Predicting Pressure Injury Risk in Pediatric Patients Using Masks During Noninvasive Ventilation With the Braden QD Scale

Abstract

Background: Respiratory devices are frequently implicated in the development of medical device related pressure injuries (MDRPI). Current risk assessment tools are not adequate to identify and prevent MDRPI. The purpose of this study was to evaluate whether the Braden Q or Braden QD scoring tool could reliably predict MDRPI in pediatric patients treated with noninvasive ventilation (NIV) using a mask

Methods: An IRB approved retrospective chart review was performed, reviewing all pediatric subjects who suffered from MDRPI while receiving NIV with a mask. The subjects’ demographics, as well as Braden Q and Braden QD scores were extracted from the Electronic Health Record (EHR) at time of admission, 48 hours prior to MDRPI, 24 hours before MDRPI, and at resolution. Braden Q and Braden QD scores were electronically binarized into "no risk" or "at risk" score ranges. McNemar test was used to assess if Braden Q and Braden QD have the same level of classification.

Results: Forty-five unique subjects ages 1 months to 23 years with MDRPI were identified which included 24 female (53.3%) and 21 males (46.7%). Braden QD had a significant predictive value for MDRPI at admission (P<0.001), at 48 hours prior to injury (P<0.001), at 24 hours prior to injury (P<0.001), at time of injury (P<0.001), and at time of MDRPI resolution (P<0.001). By way of contrast, the Braden Q tool had no predictive value and scored all subjects at "no risk of MDRPI at admission, 24 hours prior to injury, and at the time of injury. The Braden Q scored 95.6% of subjects as no risk at 48 hours prior to injury.

Conclusions: Braden QD was able to predict risk for MDRPI in pediatric subjects using NIV masks. The Braden Q had no prognostic abilities within this same group during the same time intervals. The use of the Braden QD tool may enable the prospective identification of patients at risk for MDRPI related to the use of a NIV mask so that targeted interventions can be deployed.

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