Department of Respiratory Therapy, Rady Children's Hospital and Health Center-San Diego, San Diego, CA.
Sadler Center for Quality, Rady Children's Hospital and Health Center-San Diego, San Diego, CA.
Respir Care. 2021 Aug;66(8):1234-1239. doi: 10.4187/respcare.08536. Epub 2021 May 11.
Noninvasive ventilation (NIV) masks are implicated in 59% of respiratory device-related pressure injuries in hospitalized children. Historically, the Braden Q scale was not adequate in identifying risk for pressure injury associated with devices and, therefore, was modified to the Braden QD scale. The purpose of this study was to evaluate whether the Braden QD scoring tool is better able to identify pediatric patients receiving NIV who are at risk for the development of pressure injury as compared to the previously used Braden Q scale.
This was a retrospective chart review of all pediatric subjects with NIV mask-related pressure injury. Demographics and Braden Q/Braden QD scores were extracted from the electronic health record at admission, at 48 h prior to pressure injury, at 24 h before injury, and at resolution. The scores were dichotomized into "no risk" or "at risk" score ranges on the basis of each scale's scoring parameters. The McNemar test was used to assess whether Braden Q and Braden QD have the same level of classification.
Forty-five unique subjects, ages 1 m - 23 y with NIV mask-related pressure injury were identified (24 [53.3%] female; 21 [46.7%] male). Braden QD had a significant correlation with mask-related pressure injury at admission ( < .001), at 48 h prior to injury ( < .001), at 24 h prior to injury ( < .001), at time of injury ( < .001), and at resolution of the pressure injury ( < .001). The Braden Q score did not identify pressure injury at admission, at identification of pressure injury, nor at 24 h or 48 h prior to injury.
No significant differences were found among groups in relationship to age or gender. 85% of the subjects identified as "at risk" with the Braden QD scale developed pressure injury; conversely, virtually all of the subjects with pressure injury were identified as "no risk" with the Braden Q scale.
无创通气（NIV）面罩与住院儿童中 59%的呼吸设备相关压力损伤有关。历史上，Braden Q 量表在识别与设备相关的压力损伤风险方面不够充分，因此被修改为 Braden QD 量表。本研究的目的是评估 Braden QD 评分工具是否比以前使用的 Braden Q 量表更能识别接受 NIV 的儿科患者发生压力损伤的风险。
这是一项对所有与 NIV 面罩相关压力损伤的儿科患者的回顾性图表审查。在入院时、压力损伤前 48 小时、损伤前 24 小时和愈合时，从电子病历中提取人口统计学数据和 Braden Q/Braden QD 评分。根据每个量表的评分参数，将评分分为“无风险”或“有风险”评分范围。使用 McNemar 检验评估 Braden Q 和 Braden QD 是否具有相同的分类水平。
共确定了 45 例具有 NIV 面罩相关压力损伤的独特患者（24 例[53.3%]女性；21 例[46.7%]男性）。Braden QD 在入院时（<0.001）、损伤前 48 小时（<0.001）、损伤前 24 小时（<0.001）、损伤时（<0.001）和压力损伤愈合时（<0.001）与面罩相关压力损伤有显著相关性。Braden Q 评分在入院时、压力损伤识别时以及损伤前 24 小时或 48 小时均未识别出压力损伤。
在年龄或性别方面，各组之间没有发现显著差异。85%的 Braden QD 量表“有风险”的患者发生了压力损伤；相反，几乎所有有压力损伤的患者在 Braden Q 量表中都被识别为“无风险”。
