The prognostic ability of early Braden Q Scores in critically ill children

Background Pressure ulcer ( PU ) risk assessment tools are an important component of good nursing care; however, it is essential that these tools offer a good sensitivity and specificity, in addition to clinical utility in the population being assessed. Objectives The aim of this study was to examine how the lowest Braden Q score recorded in the first 24 h of paediatric intensive care unit admission related to the risk of PU development in an English PICU (paediatric intensive care unit). Methods A retrospective cohort study was undertaken over 12 months in a single PICU in the North West of England. 891 critically ill children with a Braden Q score were evaluated. The lowest Braden Q score within the first 24 h of PICU admission was matched to reported PU development and grade. Results The Braden Q score was found to perform well in children aged 3 weeks to 8 years without congenital heart disease ( CHD ), which is the population it was validated on. At a cut off score of ≤16 it yielded a sensitivity of 100% specificity of 73.1%, positive predictive value ( PPV ) 2.56 and a negative predictive value ( NPV ) of 100 and an area under the curve ( AUC ) of 0.87(0.75–0.98). When used in other age groups and when it included children with CHD , it performed less well with lower AUC and wider confidence intervals, but it performed moderately well in the group of term to 14 years with a sensitivity of 75% specificity of 72.6%, PPV 1.5 and a NPV of 99.8 and AUC of 0.74 (0.49–0.98). Conclusion Our results in a heterogeneous UK PICU population found the Braden Q score performed well in the specific population it was validated for ( PICU children aged 3 weeks to 8 years without CHD), however, it performed moderately well in the more heterogonous PICU population of term to 14 years including children with CHD .