SIRA + P: Development and Testing

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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 subjects < 30 days of age, the comparison scale was the Neonatal Skin Risk Assessment Scale (NSRAS); for subjects 31 days through 17 years, the Braden Q Scale (Braden Q) was used; and for subjects 18 years 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.


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).


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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