Pressure Ulcer Characteristics in Pediatric Patient

Nova Zairina Lubis, Deryne Anggia Paramita, and Khairina

Departement of Dermatology and Venereology, Faculty of Medicine, Universitas Sumatera Utara

Keywords: Pressure ulcer, pediatric, medan

Abstract: Pressure ulcer is a common condition in adult patient. This condition however is not well studied in

pediatric patient. Pressure ulcers commonly formed on tissues located above bony prominences. Continuous

pressure applied on these areas (eg. by mattress surface or medical equipment) may cause tissue damages

that contribute to the ulcers formation. This is a descriptive study using culture test and sensitivity test. This

study was done in the main referral hospital of Sumatera Island, RSUP H. Adam Malik Medan from June to

October 2017. The minimum sample was 20. Steps done in this study include patient sampling, coding, data

analysis and report writing. Subject characteristics discussed in this study include age, gender, ulcer severity

grade, location, onset, and underlying disease. The most common age group found in this study was the 0-3

years old age group at 9 subjects (50%). The most common gender group found in this study was male at 15

subjects (75%). The most common ulcer grade group found in this study was grade 1 ulcer group at 9

subjects (45%). This study also found the occipital region as the most common ulcer region at 6 subjects

(30%). The most common onset found in this study was after 3-5 weeks at 10 subjects (50%). The most

common underlying disease found in this study was hydrocephalus at 5 subjects (25%).

1 INTRODUCTION

Pressure ulcer is a localized injury to the skin and/or

underlying tissue usually over a bony prominence,

as a result of pressure, or pressure in combination

with shear and/or friction (National Pressure Ulcer,

2009).

Pressure ulcer is a common clinical problem

found within hospital inpatients. This problem has

both physical and psychological implications that

may increase morbidity, mortality, and hospital cost

(Schluer, 2016).

Studies on pressure ulcer in pediatric population

has not been done extensively, unlike in adult

population (Baharestami and Ratcliff, 2007).

The

prevalence of pressure ulcer in hospital pediatric

patients ranges from 3% to 35% (Kottner et al.,

2010). From 2011-2016, 53 pediatric pressure ulcer

cases were identified in RSUP Haji Adam Malik

(Rekam Medis, 2017).

Children skins are morphologically and

functionally different to adult skins. Differences in

physiological demands also cause fluid and

electrolyte imbalance to happen more frequently in

pediatric population. Higher body surface area in

children also put them in higher risk for dehydration.

Hypoxia may occur in skin cells with minimal

perfusion. This may cause them to easily break even

under minimal trauma (Rossie, 1996).

Some known risk factors of pressure ulcer in

pediatric population include immobility and

decrease of skin sensitivity (Suddaby et al., 2005).

Communication skills limitations in ill pediatric

population also put them at higher risk to develop

pressure ulcer (Dellinger et al., 2012).

Skin discontinuity such as epidermal peeling or

skin tearing (eg. caused by frictional stress) on

pediatric population especially in critical conditions

may increase risk for developing septicemia and

death (Dellinger et al., 2012).

Secondary infection of pressure ulcer is the most

commonly found complication. Resistant

microorganisms may colonize the pressure ulcer

thus causing local infection and severe bacteremia

may also ensue thereafter (Cataldo et al., 2011).

study by Braga et al. found S. aureus (20.7%),

negative Gram bacilli (32.5%) or both (46.8%) as

the three most common etiology of pressure ulcer

secondary infection (Baraga et al., 2013).

Pressure ulcer may cause unpleasant experiences

in pediatric patients and their families, appearance

alterations, treatment time prolongation and

secondary infection. Wound caring may also prove

Lubis, N., Paramita, D. and Khairina, .

Pressure Ulcer Characteristics in Pediatric Patient.

DOI: 10.5220/0008150700560059

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 56-59

ISBN: 978-989-758-494-7

to be quite challenging in these patients (Bemabe et

al., 2012).This study aimed to address the lack of

epidemiological studies on pressure ulcer in

pediatric population in Indonesia especially in North

Sumatera. Parameters used in this study include

frequency, microbial pattern, and sensitivity test

result.

2 METHODS

This was a descriptive observational study using

cross sectional method. The study was done from

July to October 2017. The target population was

pressure ulcer inpatients at RSUP H Adam Malik

Medan. The accessible population was pressure

ulcer inpatients at rindu B, NICU and PICU of

RSUP H Adam Malik Medan. Accessible population

that fulfilled the inclusion and exclusion criteria

became the sample group in this study.

Inclusion criteria in this study include <18 years

old pressure ulcer inpatients without topical

antibiotic treatment on the pressure ulcer location.

Patients without consent to this study were excluded.

20 samples were included in this study using

consecutive sampling method. Variables used in this

study include pressure ulcer, microbial profile and

sensitivity test.

3 RESULT

Subject characteristics discussed in this study

include age, gender, ulcer severity grade, location,

onset, and underlying disease

Table 1. Subject distribution accorded to age, gender,

ulcer severity grade, location, onset, and underlying

disease.

Characteristics Decubitus ulcer

patients

n %

Age

0 – 3

>3 – 6

>6 – 9

>9 – 12

>12 – 15

>15 – 18

Total 20 100

Gender

Male

Female

Total 20 100

Ulcer Grade

Grade 1

Grade 2

Grade 3

Total 20 100

Onset (weeks)

0 – 2

3 – 5

6 – 8

Total 20 100

Location

Femoral

Iliac

Occipital

Feet

Sacrum

Scrotum

Temporal

Tibial

Knees

Arms

Total 20 100

Undelying disease

Abscess

Acute lymphoblastic

leukemia

Fracture

Head injury

Hydrocephalus

Burn wounds

Bacterial meningitis

Post appendicitis

Systemic lupus erythematosus

Intracranial space occupying

lesion

Osteomyelitis

Osteosarcoma

Total 20 100

4 DISCUSSION

The most common age group found in this study was

the 0-3 years old age group at 9 subjects (50%). A

study by Schindler et al also found similar result.

They concluded that pressure ulcers can be more

easily formed at an age above 2 years old during

admission to the hospital PICU when compared to

those of older age (Schindler et al., 2011).

A study

by Curly et al also found the mean age of pediatric

pressure ulcer inpatients was at 36 months old

(Curley et al., 2003).

The most common gender group found in this

study was male at 15 subjects (75%) compared to

female at 5 subjects (25%).Several epidemiological

studies done on children pressure ulcer patients also

found similar results. Higher percentage and

Pressure Ulcer Characteristics in Pediatric Patient

distribution of adipose tissues in females were

thought to be able to cushion the bony prominence

areas (eg. on sacrum). However, further studies are

needed (Kottner et al., 2010).

The most common ulcer grade group found in

this study was grade 1 ulcer group at 9 subjects

(45%). Similar results were also found on studies

done by Curley et al (2013).

This study also found the occipital region as the

most common ulcer region at 6 subjects (30%).

Pressure ulcers on children usually formed on body

areas that sustain the most pressure. Solis et al found

that within all age groups, occipital region usually

sustain the most pressure followed by sacrum and

scapular region (Solis et al., 1988).

Different patterns

were found in adults where ischial tuberosity,

sacrum, and heels are the most common regions

(Kottner et al., 2010). These differences were

thought to be caused by anatomical developmental

changes. Pressure burdens tend to shift from

occipital to sacrum region as people age (Solis et al.,

1988).

The most common onset found in this study was

after 3-5 weeks at 10 subjects (50%). Similar results

can be found on a study by Manning et al. where

they found 24 days as the mean inpatient treatment

duration of their subjects. They also found that

longer duration of inpatient treatment was associated

with higher risk to develop pressure ulcers (Manning

et al., 2015).

The most common underlying disease found in

this study was hydrocephalus at 5 subjects (25%).

Immobility and sensate loss are some of the main

risk factors for pediatric pressure ulcers (Bernabe,

2012).

Both conditions are known to be common in

patients with hydrocephalus.

5 CONCLUSION

The most common age group found in this study was

the 0-3 years old age group at 9 subjects (50%). The

most common gender group found in this study was

male at 15 subjects (75%). The most common ulcer

grade group found in this study was grade 1 ulcer

group at 9 subjects (45%). This study also found the

occipital region as the most common ulcer region at

6 subjects (30%). The most common onset found in

this study was after 3-5 weeks at 10 subjects (50%).

The most common underlying disease found in this

study was hydrocephalus at 5 subjects (25%).

ACKNOWLEDGMENT

This research was supported by Research

Foundation of Universitas Sumatera Utara Budget

Period of 2017. We thank our colleagues from

Department of Dermatology and Venereology,

Faculty of Medicine, Universitas Sumatera Utara,

Haji Adam Malik General Hospital, and

Microbiology Laboratory who provided insight and

expertise that greatly assisted the research.

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