Braden Score Research Articles

Tree-based Approach to Predict Hospital Acquired Pressure Injury

Despite technical advances in healthcare, the rates of hospital-acquired pressure injury (HAPI) are still high although many are potentially preventable. The purpose of this study was to determine whether tree-based prediction modeling is suitable for assessing the risk of HAPI in ICU patients. Retrospective cohort study has been carried out. A decision tree model was constructed with Age, Weight, eTube, diabetes, Braden score, Isolation, and Number of comorbid conditions as decision nodes. We used RStudio for model training and testing. Correct prediction rate of the final prediction model was 92.4 and the Area Under the ROC curve (AUC) was 0.699, which means there is about 70% chance that the model is able to distinguish between HAPI and non- HAPI. The results of this study has limited generalizability as the data were from a single academic institution. Our research finding shows that the data-driven tree-based prediction modeling may potentially support ICU sensitive risk assessment for HAPI prevention.

Spinal cord function status and risk factors of pressure injury in patients with spinal dural arteriovenous fistula: a correlation study

Objective To explore the correlation between spinal cord function and the risk of pressure injury in patients with spinal dural arteriovenous fistula (SDAVF) . Methods A total of 65 patients with SDAVF treated in Neurosurgery Department in Xuanwu Hospital between March 2013 and December 2016 was carried out. The Modified Aminoff-Logue Score (mALS) and Braden pressure Ulcer Risk Factor Assessment Scale were used to evaluated the spinal cord and the risk of pressure ulcers of the patients with SADVF. Spearman was used to analyze the correlation. Results The Preoperative mALS was (5.15±2.62) , and the Braden score was (20.88±2.09) . The postoperative Braden score was (17.25±1.61) , The result of Spearman correlation analysis showed that the total score of preoperative mALS was negatively correlated with the total score of Braden (r=-0.597, P<0.01) . Conclusions Preoperative spinal cord function was slightly impaired in patients with SDAVF. The risk of postoperative pressure injury decreased when patients have better spinal cord function. The risk of pressure injury after operation is higher than that before operation. Key words: Pressure ulcer; Spinal dural arteriovenous fistula; Spinal function; Pressure sores; Correlation analysis

Risk assessment tools for the prevention of pressure ulcers.

Risk assessment tools for the prevention of pressure ulcers.

Pressure Ulcer Prevalence, Incidence, Risk, Clinical Features, and Outcomes Among Patients in a Turkish Hospital: A Cross-sectional, Retrospective Study

This study was conducted to assess PU prevalence, incidence, clinical features, nursing care measures, and patient variables and outcomes among inpatients admitted to 13 internal medicine departments at a university hospital in Turkey between 2010 and 2014. Using a cross-sectional, retrospective design, records of all hospitalized patients were reviewed and records from patients with a PU abstracted. Patient demographics, diagnosis, Braden Scale score, and PU information were abstracted from patient files/electronic records. Data were collected to an electronic data collection form between January and December 2015 and analyzed using descriptive statistics, chi-squared, one-way analysis of variance, and Student's t test. From a population of 20 175 patients, the records of 664 patients showed the presence of a PU; the total PU prevalence rate was 3.3% and the overall PU incidence rate for 5 years was 1.8%. Ulcers were most often Stage 1 (326. 49.1%), located at the sacrum (364, 54.8%), and hospital-acquired (370, 55.7%; 175 (56%) of PU patients were oncology patients, followed by dementia/Alzheimer's patients (31, 9.2%). A significant relationship between Braden scores and general diagnoses was found (P <.01). PU incidence was highest in patients with cancer and patients >65 years old, and patients with a diagnosis of dementia/Alzheimer's were at highest risk. Many patients outside of acute care settings have a PU. Risk assessments should be conducted and appropriate nursing interventions should be provided during facility admission and follow-up care. Prospective studies on the prevention of PU development in patients at risk are warranted.

Prediction of In-Hospital Pressure Ulcer Development.

Objective: The development of in-hospital acquired pressure ulcers (PUs) is of great concern for both patients and professionals in health care. Based on the hypothesis that identification of patients who are prone to develop PU will enhance preventive measures in this group of patients, we investigated a new tool, Qscale, for in-hospital prediction of PU. Approach: A total of 383 patients were recruited from three departments. The investigations were performed in two steps: 252 patients were used to train the algorithm, and 131 patients were used in the validation. The new scale combines observational and on-site available information regarding patient mobility. Results: The validation data yielded an area under the curve (AUC) of 0.82. The Qscale had a significantly higher AUC compared with that of the Braden Scale with an AUC of 0.76 (p < 0.05). When comparing the performance at specific thresholds, a sensitivity of 47% and a specificity of 94% were observed. This was significantly (p < 0.05) better than the Braden score with a sensitivity of 20% and a specificity of 94%. Innovation: Our study showed promising results on both the training and validation data of the Qscale in comparison with the Braden Scale. Conclusion: The new scale has a potential benefit in the prevention of PU in a hospital setting.

Ensinando a Escala de Braden como estratégia para melhoria da qualidade da assistência em enfermagem

Background: The rates of adverse events are used as indicators of quality of healthcare services. One of the indicators of healthcare quality is the absence or presence of Pressure Ulcer, which causes physical and emotional disorders to the patient, presenting a huge challenge for health institutions due to the long recovery time and permanence required by the injury, raising the costs of the hospital stay. Description of the experience: This is a descriptive study, based on a experience report about the activities developed in an Extension Project and the main goal of this study was to enable the nursing team to correctly fill the Braden Scale, in order to ensure safe patient care to the patients treated at a clinic in a public hospital in Belem-PA. It was developed from March/2016 to February/2017. A total of 43 nursing professionals were trained in the morning, afternoon and evening shifts, with 8 nurses, 16 technicians and 19 nursing assistants. First, a quantitative and qualitative analysis of the scales was carried out to evaluate if they were being correctly filled. Subsequently the team training was carried out, and then a new analysis was made to evaluate the impact of the training. Final considerations: After the training, there was a significant improvement in the Braden score, since the number of patients evaluated incorrectly reduced by 20%, and the number of non-evaluated scales reduced by 14%. It was found a slightly evolution of the partial filling of the scales of only 2.6%. These numbers show that scales are not only being filled, they also allow us to state that the quality of this assessment has also improved. Therefore, it was concluded that the permanent education in health is of fundamental importance and must be a constant in the hospital services, so that more and more professionals become aware and committed to develop a safer nursing care, guaranteeing higher quality of care to the patients.

Prevalence of pressure injury in adults presenting to the emergency department by ambulance

IntroductionPressure injuries are harmful, painful, and potentially preventable. Although hospital-acquired pressure injury prevalence is decreasing, it is unclear if some pressure injuries develop before hospital admission. The objective of this study was to investigate the prevalence of pressure injury in adults on arrival by ambulance to the emergency department (ED). MethodsAn observational, cross-sectional descriptive study design was used. Participants (n = 212) were recruited from the EDs of two Australian tertiary hospitals. Full skin inspection and pressure injury risk assessment, using Braden and Waterlow scores, were undertaken within 1 h of presentation. ResultsPressure injuries were identified in 11 of 212 participants, giving a prevalence of 5.2% at presentation. Nearly all were admitted to hospital, giving a prevalence of 7.8% at this entry point. Participants with pressure injury and those at high risk of injury were found to have spent longer in the ambulance and within the ED. During ambulance transport and in the first hour of presentation to the ED, it was rare that pressure-relieving interventions were implemented, even for those with an identified pressure injury and those at high risk. ConclusionsThe results indicate that early pressure injury surveillance and risk assessment are merited at the point of presentation to the ED, so that prevention and treatment can be implemented at the earliest possible opportunity. Although it is more challenging to manage pressure injuries within the ambulance and ED, the use of pressure-relieving devices should be considered for those at greatest risk. Further research is recommended.

Braden score may be associated with time to onset of catheter-associated urinary tract infection in high-risk patients: Lessons learned from a root cause analysis tool

Timely removal of the urinary catheter is an important strategy for decreasing catheter-associated urinary tract infections (CAUTIs). Data were aggregated from an electronic root cause analysis tool, which is used to collect and guide discussions on patient factors following a CAUTI event at our facility. This identified the Braden Scale score as a possible important predictor of early-onset CAUTI in high-risk patients and could potentially be leveraged for early action in urinary catheter removal.

Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India.

Hospital-acquired pressure ulcers are a significant cause of morbidity and consume considerable financial resources. Turn protocols (repositioning patients at regular intervals) are utilized to reduce incidence of pressure ulcers. Adherence to turn protocols is particularly challenging for nursing teams, given the high number of interventions in intensive care unit, and lack of widely available tools to monitor patient position and generate alerts. We decided to develop and evaluate usefulness of a continuous patient position monitoring system to assist nurses in improving turn protocol compliance. We conducted a prospective, non-randomized, multiphase, multicentre trial. In Phase I (control group), the function of the device was not revealed to nurses so as to observe their baseline adherence to turn protocol, while Phase II (intervention group) used continuous patient position monitoring system to generate alerts, when non-compliant with the turn protocol. All consecutive patients admitted to one of the two intensive care units during the study period were screened for enrolment. Patients at risk of acquiring pressure ulcers (Braden score < 18) were considered for the study (Phase I (N = 22), Phase II (N = 25)). We analysed over 1450 h of patient position data collected from 40 patients (Phase I (N = 20), Phase II (N = 20)). Turn protocol compliance was significantly higher in Phase II (80.15 ± 8.97%) compared to the Phase I (24.36 ± 12.67%); p < 0.001. Using a continuous patient position monitoring system to provide alerts significantly improved compliance with hospital turn protocol. Nurses found the system to be useful in providing automated turn reminders and prioritising tasks.

A prediction tool for hospital-acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score.

Surgical patients are prone to developing hospital-acquired pressure ulcers (HAPU). Therefore, a better prediction tool is needed to predict risk using preoperative data. This study aimed to determine, from previously published HAPU risk factors, which factors are significant among our surgical population and to develop a prediction tool that identifies pressure ulcer risk before the operation. A literature review was first performed to elicit all the published HAPU risk factors before conducting a retrospective case-control study using medical records. The known HAPU risks were compared between patients with HAPU and without HAPU who underwent operations during the same period (July 2015-December 2016). A total of 80 HAPU cases and 189 controls were analysed. Multivariate logistic regression analyses identified eight significant risk factors: age ≥ 75 years, female gender, American Society of Anaesthesiologists ≥ 3, body mass index < 23, preoperative Braden score ≤ 14, anaemia, respiratory disease, and hypertension. The model had bootstrap-corrected c-statistic 0.78 indicating good discrimination. A cut-off score of ≥6 is strongly predictive, with a positive predictive value of 73.2% (confidence interval [CI]: 59.7%-84.2%) and a negative predictive value of 80.7% (CI: 74.3%-86.1%). SPURS contributes to the preoperative identification of pressure ulcer risk that could help nurses implement preventive measures earlier.

Comparison of Mortality Risk Prediction Among Patients ≥70 Versus

Older adults account for an increasing number of cardiac intensive care unit (CICU) admissions. This study sought to determine the predictive value of illness severity scores for mortality in CICU patients ≥70 years of age. Adult patients admitted to the CICU from 2007 to 2015 at one tertiary care hospital were reviewed. Severity of illness scores were calculated on the first CICU day. Area under the receiver-operator characteristic curve (AUROC) values were used to assess discrimination for hospital mortality in patients ≥70 versus <70 years of age. We included 10,004 patients with a mean age of 67.4 ± 15.2 years (37.4% female); 4,771 patients (47.7%) were ≥70 years of age. Patients ≥70 years of age had greater illness severity and more extensive co-morbidities compared with patients <70 years of age. Patients ≥70 years of age had higher hospital mortality (11.6% vs 6.8%, odds ratio 1.80, 95% confidence interval 1.57 to 2.07, p <0.001), with a progressive increase in mortality as a function of decade. Severity of illness scores had lower AUROC values for hospital mortality in patients ≥70 years of age compared with patients <70 years of age (all p <0.05 by DeLong test). The Braden skin score on CICU admission predicted hospital mortality with an AUROC value only slightly lower than these scores. Increasing age decade was associated with decreased postdischarge survival by Kaplan-Meier analysis (p <0.001 by log-rank). In conclusion, contemporary CICU patients ≥70 years of age have greater illness severity, more co-morbidities and higher mortality than patients <70 years of age, yet severity of illness scores are less accurate for predicting mortality in CICU patients ≥70 years of age, emphasizing the need for more effective risk-stratification methods in this population.

Pressure ulcer prevention using an alternating-pressure mattress overlay: the MATCARP project.

The primary objective was to assess the incidence of pressure ulcer (PU) in patients at high risk of PU and lying between 15-20 hours per day on an alternating-pressure mattress overlay (APMO). Secondary objectives were the patient's satisfaction with the comfort of the APMO, patient acceptance of its sound level, and the care team's assessment of its use and the moisture level. This prospective observational study was conducted in three rehabilitation centres and two nursing homes between June 2016 and March 2017. To be included, patients should not have PU at baseline and present a high risk of PU (Braden score between 10-15). The primary endpoint was the percentage of patients in whom a PU developed over a 35-day period. A total of 83 patients were included in the study. Neurological disease was responsible for the reduced mobility of 44 (53.7%) patients, 10 patients (12.0%) dropped out (one patient for a serious adverse event (femoral neck fracture) considered not to be related to the APMO, four patients for adverse events, two of which were considered to be related to APMO and five for other reasons, including, in one case, discomfort with the APMO. These patients were considered in the analysis. Over the study period, 1.2% (1/83) (95% confidence interval (CI): 0.03 to 6.53) of patients developed a PU. Patient satisfaction with the comfort of the APMO, patient acceptance of its sound level, and the care team's assessment of its use were considered satisfying for most patients. Based on the findings of this study of a low incidence of PU in participating patients, the use of an AMPO is recommended in high-risk patients lying for between 15-20 hours a day.

Investigation of the prevalence of pressure ulcers and patient-related risk factors in hospitals in the province of Erzurum: A cross-sectional study

BackgroundPressure ulcers are a significant health care problem all across the world due to their associated high mortality and morbidity rates and high health care costs. The prevalence of pressure ulcers serves as one of the most important indicators of the quality of nursing care. Study aimThis study aims to determine the prevalence of pressure ulcers and patient-related risk factors in inpatients receiving treatment in the province of Erzurum, located in the eastern part of Turkey. DesignThis is a cross-sectional study. Participantswhich included 832 inpatients hospitalized for at least 24 h after admission in five hospitals in the province of Erzurum. All of the study patients were 18 years of age or older and agreed to participate in the research. Patients hospitalized in the obstetric, emergency, and pediatric clinics were excluded from the study (due to the low probability of pressure ulcers in these clinics). InstrumentsFor the collection of data, the “Introductory Information Form” was used to learn the socio-demographic and clinical characteristics of the patients, and the “Braden Risk Assessment Scale” was used to determine the risk of pressure ulcers. The stage of the pressure ulcers of the patients was determined according to the classification of the National Pressure Ulcer Advisory Panel (NPUAP). MethodsSince the study was planned as a point prevalence study, research data were gathered by the researchers and interviewers on a single day designated for each hospital during the first week of October 2016. ResultsAmong the patients included in the study, 53.1% were male, mean age was 56.62 ± 17.95, 57.2% were treated in internal clinics, and the mean hospital stay was 9.02 ± 13.36 days. In terms of the patients' risk of pressure ulcers, it was determined that 28% were at risk. The overall prevalence of pressure ulcers was calculated to be 12.7% (for stages I-IV), with the overall prevalence decreasing by 6.7% when the patients with stage-I were excluded. Furthermore, it was found that 48.3% of the pressure ulcers were stage-I, and that the sacral region (37.3%) was the most affected region. According to the logistic regression analysis conducted to determine the factors, along with their weights, that affect the development of pressure ulcers, the age of the patient, the duration of the hospital stay, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to have an impact (p < 0.05). ConclusionIn this study, the prevalence of pressure ulcers was calculated to be 12.7%, with the highest prevalence found in intensive care clinics (35.3%). The age of the patient, the duration of the hospital stays, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to be effective in the development of pressure ulcers.

Effect of modified Braden score on prevention of pressure ulcer in patients with femoral neck fracture

Objective: To evaluate the effect of improved Braden rating scale in patients with total hip arthroplasty. Methods: Sixty patients with total hip arthroplasty were divided into observation group (n = 30) and control group (n = 30). Patients in the control group were evaluated by the Braden Score.The incidence of pressure ulcers and patient satisfaction were compared between the two groups. Results: By using the improved Braden score scale, the incidence of sore in the control group was significantly lower than that of patients. Conclusion: The improved Braden score can provide personalized nursing care for patients with femoral neck fracture and total hip arthroplasty, which can effectively eliminate the occurrence of pressure sore in high risk population.

Research on grade repositioning to prevent the development of pressure ulcers in ICU patients

Objective To discuss the effect of grade repositioning designed by our team on preventing the development of pressure ulcers in ICU patients and its influence on nursing workload of repositioning. Methods Eligible patients admitted to ICU were randomly divided into control group (traditional repositioning, 219 cases) and experimental group (grade repositioning, 230 cases). The patients in control group was routinely repositioned every 2 hours; the patients in experimental group was classified as A B C three levels according to Braden Scores and catecholamine scores, and their repositioning frequency was 1 hour, 2 hours and 4 hours respectively. Number of pressure ulcers and nursing workload of repositioning were observed and compared between the two groups. Results At last, the data analysis was included in 201 patients in control group and 220 patients in experimental group. There was no significant difference in the rate of pressure ulcer occurrence between the experimental group (0) and the control group [0.1% (2/201)](P>0.05). But the rate of skin redness occurrence was significant less in the experimental group than in the control group [1.36% (3/220) vs.11.44% (23/201) , χ2=13.20, P<0.05]. The mean repositioning times for each patient in the experimental group was significantly less than the control group [(7.22±1.81) times/day vs.(11.38±1.23) times/day], and turn over time was (42.09±1.68) min and (66.35±1.83) min which was also significantly different (t=6.563, 5.210, P<0.05). Conclusion Grade repositioning could effectively prevent critically illed patients from the occurrence of pressure ulcers, while reducing the overall nursing workload of repositioning in an ICU. Key words: Intensive care units; Pressure ulcer; Grade positioning; Workload

A Retrospective Analysis to Evaluate Seasonal Pressure Injury Incidence Differences Among Hip Fracture Patients in a Tertiary Hospital in East China

Patients with a hip fracture are at high risk for pressure injury. A retrospective review of the electronic medical records of consecutive patients with a hip fracture treated in 2016 in a single tertiary hospital in east China were examined to investigate whether time of year affected the incidence of hospital-acquired pressure injury. Data collected included demographic characteristics (patient name, hospital number, age, gender, and body mass index); possible risk factors for pressure injury, such as presence of diabetes mellitus, admission hemoglobin, admission albumin, length of surgery, and the lowest and/or last Braden Scale score before pressure injury developed; and pressure injury information, which included time of occurrence (days after surgery), location (sacrum and coccyx, ischial tuberosity, or heel), stage, and treatment outcome. Pressure injury incidence was calculated with 95% confidence intervals (CIs) in each month and season (spring, summer, autumn, and winter). Odds ratios (ORs) and 95% CIs were calculated as estimates of risk. Multivariate logistic regression was used for risk factors. Of the 235 patients with a hip fracture included in the study, 95 (40.4%) were male, 140 (59.6%) were female, and mean age was 70.4 ± 10.5 (range 48-81) years. Thirty-one (31) patients (13.2%, 95% CI 9.1%-18.2%) developed 37 pressure injuries, 30 of which (81.1%) were Stage 1. The incidence of pressure injury was lowest in November (5.0%; 95% CI: 0.0%-24.9%) and highest in June (22.7%; 95% CI: 7.8%-45.4%). Average Braden Scale scores (14.2 ± 3.2) were lower in June than in November (16.6 ± 3.5), owing to differences in the Braden Scale skin moisture subscale. Seasonally, the incidence of pressure ulcers was 20.8% (95% CI: 12.2%-32.0%) in the summer compared to 7.5% (2.5%-16.6%) in autumn (crude OR 3.3; 95% CI:1.0-12.1; P = .025). Multivariate logistic regression analysis showed the Braden Scale score was the only independent risk factor (P <.05) for pressure injury incidence. Adjusting for the Braden score, the OR of summer season was 1.537 (95% CI: 0.964-2.872). The findings suggest that humidity and temperature levels, which are very high in the summer in China, may affect pressure injury incidence and that the Braden Scale score - especially the skin-moisture level subscore - is a valid predictor of pressure injury risk in this population. While more research is needed, additional pressure injury prevention strategies should be provided for patients hospitalized with a hip fracture in the summer months.

Preventive Effect of a Microclimate-Regulating System on Pressure Ulcer Development: A Prospective, Randomized Controlled Trial in Dutch Nursing Homes.

Prevention of pressure ulcers (PrUs) is based on relieving pressure, diminishing shear stress, and controlling the skin's microclimate. Based on the recommendations in the most recent guideline for prevention of PrUs, a pressure-relieving, shear stress-diminishing, and microclimate-controlling skin interface multilayer support system (Bedcare; Sense Textile, 's-Hertogenbosch, the Netherlands) has been developed for use on top of a viscoelastic foam mattress (Formafoam, Kabelfabriek Eupen, Belgium). The aim of this study was to test the PrU preventive effect of this system compared with a viscoelastic foam mattress alone. A multicenter, prospective, randomized controlled trial was executed in 21 nursing homes in the Netherlands. Residents with a Braden score less than 16, a life expectancy of more than 3 months, and no PrUs during the last 3 months were asked to participate and included after informed consent. Residents were divided into 2 groups. The control group received a new high-quality viscoelastic foam mattress covered with a cotton sheet. The intervention group received the same new mattress, in combination with the newly developed multilayer system. Research nurses followed the participating residents for 12 weeks. The outcome parameter was the development of PrUs. Two hundred six residents participated in the study. Both groups had comparable demographics (eg, age, Braden score, care dependency, incontinence). In the control group, 5% of the residents developed a category 2, 3, or 4 PrU, and 9% in the intervention group did. These results were not statistically significant. This study shows that the multilayer system (Mini Overlay System, barrier mattress cover, and Stay and Transfer Sheet), when used as an integral system and in combination with a viscoelastic foam mattress, has no added value over the viscoelastic foam mattress/cotton sheet.

Demonstrating the Potential of Using Transcutaneous Oxygen and Carbon Dioxide Tensions to Assess the Risk of Pressure Injuries.

Pressure injuries have a high incidence in elderly and critically ill patients, and can endanger lives in severe cases. The key to reducing the incidence of pressure injuries is to find an objective, noninvasive, automatic and consistent scientific method for assessing pressure injuries. To serve this need, we conducted a clinical study to investigate the potential of using transcutaneous oxygen tension (TcPO2) and transcutaneous carbon dioxide tension (TcPCO2) for assessing pressure injuries. From the results of the study we found that first, the values of TcPO2 and TcPCO2 are sensitive to the change of pressure imposed on the measured region and to the risk status of a pressure injury when a pressure is imposed. Second, the magnitude of change in TcPO2 and TcPCO2 is higher in patients with a high risk of a pressure injury compared with those who have a low risk. Third, TcPO2 and TcPCO2 are both significantly correlated with the Braden score, the widely used score for assessing the risk of a pressure injury. Therefore, TcPO2 and TcPCO2 have a potential to be an effective and convenient scientific tool for assessing the risk of pressure injuries.

Hospital-Acquired Pressure Injury: Risk-Adjusted Comparisons in an Integrated Healthcare Delivery System.

Although healthcare organizations have decreased hospital-acquired pressure injury (HAPI) rates, HAPIs are not eliminated, driving further examination in both nursing and health services research. The objective was to describe HAPI incidence, risk factors, and risk-adjusted hospital variation within a California integrated healthcare system. Inpatient episodes were included in this retrospective cohort if patients were hospitalized between January 1, 2013, and June 30, 2015. The primary outcome was development of a HAPI over time. Predictors included cited HAPI risk factors in addition to incorporation of a longitudinal comorbidity burden (Comorbidity Point Score, Version 2 [COPS2]), a severity-of-illness score (Laboratory-Based Acute Physiology Score, Version 2 [LAPS2]), and the Braden Scale for Predicting Pressure Ulcer Risk. Analyses included HAPI inpatient episodes (n = 1661) and non-HAPI episodes (n = 726,605). HAPI incidence was 0.57 per 1,000 patient days (95% CI [0.019, 3.805]) and 0.2% of episodes. A multivariate Cox proportional hazards model showed significant (p < .001) hazard ratios (HRs) for the change from the 25th to the 75th percentile for age (HR = 1.36, 95% CI [1.25, 1.45]), higher COPS2 scores (HR = 1.10, 95% CI [1.04, 1.16]), and higher LAPS2 scores (HR = 1.38, 95% CI [1.28, 1.50]). Female gender, an emergency room admission for a medical reason, and higher Braden scores showed significant protective HRs (HR < 1.00, p < .001). After risk adjustment, significant variation remained among the 35 hospitals. Results prompt the consideration of age, severity of illness (LAPS2), comorbidity indexes (COPS2), and the Braden score as important predictors for HAPI risk. HAPI rates may be low; however, because of significant individual site variation, HAPIs remain an area to explore through both research and quality improvement initiatives.

Incidence and risk factors of pressure ulcers among general surgery patients

Context: Pressure ulcers are among the main postoperative complications which isassociated with an increased length of hospitalization. Determining risk factors of postsurgical pressureulcers is crucial for developing prevention and treatment strategies. Aims: This study aimed to investigate the incidence rate of pressure ulcer and related risk factors after general surgery. Settings and Design: This descriptive cross-sectional study was carried out in three hospitals in Mazandaran province in 2016. Materials and Methods: The sample size was 191 surgical patients undergoing general surgery by using census method. Data were collected in pre-, intra-, and post-operative period using demographic and clinical questionnaires and also, through the Braden Scale for Predicting Pressure Ulcer Risk. Statistical Analysis Used: Descriptive statistics, t-test, Chi-square, and univariateand multivariate logistic regression were used to analyze the data. Results: The incidence rate of postoperative pressure ulcers in patients was 17.8% (34 out of 191 patients). Based on the multivariate logistic regression model, significant correlations existed between the incidence of pressure ulcers and the following variables: age over 70 years old (P = 0.003), history of hypertension (P = 0.035), history of heart diseases (P = 0.029), Braden score Conclusions: Since it is critical to consider the incidence of postoperative pressure ulcers among patients, further measurements are required to identify high-risk people and use preventive protocols by nurses at pre-, intra-, and post-operative levels. Moreover, it requires extra attention in patients over 70 years, those with a history of hypertension and heart diseases, and those undergoing emergency surgery and spinal anesthesia.