Assessment tools for the risk of pressure injury in children: A systematic review

Abstract

Background

Pressure injuries in pediatric patients are associated with increased morbidity, mortality, and prolonged hospital stays, making the identification of effective risk assessment tools critical in clinical practice. Accurate risk assessment is essential in clinical practice. Although several assessment tools exist, their applicability and effectiveness vary across pediatric populations.

Objective

To identify and evaluate tools designed to assess the risk of pressure injuries in children, focusing on their characteristics, validation populations, reliability, and applicability across different clinical contexts.

Design

A systematic review was conducted.

Methods

This systematic review (PROSPERO: CRD42024527687) was conducted in accordance with the Cochrane Handbook. Comprehensive searches were performed in five databases—PubMed, Google Scholar, CINAHL, Web of Science, and Embase—for studies published between January 2010 and March 2024. Eligible studies included those describing the development, use, or validation of pressure injury risk assessment tools in children. Two independent reviewers conducted the selection and appraisal process. Methodological quality was assessed using the QUADAS-2 and QAREL checklists, with general reference to COSMIN guidelines.

Results

Of 964 records screened, 28 studies met the inclusion criteria, encompassing research from 15 countries, with Brazil being the most represented. Studies focused on pediatric and neonatal intensive care units, general wards, and surgical units. Ten different risk assessment tools were identified, including the Braden Q, Braden QD, and Glamorgan scales. The Braden QD scale—an adaptation of the Braden Q including medical device-related risk—was the most frequently evaluated. Other tools, such as the Pediatric Pressure Ulcer Prediction and Evaluation Tool and the Braden Q+P, were specifically developed or adapted for pediatric and neonatal use.

Conclusions

All identified tools demonstrated acceptable validity and inter-rater reliability. However, no single tool proved universally applicable across all pediatric contexts. The Braden QD, Braden Q, and Glamorgan scales emerged as the most comprehensive, particularly in intensive care settings, aligning with National and European Pressure Ulcer Advisory Panel recommendations. Further research is warranted to enhance tool accuracy and contextual adaptability across pediatric care environments.

Guidelines

PRISMA.