Effectiveness of preventative care strategies for reducing pressure injuries (PIs) in children aged 0-18 admitted to intensive care: A systematic review and meta-analysis

Abstract

Introduction: The development and prevention of pressure injuries is a complex phenomenon, dependent on a wide variety of extrinsic and intrinsic risk factors. Children with critical illness form an extremely vulnerable patient group with an exceptionally high risk of immobility-related and medical device-related pressure injuries. Recent reviews on this subject matter largely been focused on adult patients. The aim of this review is to systematically synthesise the evidence on the most effective interventions to prevent pressure injury development in children admitted to intensive care. Methods: Four electronic databases; CINAHL, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched. Studies were screened at three stages, title, abstract, and full text against the inclusion and exclusion. Quality appraisal was conducted using the Joanna Briggs Institute Critical Appraisal Tools and two authors independently extracted study data from included studies using a predesigned data collection form. A meta-analysis was performed using RevMan 5. Results: After removal of duplicates, twenty studies met the inclusion criteria. Observed interventions included; use of risk assessment tool, preventative skin regimes, nutrition, repositioning, support surfaces, medical devices care, and staff education and training. A bundle intervention approach was used to implement pressure ulcer preventative strategies. Meta-analysis demonstrated an associated 51% potential reduction in pressure injury post intervention (pooled OR 0.49 (95% confidence Interval (CI) 0.39 – 0.62) P < 0.0001). Conclusion: Pressure injury preventative strategies are more likely to reduce the number and severity of pressure injuries. Paediatric nurses are pivotal members of the direct care multidisciplinary team with unique expertise and influence over the risk assessment, implementation and maintenance of pressure injury preventative strategies for children admitted to intensive care.