Examining Factors That Contribute to Delayed Wound Healing in Children with Tracheostomy Wounds.

OBJECTIVE: To identify variables that may contribute to delayed wound healing times in pediatric patients with tracheostomy wounds. DESIGN: Researchers identified 134 charts spanning January 2013 to June 2017; 95 charts met the inclusion criteria. The study examined Pressure Ulcer Scale for Healing (PUSH) scores, pressure injury staging, and albumin levels. SETTING: Arkansas Children's Hospital. PATIENTS: Patients (birth to 18 years) who developed or were admitted with a wound caused by a tracheostomy device. MAIN OUTCOME MEASURE: Time in days to wound closure. MAIN RESULTS: There was a moderate positive correlation between albumin and days to healing (r = 0.432, n = 22, P = .045) with higher albumin levels associated with shorter healing times. The PUSH scores and pressure injury stage were significant in explaining 14.1% of variance in days to healing (F77,2 = 7.458; P < .001). CONCLUSIONS: Wound healing appears to be multifactorial in nature in the pediatric population; albumin levels, pressure injury stage, and PUSH scores are all positively correlated with healing times. Further research is needed to investigate the contribution of race to healing time predication for the pediatric population.

Pediatric Tracheostomy Wound Healing: A Retrospective Cohort Study.

OBJECTIVE: To compare wound products by measuring time to granulation tissue and time to complete wound healing for tracheostomy wounds in the pediatric population. METHODS: Investigators identified 134 charts of patients treated January 2013 and June 2017; 93 charts met the inclusion criteria. This study compared the use of a foam dressing (n = 34) to the foam dressing plus a wound filler (n = 59) in patients who developed or were admitted with a wound caused by a tracheostomy device. PRIMARY OUTCOME MEASURES: Time in days to granulation tissue and to wound closure. RESULTS: The average time to complete wound closure for participants in this study was 14 days. There was no statistically significant difference in time to granulation tissue or wound closure formation between the wound care products (F2,34 = 1.11, P = .34). Cluster analysis (10 splits) revealed that pressure injury stage was the best predictor, accounting for 41% of the variance in the high treatment response group (those healing in <14 days). Patients who were African American with a stage 2 pressure injury, had a PUSH score of 5 or more, and were using a foam plus a wound filler dressing were 86% more likely to be in the high-response group. CONCLUSIONS: All wounds reviewed healed with current wound care practices without surgical intervention. Best practice for healing tracheostomy wounds in pediatric patients should include the wound filler in the first 14 days based on variable interaction.

Reliability and Validity of the Patient-Specific Functional Scale in Community-Dwelling Older Adults.

BACKGROUND AND PURPOSE: Clinical measurement of physical function that is both specific to the individual and generates comparable outcome data is a fundamental need in physical therapy examination. The Patient-Specific Functional Scale (PSFS) has been found to be a reliable and valid measure of physical function in patients with musculoskeletal disorders and may have applications for other patient populations. However, the reliability and the validity of the PSFS have not been evaluated in older adults. The purpose of this study was to investigate the reliability and the validity of the PSFS in community-dwelling older adults. METHODS: Thirty-one community-dwelling older adults (11 males, 20 females), mean age = 81.1 (8.3) years, were included. Participants completed the PSFS, Lower Extremity Functional Scale (LEFS), Activity-specific Balance Confidence Scale (ABC), Short Physical Performance Battery (SPPB), Berg Balance Scale, and the Timed Up and Go on 2 separate days, 48 hours apart. Assessment scores were compared between testing days and reliability was analyzed using the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). Validity of the PSFS was assessed by comparing initial scores with the other measures using the Pearson correlation coefficient, scatter plots, and Bland-Altman plots. RESULTS: The ICC and the MDC for the PSFS were 0.82 (95% confidence interval = 0.67-0.91) and 2.8, respectively. Significant correlations (P < .05) were found when the PSFS was compared with the ABC (r = 0.68), LEFS (r = 0.81), and SPPB (r = 0.37). Bland-Altman plots and 95% limits of agreement (LOA) using z scores indicated considerable agreement between the PSFS versus the ABC (LOA =-1.6 to 1.6), LEFS (LOA =-1.2 to 1.2), and SPPB (LOA =-2.1 to 2.1). CONCLUSION: The PSFS is a reliable and valid measure of physical function in community-dwelling older adults. A change of 2.8 or greater on the PSFS suggests a true change in physical function in this population.

Enhanced tracheostomy wound healing using maltodextrin and silver alginate compounds in pediatrics: a pilot study.

BACKGROUND: Tracheostomy wounds are commonly encountered in children but rarely reported. Relatively few treatments are available or have been investigated to manage this problem. Healing times for pediatric tracheostomy wounds are often unpredictable and protracted. Recent use of maltodextrin gel (MD) and a silver alginate sponge (AG) at our institution has demonstrated expedited healing and interest in this novel treatment for tracheostomy wounds. METHODS: We conducted an 11-month retrospective review of children with wound complications following tracheostomy placement at a tertiary care facility. Wounds were evaluated and rated based upon the National Pressure Ulcer Advisory Panel staging system. Subjects identified with stage 2 or greater tracheostomy-related ulcers treated with MD and/or AG were included. Subject characteristics and wound healing rates were tabulated in a database that included age, wound site, initial and final wound stage, type of treatment, length of treatment, and complications. Tracheostomy wounds treated as an out-patient were excluded from the study. RESULTS: Eighteen subjects, which included both in-patients and out-patients, were treated with AG and/or MD during the study period for tracheostomy-related wounds. Of the 26 subjects with tracheostomies performed during the study period, 10 (38.5%) were treated for postoperative wounds. A total of 11 subjects completed their in-patient wound treatment and were thus included in the study. Average subject age was 5.3 y (range 0.25-15.6 y). Wound locations were as follows: infrastomal region (n = 8), stoma (n = 2), and lateral neck (n = 1). Six subjects had stage 2 wounds, 4 had stage 3 wounds, and 1 had a stage 4 ulcer. All wounds achieved complete epithelialization following treatment with MD and/or AG. The average length of treatment was 12.8 d (range 6-28 d). No adverse effects were identified. CONCLUSIONS: Postoperative tracheostomy wounds are common. The use of MD and AG provides an effective and safe treatment for tracheostomy-related ulcers.