Comparison of clinical characteristics according to etiological classification of pressure injuries in pediatric patients: a retrospective cohort study.

BACKGROUND: Pressure injuries remain a significant problem in health care, and more studies are needed on their recognition, prevention, and treatment in the pediatric population. OBJECTIVE: To evaluate pressure injuries in hospitalized pediatric patients according to etiology (medical device-related pressure injury [MDRPI] vs immobility-related pressure injury [IRPI]) and compare demographic, clinical, and treatment characteristics, in order to inform etiology-specific prevention and management strategies. MATERIALS AND METHODS: This single-center retrospective cohort study included pediatric patients (age at pressure injury identification, 0-211 months) hospitalized between August 2020 and December 2024. Wounds were classified as MDRPI or IRPI. Healing response was categorized as either medical (dressing and local care) or surgical treatment. RESULTS: Of 283 pressure injuries in 149 patients, 225 (128 patients) were IRPI and 58 (37 patients) MDRPI; 16 patients had both. Localization differed significantly (P < .001): IRPIs predominated in occipital and sacral regions, MDRPIs in the ear and neck. IRPIs were larger at baseline (median, 3.0 vs 1.0 cm²; P < .001) and more often unstageable (20.8%) or deep tissue (3.6%) injuries, neither observed in MDRPIs (P = .001). Surgical intervention was required for 35.0% of IRPIs vs. 7.4% of MDRPIs (P < .001); median treatment duration was longer in IRPIs (29 vs 18 days; P = .002). CONCLUSIONS: This study shows significant differences between IRPIs and MDRPIs in terms of localization, initial wound size, wound stage, healing response, and treatment duration. The findings suggest a need for etiology-specific treatment strategies for pediatric pressure injuries, as well as the importance of developing risk management protocols specific to each wound type.