As part of a quality improvement study, the incidence and severity of altered skin integrity in a tertiary pediatric intensive care unit (PICU) were investigated in an attempt to identify contributing risk factors. Demographic, severity of illness, and practice variables were collected on 271 of 357 admissions during an 18-week period. Data were analyzed from the date of PICU admission until a change in skin integrity occurred or until PICU discharge. Altered skin integrity occurred in 26 percent of admissions; 7 percent of the cases had skin breakdown. By multivariate analysis, only the Pediatric Risk of Mortality Score and white race were associated with altered skin integrity.