A comparison of the performance of the Braden Q and the Glamorgan paediatric pressure ulcer risk assessment scales in general and intensive care paediatric and neonatal units.

AIMS: To compare the predictive ability of two risk assessment scales used in children. BACKGROUND: There are several risk assessment scales (RASs) employed in paediatric settings but most have been modified from adult scales such as the Braden Q whereas the Glamorgan was an example of a scale designed for children. METHODS: Using incidence data from 513 paediatric hospital admissions, receiver operating characteristic (ROC) was employed to compare the two scales. The area under the curve (AUC) was the outcome of interest. RESULTS: The two scales were similar in this population in terms of area under the curve. Neonatal and paediatric intensive care were similar in terms of AUC for both scales but in general paediatric wards the Braden Q may be superior in predicting risk. CONCLUSION: Either scale could be used if the predictive ability was the outcome of interest. The scales appear to work well with neonatal, paediatric intensive care and general children's wards. However the Glamorgan scale is probably preferred by childrens' nurses as it is easy to use and designed for use in children. There is some suggestion that while the two scales are similar in intensive care, for general paediatrics the Braden Q may be the better scale.

Using a national guideline to prevent and manage pressure ulcers.

Developing pressure ulcers is a painful and distressing event for patients, and one that can be prevented. The National Institute for Health and Care Excellence pressure ulcer guideline has recently been updated to cover the prevention and management of this condition. This article focuses on the recommendations that are relevant to nurses, covering areas such as risk assessment, skin assessment, repositioning, pressure-redistributing devices, dressings, patient and carer information, and training and education. It also identifies what senior nurses and nurse managers must do to ensure their staff can prevent and manage pressure ulcers effectively.

Interrater reliability of the Glamorgan scale: overt and covert data.

UNLABELLED: The Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale (Glamorgan scale) had been developed using statistical analysis of patient data. The aim of this study was to assess the reliability of the Glamorgan scale using overt and covert methods. METHOD: For the overt data collection, randomly selected trained nursing staff were invited to participate. Twenty-seven trained nursing staff assessed 27 children and young people within 10 minutes of an assessment by the researcher. For the covert part of the data collection the researcher and the paediatric tissue viability (TV) link nurse risk assessed inpatients on wards and units where the overt data collection had taken place, their findings were compared with the last recorded assessment by the clinical nurses. RESULTS: In the overt data collection 24 out of 27 nurses agreed with the researcher (88.9% agreement, kappa 0.867). In the covert data collection, 41 out of 55 risk assessments had been completed. Of the 41 completed assessments 34 agreed with the researcher and tissue viability link nurse (82.9% agreement, kappa 0.763). CONCLUSION: The level of agreement was good for overt and covert interrater reliability data.

A comparison of Braden Q, Garvin and Glamorgan risk assessment scales in paediatrics.

AIMS AND OBJECTIVES: To compare three risk assessment scales with respect to predictive validity BACKGROUND: In paediatrics there are several competing scales and at least ten published paediatric pressure ulcer risk assessment scales have been identified. However there are few studies exploring the validity of such scales, and none identified that compares paediatric risk assessment scales. DESIGN: Cross sectional study METHODS: Three risk assessment scales, Braden Q, Garvin and Glamorgan, were compared. The total scores and sub-scores were tested to determine if children with pressure ulcers were significantly different from those with no pressure ulcer. Logistic regression was conducted to determine if the probability of developing a pressure ulcer was a better predictor of development of pressure ulcer compared with the total score of each scale. Receiver operating characteristic curves were computed and the area under the curve used to compare the performance of the risk assessment scales. RESULTS: Data from 236 children were collected. 71 were from children in eleven hospitals who were asked to provide data on children with pressure ulcers (although seventeen did not have a pressure ulcer) of whom five were deep (grade 4). A sample of 165 were from one hospital, of which seven had a pressure ulcer, none grade four. The Glamorgan risk assessment scale had a higher predictive ability than either the Braden Q or Garvin. The mobility sub-score of each of the risk assessment scales was the most predictive in each case. CONCLUSIONS: The Glamorgan scale is the most valid of the three paediatric risk assessment scales studied in this population. Mobility alone may be as effective as employing the more complex risk assessment scale. RELEVANCE TO CLINICAL PRACTICE: If a paediatric risk assessment scale is employed to predict risk, then unless it is valid, it may identify children who are not at risk and waste resources, or fail to identify children at risk possibly resulting in adverse health outcomes.

Inter-rater reliability of Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale.

UNLABELLED: Children who are at risk of pressure ulcers need to be identified so that preventative measures can be taken. Most paediatric pressure ulcer risk assessment scales were developed using clinical experience, or by modifying adult scales. The Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale was developed using detailed paediatric inpatient data. AIM: To establish whether the inter-rater reliability of the Glamorgan scale was adequate for use in clinical practice. METHOD: Fifteen qualified nurses randomly selected from staff working on seven paediatric wards or units in a large tertiary referral hospital have participated in the study to date. Nurses asked permission from the children and parents in their care to collect anonymous data in the risk assessment section of the Glamorgan scale. The nurse and the researcher independently assessed the child's risk. Paired risk assessments were later compared and analysed using SPSS. RESULTS: The total risk scores ranged from 15 to 34 (high to very high risk). There was 100 per cent agreement on all items except for 'inadequate nutrition'. CONCLUSION: These preliminary data indicate that the risk assessment scale is reliable. More research on the reliability and validity of this tool with specific paediatric patient groups should be carried out, ideally comparing the performance of this tool with other published paediatric pressure ulcer risk assessment tools.

Evaluation of a service development to increase detection of urinary tract infections in children.

RATIONALE, AIMS AND OBJECTIVES: It is suspected that childhood urinary tract infection (UTI) remains under-diagnosed in primary care, and is consequently the cause of subsequent morbidity from renal scarring, hypertension and eventual renal failure. Practice-based education and service developments were undertaken to try to improve the detection of childhood UTI. METHODS: A controlled before-and-after intervention study was conducted. The educational and service developments promoted awareness of and greater testing for UTI among children less than two years of age presenting with febrile illness or other potentially relevant symptoms or signs. Appropriate diagnostic equipment was provided. RESULTS AND CONCLUSIONS: More urine samples were sent by the intervention practices but without a concomitant increase in detection of UTIs. This may indicate that current practice is approaching near maximal detection of UTI in young children.

Multicentre research: lessons from the field.

Multicentre research can be used to explore and generate significant data in aspects of care that affect small numbers of children. This article describes the problems and benefits encountered by a group of nurses from 11 hospitals undertaking a multicentre study of pressure ulcers in children and young people in England and Wales. Multicentre research can generate a large amount of useful data contributing to high quality evidence-based care and can provide nurses with a valuable learning and networking experience.

Identifying the characteristics of children with pressure ulcers.

AIM: To identify the characteristics of children with pressure ulceration so that those at risk may be identified in future. METHOD: A multicentre survey was undertaken in 11 hospitals to ascertain the incidence, severity and position of pressure ulcers in paediatric inpatients. RESULTS: The most frequently reported ulcer grade involved blistering of the skin or a superficial skin break. The most frequent site was the sacrum or buttocks, heel, thigh, ear, occipital scalp, malleolus and spine. In 50 per cent (n=27) of children, pressure ulcers could be associated with equipment pressing or rubbing on the skin. CONCLUSION: Risk assessment tools designed specifically for children are needed, and more research should be undertaken to confirm the characteristics that increase children's risk of pressure ulceration and to establish the significance of individual characteristics.

Pressure ulcers in infants and children.

Although there is no agreement about the size of the problem, there is evidence that critically ill children are more at risk of pressure ulcers than the general paediatric population. In addition to tissue damage associated with immobility, equipment and objects pressing or rubbing on the child's skin have also been implicated in the development of pressure ulcers. To prevent disfiguring and potentially life-threatening pressure ulcers, it is important that risk factors are identified and minimised.

Peripheral venepuncture in infants and children.

Venepuncture can be a painful and frightening experience for children. Nurses play an active role in helping them to cope with this experience and in reducing the adverse effects of venepuncture. This article explains how infants, children and their families can be supported and cared for before, during and after venepuncture.