Accuracy of Pressure Injury Risk Assessment Tools in Paediatrics: A Systematic Review and Network Meta-Analysis.

Aim: To evaluate the accuracy of different pressure injury risk assessment tools in paediatrics and identify risk assessment tools with the best predictive performance.

Design: A systematic review and network meta-analysis.

Methods: Eight electronic databases, including PubMed, Embase, Web of Science, Cochrane Library, China Knowledge Resource Integrated Database, Weipu Database, Wanfang Database and Chinese Biomedical Database were comprehensively searched. The study was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines 2020. Two researchers independently conducted article screening, data extraction and quality assessment. Statistical analysis was performed using R 4.3.1 and Stata 14.0.

Results: A total of 20 articles were included in this study, involving 4908 patients and 13 pressure injury risk assessment tools for children, of which 15 articles were included in the network meta-analysis. The results showed that the Paediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET) had the highest superiority index, with the relative sensitivity (0.7, 95% confidence interval, CI: 0.0-1.5) and the relative specificity (1.4, 95% CI: 0.7-1.8). The next was Braden-Q combined with the Glamorgan scale, with a superiority index of 7.08, a relative sensitivity of 1.1 (95% CI: 0.5-1.5) and a relative specificity of 1.3 (95% CI: 0.8-1.7).

Conclusions: This study suggested that the PPUPET can comprehensively evaluate medical device-related pressure injuries in children, the Braden-Q scale had a better predictive performance for children aged 21 days-8 years in general paediatric departments, and the Glamorgan scale was suitable in the Paediatric Intensive Care Unit.

Relevance To Clinical Practice: This review highlights that clinical practitioners should select appropriate assessment tools based on different departments and the age of children to accurately assess the risk of pressure injuries in children.

Patient Or Public Contribution: No Patient or Public Contribution.

Protocol Registration: PROSPERO CRD42023470769. http://www.crd.york.ac.uk/PROSPERO/#recordDetails.