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American Journal of Critical Care. 2007;16: 568-574
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Skin Integrity in Critically Ill and Injured Children

By Christine A. Schindler, RN, MSN, CPNP-AC, Theresa A. Mikhailov, MD, Kay Fischer, RN, MSN, Gloria Lukasiewicz, RN, MS, Evelyn M. Kuhn, PhD and Linda Duncan, RN. Christine A. Schindler is a pediatric critical care nurse practitioner and Theresa A. Mikhailov is a pediatric inten-sivist in the Division of Pediatric Critical Care, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee. Kay Fischer is the patient care manager and Linda Duncan is a clinical enhancements and quality coordinator in the pediatric intensive care unit at Children’s Hospital of Wisconsin. Gloria Lukasiewicz is a National Association of Childrens Hospitals and Related Institutions analyst III and Evelyn M. Kuhn is a biostatistician at National Outcomes Center, Inc, Children’s Hospital and Health Systems, Milwaukee, Wisconsin.

Corresponding author: Christine Schindler, Children’s Hospital of Wisconsin, PO Box 1997, Milwaukee, WI 53201-1997 MS 681 (e-mail: cschindl{at}mcw.edu).

Background Skin breakdown increases the cost of care, may lead to increased morbidity, and has negative psychosocial implications because of secondary scarring or alopecia. The scope of this problem has not been widely studied in critically ill and injured children.

Objectives To determine the incidence of skin breakdown in critically ill and injured children and to compare the characteristics of patients who experience skin breakdown with those of patients who do not.

Methods Admission and follow-up data for a 15-week period were collected retrospectively on children admitted to a large pediatric intensive care unit. The incidence of skin breakdown was calculated. The risk for skin breakdown associated with potential risk factors (relative risk) and 95% confidence intervals were determined.

Results The sample consisted of 401 distinct stays in the intensive care unit for 373 patients. During the 401 stays, skin breakdown occurred in 34 (8.5%), redness in 25 (6.2%), and breakdown and redness in 13 (3.2%); the overall incidence was 18%. Patients who had skin breakdown or redness were younger, had longer stays, and were more likely to have respiratory illnesses and require mechanical ventilatory support than those who did not. Patients who had skin breakdown or redness had a higher risk of mortality than those who did not.

Conclusions Risk factors for skin breakdown were similar to those previously reported. Compared with children of other ages, children 2 years or younger are at higher risk for skin breakdown.




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T. A. Pasek, A. Geyser, M. Sidoni, P. Harris, J. A. Warner, A. Spence, A. Trent, L. Lazzaro, J. Balach, A. Bakota, et al.
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