Abstracts

Rationale: Pressure ulcers result from vertical pressure which compresses underlying tissue and small blood vessels, hindering blood flow and nutrient supply. Patients undergoing long-term EEG monitoring, have an increased risk of dermal breakdown where the scalp electrodes are applied. Our objective was to assess the frequency of pressure ulcers and possible contributing factors in children who are admitted to an epilepsy monitoring unit. Methods: All children admitted to the epilepsy monitoring unit at Childrens of Alabama between January and May, 2013 were assessed. Prior to the electrode application, the patients were given a Braden Scale score, a measure of mobility, nutrition, and friction (range 0-30; a score <21 indicates developmental delays and poor nutritional status). In addition, a visual inspection of the bony prominences such as the inion, mastoid and the forehead was performed. Scalp electrodes were applied with Ten20 conductive paste at designated locations using 10-20 placement guidelines. A gauze wrap was used to cover and secure the electrodes in preparation for extended monitoring. Each patient s head and electrode location was checked daily for redness and irritation at the most vulnerable locations-inion, mastoid, and forehead. When the electrodes were removed at the termination of video/EEG monitoring, the dermis was checked for breakdown.Results: 205 pediatric patients were evaluated for an average of 123 hours (23-260). Twenty three of 205 patients (11%) developed dermal breakdown at the site of electrodes by study termination. Average Braden Scale scores were similar for both groups, 26 (with skin break down) versus 27 (no skin break down). However, the patients with no skin ulcers were monitored for 51.2 hours (18-241) versus 95 hours (41-260) for those with skin break down.Conclusions: Our results indicate that approximately 10% of all pediatric patients develop skin ulceration because of EEG electrodes during an admission to the epilepsy monitoring unit. Factors promoting ulceration do not include nutritional or developmental status. The duration of long term EEG monitoring may be the strongest predictor of skin ulceration.