Predictive Performance of Device-Neonatal Skin Risk Assessment Scale to Evaluating Pressure Injuries Risk in the Neonates. An Observational Multicenter Study.

Aim: To assess the validity of a modified Neonatal Skin Risk Assessment scale (Dev-NSARS) for neonatal pressure injuries (PIs) in the neonatal intensive care unit (NICU) and neonatal sub-intensive care unit (NICU-Sub) environment.

Background: Medical devices are the leading cause of pressure injuries (PIs) in neonates, a key cause of morbidity in neonatology, significantly impacting the length of stay (LOS) and public hospital resources.

Methods: The Dev-NSRAS scale, considering the presence of medical devices, was tested on a national multicenter prospective study on newborns. The discrimination power of the Dev-NSRAS scale was compared to that of the more commonly used Glamorgan scale.

Results: Nine newborns (6.6%) developed PIs, with a total of 16 injuries, 75% (12 out of 16) of which were device related. Newborns with postconceptional age ≤ 30.8 weeks were at higher risk of developing PIs. First 24-h total Dev-NSRAS scores were compared with first 24-h Glamorgan scores, to obtain and compare respective sensitivity and specificity. During the first 24 h from admission, a very good discriminative performance was evidenced for Dev-NSRAS ≤ 11 (AUC 0.921, 95% CI: 0.899-0.940, p < 0.0001; 81.6% sensitivity and 93.6% specificity) as compared to a moderate discriminative performance shown by a Glamorgan score > 28 (AUC 0.752, 95% CI: 0.634-0.660, p < 0.0001; 92.1% sensitivity and 65.5% specificity).

Conclusions: Early application (i.e., in the first day from hospital admission) of Dev-NSRAS by the nursing personnel shows excellent accuracy in predicting the risk of developing PUs in newborns admitted to NICU and NICU-Sub, as compared to the Glamorgan scale.

Reporting method: The STROBE statement for cohort observational studies was used as the reference reporting method.

Impact: The study addressed the lack of a risk assessment scale for pressure injuries in neonates. Development and testing of a scale that demonstrated high sensitivity and specificity in the early prediction of pressure injury risk in neonates within the first 24 h. The research will have an impact in NICUs and NICU-Sub units, enabling nurses to plan personalised care to prevent pressure injuries in neonates, thereby reducing the length of hospital stays and overall healthcare costs.

Contribution: Introduce a validated scale for improving neonatal pressure injury prevention worldwide. Enhance early detection tools, reduce hospital stays and global costs.

Protocol registration: The study protocol has been approved by the Paediatric Tuscany Region Ethical Committee (date: 18 January 2021; protocol code 18/2021).