Risk factors related to the development of pressure ulcers in the critical care setting.

AIM This study identified risk factors for pressure ulcer development early in the admission stage to determine what appropriate interventions might be conducted early in the admission stage to decrease the risk of pressure ulcer development. BACKGROUND Among patients who develop pressure ulcers, 8-40% of them occur in a critical care setting. Therefore, the development of pressure ulcers is a common problem. DESIGN Prospective cohort study. METHODS The study facility was a 606-bed tertiary care hospital. Ninety eight patients admitted to the intensive care unit (ICU) or the high care unit (HCU) from 16 April 2003-15 July 2003 were evaluated in the final analysis. RESULTS The mean patient age was 62.3 (SD 16.1) years, and the incidence of pressure ulcers in this study was 11.2% during the observation period. Multivariate analysis showed that 'emergency ICU/HCU patients' and 'infrequent turning' were related to pressure ulcer development. Patients with pressure ulcers experienced significantly fewer turns and repositionings (OR = 0.452, 95% CI: 0.212-0.966], p < 0.05. Fewer pressure ulcers developed in scheduled ICU/HCU patients than in emergency ICU/HCU patients (OR = 0.041 [95% CI: 0.004-0.470], p < 0.01). CONCLUSION There was no relationship between pressure ulcer development and APACHE II score, or any medication that affected skin integrity. The frequency of turning and repositioning and patients with an emergency admission to the ICU/HCU can be the prognostic indicators for developing scoring system in critical care settings. RELEVANCE TO CLINICAL PRACTICE These patients admitted directly to ICU or HCU were in a high risk group, further preventive strategies will be required.

[1]  G. Meininger,et al.  Effect of vasodilation and vasoconstriction on microvascular pressures in skeletal muscle. , 1991, Microcirculation, endothelium, and lymphatics.

[2]  J. Bridel.  Assessing the risk of pressure sores. , 1993, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[3]  S. Stordeur,et al.  The importance of repeated risk assessment for pressure sores in cardiovascular surgery. , 1998, The Journal of cardiovascular surgery.

[4]  D. Gosnell,et al.  Pressure ulcer incidence and severity in a community hospital. , 1992, Decubitus.

[5]  D. Langemo,et al.  Pressure ulcer incidence in an acute care setting. , 1996, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[6]  S. Pang,et al.  Predicting pressure sore risk with the Norton, Braden, and Waterlow scales in a Hong Kong rehabilitation hospital. , 1998, Nursing research.

[7]  P. French,et al.  Which pressure sore risk calculator? A study of the effectiveness of the Norton scale in Hong Kong. , 1997, International journal of nursing studies.

[8]  K. Gebhardt.  Tissue viability. Preventing pressure sores in orthopaedics. , 1992, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[9]  N. Bergstrom,et al.  The Braden Scale for Predicting Pressure Sore Risk , 1987, Nursing research.

[10]  D. Langemo,et al.  National Pressure Ulcer Advisory Panel's Updated Pressure Ulcer Staging System , 2007, Dermatology nursing.

[11]  J. L. Gall,et al.  APACHE II--a severity of disease classification system. , 1986, Critical care medicine.

[12]  R. N. J. Seongsook,et al.  Validity of pressure ulcer risk assessment scales; Cubbin and Jackson, Braden, and Douglas scale , 2004 .

[13]  K. Inman,et al.  Pressure ulcer prevention: a randomized controlled trial of 2 risk-directed strategies for patient surface assignment. , 1999, Advances in wound care : the journal for prevention and healing.

[14]  D Norton,et al.  Calculating the risk: reflections on the Norton Scale. , 1989, Decubitus.

[15]  Nicholas Graves,et al.  Effect of Pressure Ulcers on Length of Hospital Stay , 2005, Infection Control &#x0026; Hospital Epidemiology.

[16]  C. Álvarez-Nieto,et al.  Risk assessment scales for pressure ulcer prevention: a systematic review. , 2006, Journal of advanced nursing.

[17]  Douglas S. Wilson.  Anæsthesia for cæsarean section , 1950, Irish journal of medical science.

[18]  N. Bergstrom,et al.  The Braden Scale for Predicting Pressure Sore Risk , 1987, Nursing research.

[19]  D. Langemo,et al.  National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. , 2007, Advances in skin & wound care.

[20]  H. Sanada,et al.  The Japanese pressure ulcer surveillance study: a retrospective cohort study to determine prevalence of pressure ulcers in Japanese hospitals. , 2008, Wounds : a compendium of clinical research and practice.

[21]  C. Lehman,et al.  Protecting the skin of the elderly patient in the intensive care unit. , 1996, Critical care nursing clinics of North America.

[22]  W. Hop,et al.  The clinical relevance of the waterlow pressure sore risk scale in the ICU , 1998, Intensive Care Medicine.

[23]  Julian Hunt.  Application of a pressure area risk calculator in an intensive care unit. , 1993, Intensive & critical care nursing.

[24]  K. Beckrich,et al.  Hospital-acquired pressure ulcers: a comparison of costs in medical vs. surgical patients. , 1999, Nursing economic$.

[25]  R. Allman,et al.  Pressure ulcer risk factors among hospitalized patients with activity limitation. , 1995, JAMA.

[26]  Capobianco Ml,et al.  Factors affecting the predictive validity of the Braden Scale. , 1996, Advances in wound care : the journal for prevention and healing.

[27]  R. Lincoln,et al.  Use of the Norton Pressure Sore Risk Assessment Scoring System with elderly patients in acute care , 1986, Journal of enterostomal therapy.

[28]  Midori Yamamoto,et al.  Comparison of therapeutic intervention and life-saving effects in patients with various disease categories treated in an intensive care unit , 1999 .

[29]  C. Fife,et al.  Incidence of pressure ulcers in a neurologic intensive care unit , 2001, Critical care medicine.

[30]  C. Theaker,et al.  Risk factors for pressure sores in the critically ill , 2000, Anaesthesia.

[31]  R. Halfens,et al.  Prevalence, risk factors and prevention of pressure ulcers in Dutch intensive care units. Results of a cross-sectional survey. , 2001, Intensive care medicine.

[32]  R. Halfens,et al.  Pressure ulcer prevalence in intensive care patients: a cross-sectional study. , 2008, Journal of evaluation in clinical practice.

[33]  N. Graves,et al.  Modeling the economic losses from pressure ulcers among hospitalized patients in Australia , 2005, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[34]  Soumitra R. Eachempati,et al.  Factors influencing the development of decubitus ulcers in critically ill surgical patients , 2001, Critical care medicine.

[35]  N. Stotts,et al.  Patients With Existing Pressure Ulcers Admitted to Acute Care , 2000, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[36]  Barbara Montgomery Dossey PhD Rn Ahn-Bc Faan,et al.  A Conceptual Schema for the Study of the Etiology of Pressure Sores , 2000 .

[37]  B. St,et al.  Effect of vasodilation and vasoconstriction on microvascular pressures in skeletal muscle. , 1991 .

[38]  D. E. Lawrence,et al.  APACHE—acute physiology and chronic health evaluation: a physiologically based classification system , 1981, Critical care medicine.

[39]  B. Cubbin,et al.  Trial of a pressure area risk calculator for intensive therapy patients. , 1991, Intensive care nursing.

[40]  Erik Buskens,et al.  Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers , 2002, BMJ : British Medical Journal.