Faculty Collaboration Database

Pediatric Skin Failure. Am J Crit Care 2017 Jul;26(4):320-328

Date

07/03/2017

Pubmed ID

28668918

DOI

10.4037/ajcc2017806

Scopus ID

2-s2.0-85029309745 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

BACKGROUND: The phenomenon of skin failure as distinct from pressure ulcers has been documented in the adult literature. However, in the pediatric population, skin injury continues to be grouped indiscriminately as various types of pressure ulcers.

OBJECTIVE: To identify and describe the phenomenon of skin failure in critically ill children.

METHODS: Retrospective chart review of 19 patients who had serious skin injuries develop. Organ dysfunction scores, medications, pressure ulcer prevention techniques used, and laboratory values in the 7 days leading up to the development of a skin lesion were evaluated.

RESULTS: At the start of the evaluation period, all patients (N = 19) had pressure ulcer prevention measures in place before the development of a serious skin injury. All of the skin lesions were full-thickness injuries on the day they were identified (as opposed to the more gradual progression from simple to complex skin injuries typically seen in pressure ulcers). As predicted, 18 of 19 patients had multiple organ dysfunction syndrome (MODS) in the week leading up to the skin injury. All patients with MODS had at least 2 dysfunctional systems, and 12 patients had 4 or more dysfunctional systems. Of the 19 patients, 8 (42%) progressed to death, compared with 1.8% in our general pediatric intensive care unit population.

CONCLUSION: Although the traditional paradigm is that pressure ulcers are preventable, a subset of pressure ulcers in critically ill children may actually represent acute skin failure as a consequence of MODS.

Author List

Cohen KE, Scanlon MC, Bemanian A, Schindler CA

Authors

Amin Bemanian in the CTSI department at Medical College of Wisconsin - CTSI
Katie E. Cohen MD Instructor in the Medicine department at Medical College of Wisconsin
Matthew C. Scanlon MD Professor in the Pediatrics department at Medical College of Wisconsin
Christine Schindler Ph.D., RN, CPNP, AC/PC Nurse Practitioner in the Nursing department at Marquette University

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adolescent
Child
Child, Preschool
Critical Care
Critical Illness
Female
Humans
Infant
Male
Multiple Organ Failure
Pressure
Pressure Ulcer
Retrospective Studies
Sacrococcygeal Region
Scalp
Skin
Survival Rate
Wounds and Injuries