New research study launches to improve pressure injury care for children with dark skin tones in hospitals

Researchers at the University of Leicester and Nottingham University Hospitals NHS Trust are leading a clinical research study aimed at preventing pressure injuries in children and young people with dark skin tones in hospitals. 

This pioneering study, which has just begun, will take place across 10 NHS hospital Trust sites nationwide.

The research, which is funded by a £250,606 national research grant, will assess a modified pressure injury risk assessment tool used in current practice to help inform and better treat this under-represented patient group in future. Hospital acquired pressure injury prevalence for children and young people ranges from 1.4% to 8% with those that are critically ill having higher prevalence (up to 43%).

Pressure injuries are usually identified as ulcers which develop in areas of the skin, especially where there are bony parts, such as elbows, heels and hips. They result when patients lie in bed, sit in wheelchairs, or have to wear casts for an extended period of time. Medical device attachments on hospitalised children can also cause pressure injuries. This can result in the need for more treatment, or even prolonged hospital admission. 

Caring for an injury starts with an assessment tool. However, those currently available have not been developed with consideration for different skin tones and therefore may not effectively identify pressure injury risk for those with dark skin tones. Clinicians need to make sure that tools are fit for purpose for our diverse communities. 

Now, a pioneering study being led by Dr Takawira Marufu, Clinical Academic Nursing research Lead at Nottingham University Hospitals, and Professor Joseph Manning MBE, Professor of Nursing and Child Health at Nottingham University Hospitals and the University of Leicester, aims to modify and validate the existing BRADEN-QD pressure risk assessment tool to measure its effectiveness for multiple skin tones. 

The 18-month project will look to address critical knowledge gaps and improve pressure injury risk assessment for all children and young people. 

Dr Taka Marufu, Co-Chief Investigator of the study, said: “Pressure injuries are a concern and are the cause of real distress and sometimes even long stays in hospital for children and young people – something we really want to avoid.

“At the end of this study we hope to have an accurate and reliable pressure injury risk assessment tool for use in all infants and children admitted to hospital. This is why we will include patients with dark skin tones who have so far been under-represented in similar previous studies.” 

Professor Joseph Manning, Co-Chief Investigator for the study, said: “We are extremely excited to be leading this important study to address critical evidence gaps in the provision of safe and effective care to all the children and young people in hospital.

“We have been overwhelmed by the significant interest and support from local, regional and national providers of NHS hospital care to children and young people who want to participate in this research.  

“In a similar approach to our other research, we have worked with children and their families to develop this study.  We will continue to engage and involve through inclusive approaches, children, young people and families in this research and beyond to ensure it continues to reflect the views and perspectives of the diverse communities we serve.” 

The study will be split into two key phases over its 18-month duration. 

Phase 1 is holding focus groups with key stakeholders including patients, their families and healthcare professionals. This will look at identifying issues that are contributing to pressure injuries in children and young people specifically with darker skin tones and prioritising them according to the relevance of the study. Around 20 participants will be recruited for this first phase through various clinical patient and public involvement and engagement and charity networks, and the use of digital and printed media. 

Phase 2 aims to recruit over 500 children and young people that are hospitalised with darker skin tones and who fit the criteria. These patients will be tested using the modified and/or unmodified pressure injury assessment tool(s) to evaluate its effectiveness in identifying pressure injury risks. 

Participants and their families will play a vital role in this study by contributing their valuable insights into this study and therefore improving and shaping the future care of children and young people with darker skin tones who have or may develop a pressure injury. 

The research study is funded by the National Institute for Health and Care Research (NIHR) Research for Patient Benefit (RfPB) programme.