Hospital Acquired Pressure Injury in Pediatrics: Patterns and Characteristics of Injuries Over a Six Year Period

Background: Hospital-acquired pressure injury (HAPI) is a serious, often preventable problem increasing costs, length of stay, and patient suffering. Although well documented in adults, there is little evidence regarding the pediatric population. Our institution recognized areas for improvement. We set out to describe HAPI in infants and children and, based on the pattern and characteristics of these injuries, develop specific, targeted interventions to improve patient outcomes, including a wide array of medical device-related HAPI (MDRHAPI).

Method: An IRB-approved study consisting of a series of prevalence surveys was conducted. A web-based tool, Research Electronic Data Capture (REDCap¹), was used to document presence, severity and etiology of HAPI and review accuracy of clinical documentation. The research study evolved into quality improvement and REDCap allowed for survey customization where medical devices, locations, and anesthetized procedures were assessed and trended over a six year period. Summary statistics were used to determine prevalence for each HAPI category. 

Results: Over 25 quarterly surveys, a total of 10,892 patients were assessed with an average of 435 patients per survey. Prevalence rates ranged from 4.93% early on, to 0.7%, with a median of 1.63%. MDRHAPI accounted for 70-100% of the injuries. Respiratory devices were the most frequent cause of MDRHAPI, followed by vascular devices and orthotics. Injury location corresponded to etiology; MDRHAPI were located around the face, neck and extremities, whereas immobility HAPI were most often occiput and sacrum. Trending of HAPI over time will be presented along with specific practice changes and interventions.

Implications: This data confirms that MDRHAPI is a leading cause of HAPI in pediatrics. Using a customizable tool such as REDCap assists in “drilling down” to the root cause of each HAPI, allowing for targeted interventions. Ongoing prevalence surveys continue to monitor care and patient outcomes, striving for sustainability of improvements.