Pressure ulcer in patients with severe traumatic brain injury: significant factors and association with neurological outcome

Abstract

To assess the factors associated with development of pressure ulcer in patients with severe traumatic brain injury (TBI) and study its prognostic significance with respect to neurological outcome at three months. Patients with severe TBI are prone to develop pressure ulcer due to various factors, which have never been studied in detail. Prospective longitudinal study. Eighty-nine patients of TBI in age group 20-60 years admitted with Glasgow Coma Scale (GCS) 4-8 without serious systemic disorder were enrolled for the study. Patient characteristics, haemoglobin, serum albumin levels at admission and their weekly changes till 21 days were noted along with daily assessment for presence of pressure ulcer. Mortality was assessed at 21 days and neurological outcome at three months through telephonic interview. Of 89 patients studied, pressure ulcer was observed in 6 (7%) and 14 (16%) at the end of two and three weeks, respectively. Pressure ulcer in univariate analysis was significantly associated with poorer GCS (p = 0·05), delayed enteral feeding (p = 0·005) and fall in haemoglobin at two weeks (p = 0·005). Only the latter two were found significant in multivariate analysis. Age, gender, surgical intervention, tracheostomy, prolonged fever and change in albumin had no significant association with pressure ulcer development. Presence of pressure ulcer was significantly associated with mortality at 21 days (p = 0·006) and unfavourable neurological outcome at three months (p = 0·01). The significant factors influencing pressure ulcer development in patients with TBI were delayed enteral feeding and fall in haemoglobin. Pressure ulcer had significant association with mortality at 21 days and recovery status at three months. Early nutritional supplementation and monitoring of haemoglobin should be an important part of nursing care interventions for patients at increased risk of developing pressure ulcer.