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663: Novel use of pressure mapping to determine acceptable load times in children undergoing neurosurgery

Carmean Amanda; Sprigle, Stephen; Stockwell, Jana
Critical Care Medicine: December 2013
doi: 10.1097/01.ccm.0000439901.06700.0d
Poster Session: Epidemiology/Outcomes 13: PDF Only

Introduction: Development of a Stage III or IV pressure ulcer acquired after admission to a health care facility is one of the National Quality Forum's 27 "Never Events". Although much research exists on the incidence and factors that predispose adults to deep tissue injury, scant data exists in pediatric literature. Hospitalized children generally have a low incidence of pressure ulcers, yet for critically ill children in a Pediatric Intensive Care Unit (PICU) the incidence is much greater. In an attempt to better understand the impact of load bearing and pressure distribution in children, we first undertook to study a patient population in a static, relatively controlled environment with minimal patient manipulations and a clear delineation of load exposure times. Methods: Children undergoing neurosurgical procedures at Children's Healthcare of Atlanta Egleston were eligible for enrollment if age < 18 yrs, weight > 10 kg, no prior skin injury/pressure ulcer in the regions of interest (ROI, sacrum and bilateral scapulae), and approved for participation by the neurosurgeon. Three patients were consented. The FSA BodiTrak 32x32 pressure mapping system (Vista Medical) was placed under each patient prior to the start of the neurosurgical procedure. Data was recorded at variant collection rates throughout the entire procedure. A record was maintained of any manipulation or change in the patient's positioning. Skin was assessed before and after the procedure and modified Braden Q scores documented. Data collected in the FSA 4 Clinical Software (Vista Medical) platform was transferred to a graphical user interface (GUI) for analysis. Results: Three subjects have been enrolled and completed data collection as of July 2013. The data collection times ranged from approximately 1.5 hours to 5.5 hours depending on the procedure being performed. No patient had skin changes noted after completion of the surgical exposure time. All subjects had a pre- and post-surgical modified Braden Q score of > 17. Throughout the data collection times it was noted visually that the areas shown on the FSA software consistently corresponded to the chosen ROI (sacrum and bilateral scapulae). Preliminary analysis from the GUI appears to show that it is feasible to create normative acceptable load per hour measurements based on these test subjects. Further analysis is pending. Conclusions: Based on preliminary results, pressure mapping technology is reliable in measuring pressure loading in a pediatric population. With this technology, normative values of acceptable skin loading times for patients can be ascertained. More research would be needed to assess the interaction of other pressure ulcer risk factors, such as critical illness, has on theses acceptable loading times.

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins