SIRA+P: Development and Testing.

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Decision support; Pressure injury; Pressure ulcer; Risk assessment; Skin injury


Objectives: To describe the development of a new skin risk assessment scale called Skin Injury Risk Assessment and Prevention (SIRA+P) and to establish initial reliability and validity of the scale among patients ranging in age from birth, including pre-term, to adulthood, regardless of age or acuity of illness.

Study design: The single-site study was a retrospective chart review to evaluate the measurement properties of SIRA+P. Charts of 385 patients of all ages and in all units (including the neonatal and pediatric intensive care units) of a free-standing children's hospital were included. Concurrent validity was assessed with scales having previously established reliability and validity. For subjectsage, the comparison scale was the Neonatal Skin Risk Assessment Scale (NSRAS); for subjects 31days through 17years, the Braden Q Scale (Braden Q) was used; and for subjects 18years and older, the Braden Scale (Braden) was used. Interrater reliability was examined using Intraclass Correlation Coefficients (ICC). Concurrent validity procedures compared SIRA+P with NSRAS, Braden Q, and Braden using Pearson Correlation Coefficients.

Results: Interrater reliability for SIRA+P was very high (0.878). SIRA+P strongly correlated with the NSRAS (0.725), the Braden Q (-0.634), and the Braden (-0.778).

Conclusion: SIRA+P is designed to be used within the EHR and includes nursing decision support to guide pressure injury prevention interventions for specific skin integrity risks. SIRA+P has good interrater reliability, is valid across all age groups and accounts for device-related pressure.

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Journal of pediatric nursing



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MeSH Keywords

Adolescent; Age Distribution; Child; Child, Hospitalized; Child, Preschool; Clinical Decision-Making; Cohort Studies; Female; Hospitals, Pediatric; Humans; Incidence; Infant; Infant, Newborn; Male; Nursing Assessment; Observer Variation; Pediatric Nursing; Physical Examination; Pressure Ulcer; Prognosis; Reproducibility of Results; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Distribution; Skin; Skin Care


Decision support; Pressure injury; Pressure ulcer; Risk assessment; Skin injury

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