Incidence density and device-related pressure injury patterns in paediatric intensive care.

Objective

To determine pressure injury (PI) incidence density in a paediatric intensive care unit (PICU) over five years and describe diagnosis-specific anatomical and device-related PI (DRPI) patterns.

Method

This single-centre retrospective study included patients with stage 2 or higher PIs recorded in a tertiary hospital PICU incidence report from January 2021 to December 2025, using de-identified quality-indicator data. The incidence density was calculated per 1000 patient days. PIs were grouped as superficial (stage 2), severe (deep tissue PI, unstageable, stage 3-4) or mucosal. Patient variables were analysed per patient and injury variables per PI, using Mann-Whitney U and Kruskal-Wallis tests.

Results

The study cohort comprised 94 patients. During 12,371 patient days, 107 PIs occurred, giving an incidence density of 8.65 per 1000 patient days. Patients with cardiovascular illness (n=41, 43.6%; median age 15 months) were younger than other groups (U=750.0; p=0.010). The head/neck was the most common site overall, but pelvic/gluteal PIs were more frequent in patients with cardiovascular illness (37.0%), whereas 83.3% of PIs in patients with respiratory and neurological illness occurred at the head/neck. At least one device was in place for every PI (median 5), and 51 PIs (47.7%) were classified as DRPIs. DRPIs accounted for 71.2% of head/neck PIs, of which 95.7% involved respiratory devices. Risk scores did not differ across severity groups (Braden Scale H=2.40; p=0.301, Braden Q H=1.68; p=0.431, Neonatal/Infant Braden Q H=0.70; p=0.705).

Conclusion

In this study PI patterns differed by diagnostic group, supporting pelvic/gluteal protection for patients with cardiovascular illness and device-related head/neck prevention for patients with respiratory and neurological illness. A risk-assessment tool reflecting device-related risk should be considered.