A Comparison of the Braden Q and the Braden QD Scale to Assess Pediatric Risk for Pressure Injuries During Noninvasive Ventilation

Abstract

Background: Noninvasive ventilation (NIV) masks are implicated in 59% of respiratory device-related pressure injuries in hospitalized children. Historically, the Braden Q scale was not adequate in identifying risk for pressure injury associated with devices and, therefore, was modified to the Braden QD scale. The purpose of this study was to evaluate whether the Braden QD scoring tool is better able to identify pediatric patients receiving NIV who are at risk for the development of pressure injury as compared to the previously used Braden Q scale.

Methods: This was a retrospective chart review of all pediatric subjects with NIV mask-related pressure injury. Demographics and Braden Q/Braden QD scores were extracted from the electronic health record at admission, at 48 h prior to pressure injury, at 24 h before injury, and at resolution. The scores were dichotomized into "no risk" or "at risk" score ranges on the basis of each scale's scoring parameters. The McNemar test was used to assess whether Braden Q and Braden QD have the same level of classification.

Results: Forty-five unique subjects, ages 1 m - 23 y with NIV mask-related pressure injury were identified (24 [53.3%] female; 21 [46.7%] male). Braden QD had a significant correlation with mask-related pressure injury at admission (P < .001), at 48 h prior to injury (P < .001), at 24 h prior to injury (P < .001), at time of injury (P < .001), and at resolution of the pressure injury (P < .001). The Braden Q score did not identify pressure injury at admission, at identification of pressure injury, nor at 24 h or 48 h prior to injury.

Conclusions: No significant differences were found among groups in relationship to age or gender. 85% of the subjects identified as "at risk" with the Braden QD scale developed pressure injury; conversely, virtually all of the subjects with pressure injury were identified as "no risk" with the Braden Q scale.

Keywords: Braden Q; Braden QD; bi-level; hospital-acquired pressure injury; noninvasive ventilation; pediatrics; pressure injury; pressure ulcer; respiratory device-related pressure injury; skin.