Letter to the editor.

Increasingly researchers and clinicians alike are acknowledging that a collaborative approach in the development of valid and reliable risk assessment instruments for the identification of hospital-acquired pressure ulcers (HAPUs) in the pediatric population is critical. Without researcher-clinician collaboration, the clinical relevance of any new instrument cannot be ensured (Murray et al., 2013). We appreciate the work by Leonard et al. (2013) that explored the predictive ability of an abbreviated pressure ulcer risk prediction tool. Specifically, the researchers sought to determine whether using a modified version of the Glamorgan Pressure Ulcer Risk Assessment Scale (mGS) would alter the pressure ulcer risk identification when compared to the original Glamorgan Pressure Ulcer Risk Assessment Scale (GS) (Willock et al., 2009). Prospective data were collected from a convenience sample of critically ill pediatric patients (n1⁄4 133) only. However, the GS was designed for use with the general pediatric inpatient ward population. The mGS contains only two items (mobility and equipment) whereas the GS contains nine items (mobility, equipment, significant anemia, persistent pyrexia, poor peripheral perfusion, inadequate nutrition, low serum albumin, weight, and incontinence). Using a 2-item instrument would be less burdensome for busy clinicians than using a 9-item instrument. While parsimony is a desirable characteristic of any instrument used in the clinical setting, we think the authors have now thrown the baby out with the bathwater. It makes sense, given how the GS and now the mGS are scored, that reduced mobility and/or devices pressing or rubbing on the skin, will place a patient at risk for an immobility-related or devicerelated pressure ulcer. But, do we really need a tool to tell us this? Do we need to differentiate the level of risk from ‘‘at risk,’’ ‘‘at high risk,’’ and ‘‘at very high risk’’? We think not.