risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…In spina bifida, heel pressure injuries were reported to be the most common location for pressure injuries; whereas in the pediatric intensive care unit, pressure injuries were most common on the scalp and face area; in children with congenital heart disease, pressure injury occurred most commonly at the sacrum, buttocks, or coccyx. 14,15,17,18 The variable pressure injury locations seen in hospitalized children reflect the different patient specific risk factors. Our results indicate that in children and adolescents with NCCC, pressure injuries were most commonly located at the heel, followed by the sacral/buttocks/groin region, then the knee.…”

Section: Discussionmentioning

confidence: 99%

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Determining Incidence and Risk Factors of Pressure Injury After Orthopaedic Surgery in Children and Adolescents With Neuromuscular Complex Chronic Conditions

Samineni

Miller

Hopkinson

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Pressure injuries are serious yet often preventable alterations in skin integrity prevalent in orthopaedics, especially in pediatric patients with neuromuscular complex chronic conditions (NCCC). The aims of this study were to (1) estimate incidence of pressure injury in children with NCCC after orthopaedic surgery; (2) determine risk factors for pressure injury development; and (3) describe severity and location of pressure injuries. Methods: Children and adolescents (< 22 y old) with NCCC who underwent orthopaedic surgery at a single tertiary-care children's hospital between 2016 and 2020 were retrospectively identified. A matched case-control design was used to match patients who developed a pressure injury within 1.5 months after surgery to subjects who did not develop a pressure injury using a 1:1 matching based on neuromuscular diagnosis, age, sex, and type of surgery. Patient characteristics, comorbidities, pressure injury characteristics, and a pressure injury risk assessment score utilizing the Braden QD scale were compared across pressure injury groups. Results: Of 564 children with NCCC who underwent orthopaedic surgery, 43 (7.6%) developed a postoperative pressure injury. Pressure injuries were primarily located on the heel, followed by sacral/groin/buttocks, then knee. The most common diagnosis was cerebral palsy with associated neuromuscular scoliosis, and hip reconstruction was the most common surgical procedure. The pressure injury cohort had significantly more patients who were non-ambulatory (GMFCS IV/V), with a seizure disorder, g-tube, nonverbal status, wheelchair usage, and had additional medical devices. Median Braden QD risk score was higher in the injury cohort and a cutoff ≥ 12 was optimal for predicting pressure injury development.Conclusions: Pressure injuries after orthopaedic surgery are not uncommon in children with NCCC. The entire care team should be aware of additional risk factors associated with pressure injury development, including the diagnosis of cerebral palsy with neuromuscular scoliosis, seizure disorder, nonverbal status, g-tube, and the presence of multiple medical devices. Implementation of evidence-based pressure injury prevention guidelines on identified high-risk children with NCCC may reduce pressure injury risk and improve the postoperative course. Level of Evidence: Level III.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Determining Incidence and Risk Factors of Pressure Injury After Orthopaedic Surgery in Children and Adolescents With Neuromuscular Complex Chronic Conditions

Samineni

Miller

Hopkinson

et al. 2022

Journal of Pediatric Orthopaedics

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“…As discussed by Rethlefsen, 29 foot pressure injuries develop in approximately 10% of paediatric patients suffering from spina bifida. In our study, we treated two such patients with different flaps.…”

Section: Discussionmentioning

confidence: 98%

“…As discussed by Rethlefsen, 29 foot pressure injuries develop in approximately 10% of paediatric patients suffering from spina bifida.…”

Section: Recurrencesmentioning

confidence: 98%

Surgical treatment of pressure injuries in children: A multicentre experience

Pignatti

D’Arpa

Roche

et al. 2021

Wound Repair Regeneration

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Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas.They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1-17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum (6/18 patients), lower limb (3/18 patients), thoracic spine (2/18 patients), ischium (3/18 patients, bilateral in one patient), temporal area (3/18 patients), hypogastrium (1/18 patients) and were associated to medical devices in three cases. Flaps were followed for a minimum of 19 months and up to 13 years. Only two patients developed true recurrences that were treated again surgically. Pressure injuries are infrequent in children and rarely need surgical treatment. Pedicled flaps have a high success rate. Recurrences, contrary to what is reported in the literature, were rare.

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Foot deformity and quality of life among independently ambulating children with spina bifida in South Korea

et al. 2023

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Background Children with spina bifida (SB) may have congenital or acquired foot deformities due to neurological defects in the spinal cord. As the musculoskeletal system keeps growing, foot deformities can develop or become aggravated. Thus, healthcare providers should provide constant monitoring and proper orthopedic management. Since foot deformities can affect not only the gait but also the daily life of children with SB, it is necessary to investigate the impact of foot deformities on everyday life. The purpose of this study was to examine the relationship between foot deformity and health-related quality of life (HRQoL) among independently ambulating children with SB. Methods This cross-sectional study examined the associations between foot deformity and HRQoL using two patient-reported outcome measures (Oxford Ankle Foot Questionnaire, Pediatric Outcomes Data Collection Instrument) in 93 children with SB aged 7–18 years between January 2020 and July 2021. Results Children with foot deformity (n = 54) reported lower scores in all subscales (physical, school and play, emotional, and footwear) of the Oxford Ankle Foot Questionnaire for children than those without foot deformity (n = 39; p < 0.001). Additionally, in terms of the Pediatric Outcomes Data Collection Instrument, children with foot deformity also reported poorer scores in four subscales (transfer and basic mobility, sports and physical functioning, comfort and pain, happiness with physical functioning; p < 0.001) than those without foot deformity, whereas upper extremity functioning was not significantly affected. Children with foot deformities, particularly those with bilateral foot deformities, equinus deformities, or mixed deformities, which are different types of right and left foot deformities, have a lower perceived HRQoL (p < 0.05). Conclusions Among independently ambulating children with SB, those with foot deformities showed lower HRQoL. Moreover, children with foot deformities tend to have other clinical problems, including bladder and bowel dysfunction. Therefore, orthopedic management should consider the multifaceted factors that affect children’s daily life and HRQoL.

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The prevalence and risk factors for foot pressure ulcers in ambulatory pediatric patients with spina bifida

Cited by 4 publications

References 14 publications

Determining Incidence and Risk Factors of Pressure Injury After Orthopaedic Surgery in Children and Adolescents With Neuromuscular Complex Chronic Conditions

Determining Incidence and Risk Factors of Pressure Injury After Orthopaedic Surgery in Children and Adolescents With Neuromuscular Complex Chronic Conditions

Surgical treatment of pressure injuries in children: A multicentre experience

Foot deformity and quality of life among independently ambulating children with spina bifida in South Korea

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