Braden Scale Research Articles

Physical Therapy Rehabilitation Management on Burn Injury: A Case Report

Introduction: Burns are incidents that cause damage to body tissues including the skin and surrounding tissues resulted from thermal exposures such as flames and extreme cold temperature (frostbite), or other causes. Physical therapy management play important roles in burn injury to improve functional status and reduce pain. In this article we will discuss the importance of physical therapy management in patient with burn injury
 Case description: A 61-year-old female patient was struck by fire caused by a gas stove explosion while cooking, and trapped in a closed room for 9 minutes. The patient has received debridement and continued physical therapy rehabilitation. The rehabilitation program was including range of motion (ROM) exercise, pumping exercise, breathing exercise, chest physical therapy, and positioning.
 Results: After undergoing physical therapy management for one week, the results showed a significant increase in the range of motion, muscle strength (shoulder, MMT= 4; elbow, MMT= 3; hip, MMT= 2; knee and ankle, MMT= 3), skin integrity (Braden Scale: 18, considered as low risk), and functional status (Barthel Index: 9, considered as moderate dependence). Conversely, the value of silent pain and tenderness were decreased (NPRS: 0/10 and 2/10, respectively). However, no change was observed in motion pain (NPRS: 3/10).
 Conclusions: Physical therapy rehabilitation can increase ROM, muscle strength, and function in the extremities. In addition, this rehabilitation program positively impacts improving the patient's functional abilities.

The effect of a pressure ulcer prevention care bundle on nursing workload costs

AimThis study investigated the effect of care under the guidance of a pressure ulcer prevention care bundle on pressure ulcer incidence rates and on nursing workload costs. Design, setting, and participantsThis prospective pre-post interventional study was conducted in an anesthesia and reanimation intensive care unit. The sample consisted of 16 nurses and 84 patients. MethodsThe study was conducted in two periods: (1) nursing workload of pre-care bundle period and (2) nursing workload of post-care bundle period. In the collection of data, 6 forms (the demographic data forms, the Braden scale, nurse information form, the care bundle follow-up form and nursing workload follow-up form) were administered. The main outcomes of the study; Pressure ulcer incidence rate was evaluated with Form V, and nursing workload costs were evaluated with Form VI. These forms were evaluated daily by the nurses. In the first period (15.09.2018–30.11.2018), pressure ulcer incidence rates and nursing workload costs were evaluated before training. Then, the researcher trained nurses on how to prevent pressure ulcers and use the care bundle. The care bundles components were risk assessment, skincare, activity, in-service training, nutrition, wetness/incontinence and support surface management, and keeping records. In the second period (01.12.2018–15.02.2019), pressure ulcer incidence rates and nursing workload costs were evaluated after the training. The outcomes of the two periods regarding the incidence of pressure ulcers and nursing workload costs were compared. ResultsThe pressure ulcer incidence rates before and after the care bundle were 22.1 and 13.0 per 100 patient-day, respectively. There was a decrease in pressure ulcer incidence rates after the care bundle, but it wasn't significant (p = 0.138). The total workload cost of pressure ulcer prevention was significantly lower after the care bundle than before (p = 0.001). ConclusionThe pressure ulcer incidence rates were lower after the care bundle than before, albeit insignificantly. The total pressure ulcer prevention workload costs were significantly lower after the care bundle than before. The reduction in pressure ulcer incidence and workload cost indicates that the use of care bundle is effective. Healthcare professionals in intensive care units should use a pressure ulcer prevention care bundle more often.

Effect of Varying Repositioning Frequency on Pressure Injury Prevention in Nursing Home Residents: TEAM-UP Trial Results.

ABSTRACTOBJECTIVETo investigate the clinical effectiveness of three nursing-home-wide repositioning intervals (2-, 3-, or 4-hour) without compromising pressure injury (PrI) incidence in 4 weeks.METHODSAn embedded pragmatic cluster randomized controlled trial was conducted in nine nursing homes (NHs) that were randomly assigned to one of three repositioning intervals. Baseline (12 months) and 4-week intervention data were provided during the TEAM-UP (Turn Everyone And Move for Ulcer Prevention) study. Intervention residents were without current PrIs, had PrI risk (Braden Scale score) ≥10 (not severe risk), and used viable 7-inch high-density foam mattresses. Each arm includes three NHs with an assigned single repositioning interval (2-, 3-, or 4-hour) as standard care during the intervention. A wireless patient monitoring system, using wearable single-use patient sensors, cued nursing staff by displaying resident repositioning needs on conveniently placed monitors. The primary outcome was PrI incidence; the secondary outcome was staff repositioning compliance fidelity.RESULTSFrom May 2017 to October 2019, 1,100 residents from nine NHs were fitted with sensors; 108 of these were ineligible for some analyses because of missing baseline data. The effective sample size included 992 residents (mean age, 78 ± 13 years; 63% women). The PrI incidence during the intervention was 0.0% compared with 5.24% at baseline, even though intervention resident clinical risk scores were significantly higher (P < .001). Repositioning compliance for the 4-hour repositioning interval (95%) was significantly better than for the 2-hour (80%) or 3-hour (90%) intervals (P < .001).CONCLUSIONSFindings suggest that current 2-hour protocols can be relaxed for many NH residents without compromising PrI prevention. A causal link was not established between repositioning interval treatments and PrI outcome; however, no new PrIs developed. Compliance improved as repositioning interval lengthened.

Medical device related pressure ulcers in Jordan: Prevalence study among critically ill patients.

BackgroundMedical device‐related pressure ulcers are increasingly common in critical care units. These ulcers can be complicated due to the necessity of the device for diagnosis or treatment.PurposeTo determine the prevalence of and risk for medical device‐related pressure ulcers in critical care units in Jordan in addition to identifying the preventive measures for those ulcers as well as identifying the most frequently used medical devices that cause ulcers and to assess the relationships between prevention measures and developing ulcers.MethodsA cross‐sectional survey was used to assess ulcers among 318 patients who were elder than 18 years old. Data collection was based on an outline published by the European Pressure Ulcer Advisory Panel, Braden Scale, and an author‐developed specific checklist.ResultsThe prevalence rate of medical device‐related pressure ulcers was 38.1%. Most affected sites were sacrum and heel, and most affected were those with old age, being admitted to public hospitals, and with a prolonged hospital stay. About half of the patients (46.3%) had severe risk. Only 17% of the patients who were at risk got adequate preventive measures. Face masks, endotracheal tubes, pulse oximetry probes, and intravenous catheters were associated with almost half of the ulcers.ConclusionMedical device‐related pressure ulcers are threats to patient safety and quality of nursing care in hospitals, which require determining appropriate preventive measures. Key messages:Medical device‐related pressure ulcers are common among patients in critical care units, which raise the need to evaluate the prevalence of such type of ulcers in those patients.Three hundred and eighteen patients were investigated for the prevalence of medical device‐related pressure ulcers through a cross‐sectional survey.Patients in critical care units in Jordan had a high prevalence rate for medical device‐related pressure ulcers, which require the need to apply appropriate preventive measures.

Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey.

PURPOSE:The purpose of this study was to evaluate the implementation of pressure injury (PI) prevention strategies in adult acute care settings in the United States using the data from the 2018/2019 International Pressure Ulcer Prevalence (IPUP) Survey.DESIGN:Observational, cohort study with cross-sectional data collection and retrospective data analysis.SUBJECTS AND SETTING:The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in the 2018 and/or 2019 IPUP Survey. Slightly less than half (49.4%, n = 146,231) were male, 50% (n = 148,997) were female, 0.6% (n = 17,760) were unknown. Their mean age was 64.29 (SD 17.2) years.METHODS:Data from the 2018/2019 IPUP database were analyzed to evaluate the implementation of prevention strategies including repositioning, support surface use, head-of-bed (HOB) elevation, heel elevation, moisture management, minimizing linen layers, and nutritional support. Practices were analyzed for differences between patients without pressure injuries, and patients with Stage 1 and 2 hospital-acquired pressure injury (HAPI), and those with severe HAPIs (Stage 3, Stage 4, unstageable, and deep tissue pressure injury). Acute care unit types included critical or intensive care units, medical-surgical inpatient care units, and step-down units.RESULTS:Compliance rates to PI prevention strategies varied among patients at risk for HAPIs (Braden Scale for Pressure Sore Risk score ≤18). Daily skin assessment was performed for 86% of patients with no HAPIs and 96.8% of patients with severe HAPIs. Pressure redistribution was used in 74.6% of all patients and in over 90% of patients with severe HAPIs; however, compliance to routine repositioning was reported at lower levels between 67% and 84%, respectively. Heel elevation was reported for over 60% of the patients with severe HAPIs while 31.9% did not receive heel elevation, though only 6% were reported as not needing elevation. The majority of patients had HOB greater than the 30° at the time of the data collection; compliance with minimizing linen layers (≤3) was reported in 76% or more. Moisture management strategies were reportedly used in more than 71% of all patients and 89% for patients with severe HAPIs. Nutrition support was used for 55% to 82% of the patients and only documented as contraindicated in fewer than 2% of all groups.CONCLUSION:Study findings revealed substantial compliance rates to PI prevention strategies. Nevertheless, there is potential for improvement in the implementation of some of the most basic prevention strategies including repositioning, heel elevation, nutritional support, and moisture management.

Evaluation of an educational film as a learning tool for nurses caring for seniors with pressure ulcers

Background: Pressure ulcers last to be a severe and prevalent health condition in hospitals; they have been considered the most physically debilitating and expensive problems of the twentieth century. Advanced pressure ulcers are common in the elderly; about 70% happen in cases 65 years or older, peaking range from 70 and 80. Many pressure ulcers are considered preventable or even treatable with the proper procedures to preserve skin integrity. Objectives: This work aims to evaluate the influence of an instructional film on nurses caring for seniors with pressure ulcers in terms of attitude and knowledge. Materials and Method. The research employed a quasi-experimental design and was conducted in intensive care Units of the General Mansoura Hospital, Specialized Medical Hospital, and Emergency Hospital in Dakhalia governorate. The research surveyed 69 nurses. Two instruments were utilized in this research: the Braden Scale and a two-part structured interview schedule sheet. Results: Following the educational film, the nurse's practice and knowledge increased, plus there was an enhancement in wound healing of pressure ulcers for older adults. Conclusion: This study concluded that nurses' knowledge and attitude have improved after displaying the educational film program.

Overall Survival among Patients with Cancer and Pressure Injury and Its Association with Braden Scale Score.

Background: The overall survival (OS) of hospitalized cancer patients with pressure injury (PI) has not been studied in a large cohort. Objective: To assess risk factors associated with OS of hospitalized cancer patients with PI. Methods: After IRB approval, charts of 445 hospitalized cancer patients with PI were reviewed. Kaplan-Meier method was used to estimate the OS time and log-rank test was used to assess the association between OS and other variables. Results: Stage 1, 2, 3, 4, deep tissue injury, unstageable, and unknown stage were 79 (17.8%), 91 (20.4%), 24 (5.4%), 3 (0.7%), 144 (32.4%), 36 (8.1%), and 68 (15.3%), respectively. The OS rate is 55.3% at one month. OS is significantly associated with Braden Scale (BS) Score. The OS time is significantly shorter in patients with advanced disease. Conclusion: Cancer patients with PI have limited OS, especially those with ≤14 BS and advanced diseases.

Risk factors for hospital-acquired and community-acquired pressure injuries: a multicentre mixed case–control study

ObjectivesTo separately examine and comprehensively compare the risk factors for hospital-acquired (HAPIs) and community-acquired pressure injuries (CAPIs).DesignA mixed case–control study.SettingFour medical centres in China.ParticipantsInclusion criteria included patients who were (1)...

Pressure Injury Development, Mitigation, and Outcomes of Patients Proned for Acute Respiratory Distress Syndrome.

To describe trends and risk factors for pressure injuries (PIs) in adult critical care patients proned to alleviate acute respiratory distress syndrome secondary to COVID-19 and examine the effectiveness of products and strategies used to mitigate PIs. The authors conducted a retrospective chart review between April 9 and June 8, 2020. Demographic data were analyzed using descriptive statistics. Differences between groups with and without PIs were analyzed. Among 147 patients, significant PI risk factors included male sex (P = .019), high body mass index (>40 kg/m2; P = .020), low Braden Scale score (<12; P = .018), and low-dose vasopressor therapy (P = .020). Taping endotracheal tubes (ETTs) caused significantly fewer facial PIs than commercial ETT holders (P < .0001). Maximum prone duration/session was a significant risk factor for anterior PIs (P = .016), which dropped 71% with newer pressure redistribution products. d-Dimer greater than 3,200 μg/mL (P = .042) was a significant risk factor for sacrococcygeal PIs while supine. Mortality was 30%; significant risk factors included age older than 60 years (P = .005), Sequential Organ Failure Assessment score greater than 11 (P = .003), and comorbid congestive heart failure (P = .016). Taping the ETT, limiting the maximum duration of prone positioning to less than 32 hours, and frequent repositioning while supine may reduce the number of modifiable risk factors for PIs. Standardized methods for testing products for PI prevention will inform individualized patient care.

Risk Factor Forecasting System for Pressure Injuries Through Artificial Neural Network

The appearance of pressure injuries is very common in patients bedridden for a long time due to a surgical procedure or a recovery process caused by an accident. Many studies have been carried out to monitor and prevent this condition, but the methodology used requires the direct or indirect intervention of a health professional to classify the risk of wound development. This study aims to demonstrate the development of a system capable of predicting the risk factor for the development of pressure injuries through the analysis of the Braden Scale parameters inserted by a health professional on an electronic interface, where through an algorithm based on artificial neural networks, which is responsible for processing, it will be possible to carry out the classification of the risk factor for pressure injuries. To acquire the friction and shear parameters, force sensors were used in a matrix architecture, together with a signal conditioning circuit as well as a control and communication drive via USB with the computer for sending data, as well as a graphical interface for entry of other parameters by the health professional.

Comparison of The Assessment of The Braden Scale and The Gosnell Scale in Assessing The Level of Risk of Pressure Sores in Bed Rest Patients

Background: Pressure sores will make the healing process take a long time. Skin care to prevent pressure sores can be started since the patient is identified as being at risk for pressure ulcers through a pressure ulcer risk assessment, a pressure ulcer risk assessment method using two scales, namely the Braden and Gosnell scales.&#x0D; Objectives: This study aims to compare the assessment of the Braden scale and the Gosnell scale in assessing the level of risk of pressure sores in bed rest patients.&#x0D; Methods: This research design uses quantitative with comparative studies. The population is 706 people with a total sample of 61 people by accidental sampling. The research was conducted on 12 August – 25 September 2020. Data were analyzed univariate and bivariate using test Kappa.&#x0D; Results: The results show that most of the risk levels of pressure sores are more with moderate risk as much as 47.5% assessed by the Braden scale. Most of the level of risk of pressure sores is more with a mild risk of 62.3% assessed by the Gosnell scale. The Gosnell scale is better used to measure pressure sores in bed rest patients in the Inpatient Room at Bhayangkara Hospital Jambi in 2020 by showing the Kappa test value of 0.797.&#x0D; Conclusion: The Gosnell scale is better used to measure pressure sores in bed rest patients. It is recommended that the Gosnell test scale be applied in hospitals as an assessment of the risk of pressure sores in bed rest patients.

Factors affecting the incidence and prevalence of pressure ulcers in COVID-19 patients admitted with a Braden scale below 14 in the intensive care unit: Retrospective cohort study.

The pandemic of coronavirus (COVID‐19) has significantly increased the admission of patients with extensive complications, especially for respiratory support, to intensive care units (ICUs) worldwide. These patients also suffer from pressure ulcers (PUs) as another complication that occurs due to increased length of hospitalisation and acute conditions of patients. Therefore, this study aimed to evaluate the incidence and prevalence of PU and the factors affecting it in COVID‐19 patients admitted to ICUs. This cohort retrospective study used registry data in Imam Reza Hospital located in west of Iran. Four hundred and forty‐five COVID‐19 patients older than 20 years hospitalised in corona ICUs from 20 March 2020 to 30 December 2020, with a Braden score of less than 14 were included in the study. To investigate the relationship between variables in rate prevalence, univariate logistic regression analysis was used to calculate odds ratio, and for incidence rate in estimating PU risk generated in ICUs, hazard ratio was calculated using cox regression. One hundred and eighty‐three (41.12%) patients were male. The mean age of patients was 63 (SD = ±9.78) years. A total of 1152 cases of PU were generated, with the highest prevalence of PU with 234 cases in the sacrum. One hundred and seventy‐six (55.87%) patients underwent non‐invasive ventilation ulcers. The prevalence of PU was 79.7%. The highest prevalence was found in people over 80 years with 90.67%. The incidence ratio was 46.74%. The highest number of new cases was seen in diabetic patients with 60.96%. First‐degree ulcers were the most common degree of ulceration in 252 (55.38%) patients. Incidence and prevalence excluding first‐degree wounds were 24.04% and 49.66%, respectively. Age, Braden score, BMI, comorbidity, diabetes mellitus, stool incontinence, Glasgow coma scale, vasopressor, and length of hospital stay were significantly associated with PU (P < .05). The incidence and prevalence of PU in patients were high in this study. The length of hospitalisation and Braden score were the most important factors in the development of PU. The widespread prevalence of COVID‐19 and the relatively long stay of patients in the ICU created unfavourable conditions for patients and the treatment system, therefore, it emphasised the use of appropriate measures to prevent PU to avoid double costs and longer stays.

Munro Pressure Ulcer Risk Assessment Scale in Adult Patients Undergoing General Anesthesia in the Operating Room.

Pressure ulcers are a common complication of immobility and frequently occur in surgical patients. The occurrence of pressure ulcers is affected by many factors, such as operation time and position, anesthesia method, and postoperative nursing. The aim of this study was to investigate the Munro Pressure Ulcer Risk Assessment Scale's value in predicting acute pressure ulcers in general anesthesia patients. This case-control study included patients who underwent more than 2 hours of general anesthesia in our hospital from January 2018 to December 2020. The case group comprised 42 patients who had pressure sores in surgical compression sites within 3 days after surgery. The control group consisted of 84 patients without acute pressure sores after surgery. Baseline patient data were compared between the two groups, and a logistic multivariate model was used to analyze potential risk factors for acute pressure ulcers. The Munro Pressure Ulcer Risk Assessment Scale scores and Braden scale scores were compared between the two groups during and after surgery. A receiver operating characteristic curve was used to evaluate the clinical value of the two scales (administered at the two time points) in predicting the occurrence of acute pressure ulcers after surgery. The operation and anesthesia times of patients in the case group were longer than those in the control group (P < 0.05). The proportion of comatose patients and patients with diabetes were significantly higher in the case group. While the case group had higher Munro scores during and after surgery compared to the control group (P < 0.05), Braden scores at the corresponding time points were lower (P < 0.05). The following variables were identified as independent risk factors of acute pressure ulcers: prolonged operation time and anesthesia time, increase in Munro scores during and after operation, decrease in Braden scores during and after operation, and comatose status (P < 0.05). The area under the receiver operating characteristic curve (AUC) of the postoperative Munro score for predicting postoperative pressure ulcer risk was 0.774; the sensitivity and specificity were 67.73% and 80.58%, respectively. The AUC of the intraoperative Braden score for predicting postoperative pressure ulcer risk was 0.836, with a sensitivity of 78.95% and specificity of 78.00%. The AUC of the postoperative Braden score for predicting postoperative pressure ulcer risk was 0.809, with a sensitivity of 73.58% and specificity of 64.26% (P < 0.05). Our results indicate that the intraoperative Munro Pressure Ulcer Risk Assessment Scale is highly effective for predicting the risk of postoperative pressure ulcers in surgical patients who require general anesthesia.

Evaluation of Patients’ Adverse Events During Contact Isolation for Vancomycin-Resistant Enterococci Using a Matched Cohort Study With Propensity Score

Although contact isolation has been widely recommended for multidrug-resistant organisms, contact isolation has raised some concerns that it may bring unintended patient harms. To compare adverse events between a contact isolation group with vancomycin-resistant Enterococcus (VRE) and a matched comparison group using a relatively large data set from full electronic medical records (EMR) and propensity score-matching methods. This retrospective, matched cohort study was conducted at Seoul National University Bundang Hospital (SNUBH) in Korea, a tertiary, university-affiliated hospital that has 1337 inpatient beds. Participants included a total of 98 529 hospitalized adult patients (aged ≥18 years) during 2015 to 2017. Contact isolation in a single or shared double room. As adverse contact isolation-related outcomes, falls and pressure ulcers were included. All relevant EMR data were extracted from the SNUBH clinical data warehouse. Risk factors for adverse events were included in the propensity score model based on literature reviews, such as Braden scale score and Hendrich II fall risk score. A fine stratification and weighting (FSW) and a 1:10 nearest neighbor (NN) propensity score matching as a sensitivity analysis were adopted to compare adverse events between the 2 groups for the observation period from the study entry date and the exit date. Time-to-event analyses with a Cox proportional hazard model were conducted in December 2021. For comparison of outcomes in wards, 177 patients (mean [SD] age, 67.38 [14.12] years; 98 [55.4%] female) with VRE and 93 022 patients (mean [SD] age, 56.44 [16.88] years; 49 462 [53.2%] female) without VRE were included and no difference was found in basic characteristics from the FSW (VRE contact isolation [n = 172] vs comparison [n = 69 434]) as well as from the 1:10 NN (VRE contact isolation [n = 168] vs comparison [n = 1650]). Among 177 patients with VRE contact isolation, 8 pressure ulcers and 3 falls occurred during their hospital stays; incidence rates of adverse events were 2.5 and 0.9 per 1000 patient-days, respectively (pressure ulcer incidence rate from the FSW: 2.53 per 1000 patient-days [95% CI, 1.09-4.99 per 1000 patient-days]; pressure ulcer incidence rate from the 1:10 NN: 2.54 per 1000 patient-days [95% CI, 1.10-5.01 per 1000 patient-days]; fall incidence rate from the FSW: 0.87 per 1000 patient-days [95% CI, 0.18-2.54 per 1000 patient-days]; fall incidence rate from the 1:10 NN: 0.87 per 1000 patient-days [95% CI, 0.18-2.55 per 1000 patient-days]). The hazard ratios for adverse events showed no statistically significant differences for both groups: 1.42 (95% CI, 0.67-2.99) for pressure ulcer and 0.66 (95% CI, 0.20-2.13) for fall from the FSW. In this cohort study, no association was found between the likelihood of adverse events and contact isolation using propensity score-matching methods and closely related covariates for adverse events.

Intensive Care Pressure Injuries: A Cohort Study Using the CALCULATE and Braden Scales.

Identify both the risk of developing pressure injuries (PIs) by applying the CALCULATE (CriticAL Care pressure ULcer Assessment Tool made Easy) and Braden Scales and the incidence of PIs in adult patients in intensive care. This prospective cohort study was conducted from March 2016 to February 2017 in an adult ICU. The Braden and CALCULATE scales were applied every 48 hours until medical discharge, death, or PI development. The sample included 100 patients. The investigators obtained 818 evaluations (409 Braden and 409 CALCULATE) with an average of 4.1 observations per patient. According to the CALCULATE scale, 49 participants (49%) were classified as very high risk, compared with 40 participants (40%; P = .204) according to the Braden Scale. Thirty-five patients developed 37 PIs, with a total incidence of 35%. The mean age of patients who developed PIs was 60.3 (SD, 13.7) years, and they averaged 9.2 (SD, 6.8) days of hospitalization, with diagnoses related to cardiorespiratory and neurologic diseases and associated comorbidities of hypertension, diabetes mellitus, and smoking. The most affected site was the sacral region; 64.9% of the injuries were classified as stage 1. Patients in intensive care were high risk according to both PI scales, and many developed PIs. It is evident that even when preventive measures are used, they are insufficient without the implementation of preventive protocols.

Validez convergente y discriminativa del índice Frágil-VIG con la escala de Braden en personas atendidas en atención domiciliaria

The Frail-VIG index and the Braden scale are validated instruments for assessing frailty and the risk of developing dependency-related skin lesions respectively. The Frail-VIG index is a multidimensional instrument that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. ObjectiveOur aim was to investigate the convergent and discriminative validity of the Frail-VIG index with regard to Braden scale value. MethodsWe carried out a cross-sectional study in 2 primary health care centres of the Catalan Institute of Health, Barcelona (Spain). Participants in the study were all people included under a home care programme during the year 2018. No exclusion criteria were applied. We used the Frail-VIG index to measure frailty and the Braden scale to measure the risk of developing pressure ulcers. Trained nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient. ResultsFour hundred and twelve participants were included. Frail-VIG score and Braden scale value were negatively correlated (r=−0.597; P<.0001). Non-frail people had a lower risk of developing dependency-related skin lesions than moderate to severe frail people. The Braden scale value declined significantly as the Frail-VIG index score increased. ConclusionsFrail-VIG index demonstrated a convergent validity with the Braden scale. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with a higher and lower risk of developing. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.

Factors Associated With Pressure Injury Development in Older Hospitalized Patients: A Prospective Descriptive Study

BACKGROUND: Pressure injuries (PIs) can occur in immobile patients, with advancing age increasing the risk of their development. PURPOSE: To investigate factors associated with the development of PIs in older patients who were hospitalized. METHODS: A prospective descriptive study was conducted in August and September 2018 at the Department of Geriatrics, Jiangsu Province Hospital, China. Hospitalized patients aged 65 years and older were enrolled and monitored for 1 month. RESULTS: Pressure injuries developed in 20 participants (16.7%). Patients in whom PIs developed showed lower hemoglobin levels, thinner skinfold thickness, higher sacrococcygeal pressure, higher Ohura-Hotta scale scores, lower Braden scale scores, lower body mass index, and lower albumin levels compared with those in whom PIs did not develop. Multivariate analysis showed that higher sacrococcygeal pressure (odds ratio [OR] = 1.06; 95% confidence interval [CI], 1.00-1.11, P = .045), lower Braden scale score (OR = 0.66; 95% CI, 0.48-0.92; P = .012), and lower albumin level (OR = 0.66; 95% CI, 0.49-0.89; P = .006) were independent predictors of PIs. CONCLUSION: Additional studies are needed to evaluate sacrococcygeal pressure, Braden scale score, and albumin levels as independent predictors of PIs in older hospitalized patients.

Assessment of the accuracy of the CALCULATE scale for pressure injury in critically ill patients

IntroductionPressure injury is damage to the skin and underlying soft tissue that occurs in response to intense and/or prolonged skin pressure. The Braden scale is the most used in health services to assess pressure injury. However, this scale was not specifically developed for critically ill patients. The Critical Care Pressure Ulcer Assessment Tool Made Easy (CALCULATE) scale was developed for patients in intensive care units. ObjectiveThe objective of this study was to compare the accuracy of the CALCULATE scale with that of Braden in predicting the risk of pressure injury in critically ill patients. MethodsThis was a prospective cohort study, involving patients who did not have pressure injury on admission to the intensive care unit of a tertiary hospital in the city of Porto Alegre, Brazil. Data collection took place between January and July 2020 using the Braden and CALCULATE scales, in addition to clinical and sociodemographic variables. Patients were followed up until discharge from the intensive care unit or death. ResultsFifty-one patients were included in the study. Of these, 29 (56.9%) developed pressure injury. To predict pressure injury onset, the areas under the receiver operator characteristic curve of the Braden scale on the first day and the lowest score during the first 3 days were 0.71 (0.56–0.86) and 0.70 (0.53–0.87), respectively. The areas under the receiver operator characteristic curve of the CALCULATE scale on the first day and the highest score during the first 3 days were 0.91 (0.82–0.99) and 0.92 (0.85–1.00), respectively. In the logistic regression analysis, the CALCULATE scale on the first day remained an independent predictor of pressure injury onset after controlling for age and length of stay in the intensive care unit. ConclusionWe found that the CALCULATE scale may be more accurate than the Braden scale as a tool to assess the risk of developing pressure injury in critically ill patients.

Predictors of COVID-19 disease severity augment the Braden scale in the prediction of pressure ulcer development among COVID-19–positive intensive care unit patients: A case-control study

Predictors of COVID-19 disease severity augment the Braden scale in the prediction of pressure ulcer development among COVID-19–positive intensive care unit patients: A case-control study

Efficacy of nutritional support protocol for patients with pressure ulcer: comparison of before and after the protocol

ObjectivesBecause most patients who develop pressure ulcer (PU) are malnourished, additional nutritional support is important for PU improvement. The aim of this study was to investigate the potential benefit of a simple nutritional support protocol in PU improvement. MethodsThis study was a comparative before-and-after study, prospectively performed from May to December 2020. Participants were inpatients of Seoul National University Hospital (SNUH), South Korea. Among the patients who developed PU from May to December 2020, those on enteral nutrition were included in the protocol group. Application of the nutritional support protocol was established in May 2020 in SNUH. Serum levels of prealbumin, transferrin, cholesterol, and zinc were measured initially and 2 and 4 wk after protocol application to evaluate clinical course. A tailored regimen that adjusted the amount of protein and trace elements was provided according to consultation with the nutritional support team. Size and Pressure Ulcer Scale for Healing was evaluated every 2 wk by the same nurse in charge of PU. To validate the efficacy of the protocol, patients who developed PU from May to December 2018, were hospitalized for >2 wk, and who received enteral nutrition were selected as a control group. ResultsSixty-one patients were included in the protocol group and 100 were in the control group. The protocol group had a higher proportion of PU improvement (85.2 versus 50%; P < 0.001), daily protein intake (1.6 ± 3.2 versus 0.9 ± 0.4; P = 0.048), Braden scale (12.9 ± 1.8 versus 12.3 ± 1.8; P = 0.025), and baseline albumin level (3.1 ± 0.5 versus 2.8 ± 0.4; P = 0.001) when compared with the control group. Multivariate analysis showed that implementation of the nutritional support protocol was the most effective factor in improving PU (odds ratio, 0.18; 95% confidence interval, 0.089–0.366; P < 0.001). ConclusionsA simple nutritional support protocol was easy to develop and its application contributed significantly to the recovery of PU.