Psychometric evaluation of a new pressure ulcer skin risk assessment scale for the pediatric burn patient

Abstract

Prevention of pressure ulcers is a primary goal in nursing practice, and achievement implies excellence in clinical care. One component of prevention is to understand the risk for pressure ulcer development. The benefit of knowing risk is to initiate pressure ulcer preventive interventions. Pressure ulcers are a significant problem in the pediatric burn patient population. Unfortunately, no skin risk assessment scale exist that capture the unique risk indices of the burn injury, thus the Pressure Ulcer Skin Risk Assessment Scale (PrUSRAS) was developed. The purpose of this study was to evaluate the validity, reliability and predictability of scores from the PrUSRAS. One hundred sixty-three burn patients from three pediatric burn Shriners Hospitals (Galveston, Cincinnati and Sacramento) were assessed with the PrUSRAS and followed to determine if pressure ulcers developed. The pressure ulcer incidence rate was 24.6%. Demographic data revealed significant findings: children who developed pressure ulcers had a higher mean percent burn injury (53%), increased number of mean hours in the operating room (>9 hours) and had a longer mean length of stay (46.7 days) compared to those children who did not develop pressure ulcers. Two estimates of reliability of PrUSRAS scores were computed: the intraclass correlation coefficient (ICC) and Cronbach’s coefficient alpha. The ICC calculation was 1.0. Cronbach’s coefficient alpha was low at 0.559. An exploratory factor analysis was used to assess construct validity. The analysis identified a 4-factor model, which was not readily interpretable. Logistic regression was used to predict the occurrence of pressure ulcers. Only three of the PrUSRAS items were significant predictors of pressure ulcers in the pediatric burn patients—percent burn, number of splints and prior or current pressure ulcers. The PrUSRAS is better at vii predicting children who will not get a pressure ulcer (95%) than it is at predicting those who will get a pressure ulcer (54%). Although this study did not provide evidence the PrUSRAS can identify risk of pressure ulcers in the pediatric burn patient the three significant pressure ulcer risk factors can be used in clinical practice to screen.