Pressure Ulcers In Patients Research Articles

Evaluating the validity of the Braden scale using longitudinal electronic medical records.

In this study, we evaluated the validity of the Braden scale in assessing the risk of pressure ulcers. Longitudinal clinical data including weekly Braden scale scores for 1,138 patients admitted to a university hospital who developed pressure ulcers during the hospital stay and 4,794 who did not develop pressure ulcers were extracted from the hospital's electronic medical record system. Braden scale scores at three points during hospitalization were analyzed: the initial score at admission, the last score recorded before diagnosis (for pressure ulcer patients) or before discharge (for those without pressure ulcers), and the minimum (highest-risk) score recorded. Using these data, the predictive validity of the scale was evaluated using a cut-off score of 18, followed by an evaluation of the relative advantages and disadvantages of cut-off scores from 12 to 19. Among patients in the general units, the minimum score had the greatest sensitivity (0.85), negative predictive value (NPV; 0.98), and Youden index (0.73). Among patients in the intensive care units, the last score had the best NPV (0.65), Youden index (0.53), and area under the receiver operating characteristic curve (0.78), while the minimum score had the highest sensitivity (0.88). The optimal cut-off score for patients in the general units was 19 and for those in the intensive care units was 18. These results support a higher cut-off score than previously recommended, particularly for severely ill patients who are more prone to developing pressure ulcers.

Relationship between inpatient pressure ulcer prevalence and patientsatisfaction levels based on US Medicare's Hospital Compare data.

Keywords: consumer satisfaction; hospitals; patient harm; patient safety; patient satisfaction; patients; pressure ulcer

Neuroprotective effect of erythropoietin against pressure ulcer in a mouse model of small fiber neuropathy.

An increased risk of skin pressure ulcers (PUs) is common in patients with sensory neuropathies, including those caused by diabetes mellitus. Recombinant human erythropoietin (rhEPO) has been shown to protect the skin against PUs developed in animal models of long-term diabetes. The aim of this work was to determine whether rhEPO could prevent PU formation in a mouse model of drug-inducedSFN. Functional SFN was induced by systemic injection of resiniferatoxin (RTX, 50 µg/kg, i.p.). RhEPO (3000 UI/kg, i.p.) was given the day before RTX injection and then every other day. Seven days after RTX administration, PUs were induced by applying two magnetic plates on the dorsal skin. RTX-treated mice expressed thermal and mechanical hypoalgesia and showed calcitonin gene-related peptide (CGRP) and substance P (SP) depletion without nerve degeneration or vascular dysfunction. RTX mice developed significantly larger stage 2 PUs than Vehicle mice. RhEPO prevented thermal and mechanical hypoalgesia and neuropeptide depletion in small nerve fibers. RhEPO increased hematocrit and altered endothelium-dependent vasodilatation without any effect on PU formation in Vehicle mice. The characteristics of PUs in RTX mice treated with rhEPO and Vehicle mice were found similar. In conclusion, RTX appeared to increased PU development through depletion of CGRP and SP in small nerve fibers, whereas systemic rhEPO treatment had beneficial effect on peptidergic nerve fibers and restored skin protective capacities against ischemic pressure. Our findings support the evaluation of rhEPO and/or its non-hematopoietic analogs in preventing to prevent PUs in patients with SFN.

Analysis of operating room related factors and nursing countermeasures for pressure ulcers in patients with laparoscopic surgery

Objective To study operating room related factors and nursing countermeasures for pressure ulcers in patients with lap -aroscopic surgery.Methods Totaled of 180 patients with laparoscopic surgery data were retrospectively analysized , the operating room relat-ed causes of pressure ulcers were discussed , and put forward nursing countermeasures.Results Among the 186 patients with laparoscopic surgery a total of stage Ⅰ-Ⅱpressure sores 17cases, the incidence of pressure ulcers was 9.14%;operating rooms related reasons includ-ed operation position , operation time too long , skin moisture, intraoperative hypotension state duration , hypoxemia etc ..Conclusions Laparoscopic surgery in patients with postoperative pressure sores are the result of a variety of factors , according to the related reasons for pressure sores , intraoperative strengthen preventive measures can help to reduce the incidence of pressure ulcers after surgery . Key words: Laparoscopic surgery Pressure ulcers Operating room Related reasons Nursing countermeasures

Body mass index and pressure ulcers: improved predictability of pressure ulcers in intensive care patients.

Obesity contributes to immobility and subsequent pressure on skin surfaces. Knowledge of the relationship between obesity and development of pressure ulcers in intensive care patients will provide better understanding of which patients are at high risk for pressure ulcers and allow more efficient prevention. To examine the incidence of pressure ulcers in patients who differ in body mass index and to determine whether inclusion of body mass index enhanced use of the Braden scale in the prediction of pressure ulcers. In this retrospective cohort study, data were collected from the medical records of 4 groups of patients with different body mass index values: underweight, normal weight, obese, and extremely obese. Data included patients' demographics, body weight, score on the Braden scale, and occurrence of pressure ulcers. The incidence of pressure ulcers in the underweight, normal weight, obese, and extremely obese groups was 8.6%, 5.5%, 2.8%, and 9.9%, respectively. When both the score on the Braden scale and the body mass index were predictive of pressure ulcers, extremely obese patients were about 2 times more likely to experience an ulcer than were normal weight patients. In the final model, the area under the curve was 0.71. The baseline area under the curve for the Braden scale was 0.68. Body mass index and incidence of pressure ulcers were related in intensive care patients. Addition of body mass index did not appreciably improve the accuracy of the Braden scale for predicting pressure ulcers.

Use of high frequency ultrasound to detect changes in skin integrity: An image evaluation validation procedure

High frequency ultrasound (HFUS) scanning may be used for prevention, detection and monitoring of pressure ulcers in patients at risk and is amenable for portable, bedside use by a variety of clinicians. Limited data are available about the criteria to determine an ideal image or measures of tissue changes representative of tissue injury. We developed and evaluated criteria for overall image quality and measures of tissue integrity. In 40 mechanically ventilated adults in 3 ICUs, 241 HFUS sacral images were evaluated for agreement using criteria for overall image quality and tissue changes (dermal, hypodermal layer thickness and layer density). HFUS sacral images (N=241) were evaluated in three analyses and showed poor agreement in all three analyses using the specific criteria for global quality, however when criteria were collapsed agreement was good to substantial. Evaluator agreement for layer thickness and layer density was also good. A global rating is adequate for identifying good images. Agreement for measurements of layer thickness and density were also good and may be useful to identify early changes in tissue integrity leading to tissue injury. Additional data are needed concerning the association of changes in layer thickness and layer density to eventual tissue injury.

Perioperative use of bispectral (BIS) monitor for a pressure ulcer patient with locked‐in syndrome (LIS)

The bispectral (BIS) monitor uses brain electroencephalographic data to measure the depth of sedation and pharmacological response during anaesthetic procedures. In this case, the BIS monitor was used for another purpose, to demonstrate postoperatively to the nursing staff that a patient with history of locked-in syndrome (LIS), who underwent pressure ulcer debridement, had periods of wakefulness and apparent sensation, even with his eyes closed. Furthermore, as patients with LIS can feel pain, despite being unable to move, local block or general anaesthesia should be provided for sharp surgical debridement and other painful procedures. This use of the BIS has shown that as a general rule, the staff should treat the patient as though he might be awake and sensate even if he does not open his eyes or move his limbs. The goal of this study was to continuously monitor pain level and communicate these findings to the entire wound team, i.e. anaesthesiologists, surgeons and nurses.

Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial.

To identify predictive factors associated with the development of pressure ulcers in patients at risk who receive standardized preventive care. Numerous studies have examined factors that predict risk for pressure ulcer development. Only a few studies identified risk factors associated with pressure ulcer development in hospitalized patients receiving standardized preventive care. Secondary analyses of data collected in a multicentre randomized controlled trial. The sample consisted of 610 consecutive patients at risk for pressure ulcer development (Braden Score <17) receiving standardized preventive care measures. Patient demographic information, data on skin and risk assessment, medical history and diagnosis were collected during 26months (December 2007-January 2010). Predictive factors were identified using multivariate statistics. Pressure ulcers in category II-IV were significantly associated with non-blanchable erythema, urogenital disorders and higher body temperature. Predictive factors significantly associated with superficial pressure ulcers were admission to an internal medicine ward, incontinence-associated dermatitis, non-blanchable erythema and a lower Braden score. Superficial sacral pressure ulcers were significantly associated with incontinence-associated dermatitis. Despite the standardized preventive measures they received, hospitalized patients with non-blanchable erythema, urogenital disorders and a higher body temperature were at increased risk for developing pressure ulcers. Improved identification of at-risk patients can be achieved by taking into account specific predictive factors. Even if preventive measures are in place, continuous assessment and tailoring of interventions is necessary in all patients at risk. Daily skin observation can be used to continuously monitor the effectiveness of the intervention.

Hydrocolloid dressings for preventing pressure ulcers: A Meta-analysis

Objective To evaluate the effects of hydrocolloid dressings with conventional care in the prevention of pressure ulcers.Methods Randomised controlled trials and quasi-randomised trials,which assessed the effects of hydrocolloid dressings in preventing pressure ulcers compared to conventional care were sought.Data were pooled using RevMan 5.0.Results 17 eligible trials were identified with a total of 1 371 study participants.Meta-analysis showed that:Compared to conventional care,conventional care and hydrocolloid dressings were effective for preventing pressure ulcers for patients at risk of pressure ulcers [RR =0.29,95％CI (0.18,0.46)] and using noninvasive positive pressure ventilator [RR=0.30,95％CI (0.18,0.52).Conclusions Hydrocolloid drcssings and conventional care can reduce the pressure ulcer incidence of patients at risk of pressure ulcer or using noninvasive positive pressure ventilator. Key words: Pressure ulcer, Prevention; Hydrocolloid; Dressing; Meta-analysis

Analysis on the risk factors of acute pressure ulcer in liver transplantation patients

Objective To analyze the risk factors of acute pressure ulcer in liver transplantation patients after operation to look for the nursing method.Methods Ninety-five liver transplantation patients from January 2005 to September 2013 were chosen,and their basic information were collected,and the indicator associated with the occurrence of pressure ulcer before,during and after the operation were recorded and the risk factors were analyzed,and the effect of medical factors on the incidence of pressure ulcer in patients with liver transplantation were evaluated.Results Thirty patients had the pressure ulcers within three days after operation,and the fourteen cases(46.67％) occurred on the day of operation,and nine (30.00％),five (16.67％),two (6.66％) respectively occurred on the first,second and third day of operation.The cases of pressure ulcers occurred in the sacral and heel area were respectively nineteen (63.33％) and nine cases (30.00％).The differences were found in the incidence rate of pressure ulcers in patients with different the score of Braden,the level of serum total protein,the operative time,the blood loss,the first time to get out of bed and compliance behavior (x2/Z =6.338,7.787,4.005,12.960,4.163,6.257,respectively; P ＜ 0.05).The maximum cases of pressure ulcers caused by the lack of cognition were twelve cases (40.00％),followed by seven cases (23.33％) which caused by the less frequency evaluation.Conclusions The occurrence of acute pressure ulcer is closely related to the score of Braden,the level of serum total protein,the operative time,the blood loss,the first time to get out of bed and compliance behavior,and nursing measures should be taken according to the risk factors to reduce the incidence of pressure ulcer after operation. Key words: Liver transplantation; Risk factor; Pressure ulcer

Pressure ulcers in patients with traumatic spinal cord injury: subsidies in microbiological identification

Pressure ulcers in patients with traumatic spinal cord injury: subsidies in microbiological identification

Impact of Pressure Ulcers on Outcomes in Inpatient Rehabilitation Facilities

The aim of this study was to examine the impact of pressure ulcers on inpatient rehabilitation facility (IRF) outcomes. This is a retrospective analysis of the IRF data in the United States from the Uniform Data System for Medical Rehabilitation between 2009 and 2011. The study sample included 2902 pairs of pressure ulcer and pressure ulcer-free patients upon IRF admission, matching on age at admission, sex, impairment groups, and comorbidity tier measures. The study outcomes were cognition and motor functional gains measured by the Functional Independence Measure instrument, IRF length of stay, and discharge to the community. The mean pressure ulcer prevalence upon IRF admission was 5.23%. After controlling for other covariates under study, the pressure ulcer group had a lower motor gain (20.12 vs. 21.58, P < 0.0001), had a longer length of stay (16.5 vs. 15.5, P < 0.0001), and were less likely to be discharged to the community after IRF stay (odds ratio, 0.72; 95% confidence interval, 0.62-0.84) than the patients without a pressure ulcer. The presence of a pressure ulcer among the patients seen in United States IRFs had no impact on cognition functional gain but was associated with a minor lower motor gain, a longer IRF length of stay, and lower odds of being discharged to the community.

The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning

Placing patients with severe acute respiratory distress syndrome (ARDS) in the prone position has been shown to improve survival as compared to the supine position. However, a higher frequency of pressure ulcers has been reported in patients in the prone position. The objective of this study was to verify the impact of prone positioning on pressure ulcers in patients with severe ARDS. This was an ancillary study of a prospective multicentre randomised controlled trial in patients with severe ARDS in which the early application of long prone-positioning sessions was compared to supine positioning in terms of mortality. Pressure ulcers were assessed at the time of randomisation, 7 days later and on discharge from the intensive care unit (ICU), using the four-stage Pressure Ulcers Advisory Panel system. The primary end-point was the incidence (with reference to 1,000 days of invasive mechanical ventilation or 1,000 days of ICU stay) of new patients with pressure ulcers at stage 2 or higher from randomisation to ICU discharge. At randomisation, of the 229 patients allocated to the supine position and the 237 patients allocated to the prone position, the number of patients with pressure ulcers was not significantly different between groups. The incidence of new patients with pressure ulcers from randomisation to ICU discharge was 20.80 and 14.26/1,000 days of invasive mechanical ventilation (P = 0.061) and 13.92 and 7.72/1,000 of ICU days (P = 0.002) in the prone and supine groups, respectively. Position group [odds ratio (OR) 1.5408, P = 0.0653], age >60 years (OR 1.5340, P = 0.0019), female gender (OR 0.5075, P = 0.019), body mass index of >28.4 kg/m(2) (OR 1.9804, P = 0.0037), and a Simplified Acute Physiology Score II at inclusion of >46 (OR 1.2765, P = 0.3158) were the covariates independently associated to the acquisition of pressure ulcers. In patients with severe ARDS, prone positioning was associated with a higher frequency of pressure ulcers than the supine position. Prone positioning improves survival in patients with severe ARDS and, therefore, survivors who received this intervention had a greater likelihood of having pressure ulcers documented as part of their follow-up. There are risk groups for the development of pressure ulcers in severe ARDS, and these patients need surveillance and active prevention.

Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit

The development of stage III or IV pressure ulcers is currently considered a never event. Critical care patients are at high risk for development of pressure ulcers because of the increased use of devices, hemodynamic instability, and the use of vasoactive medications. This article addresses risk factors, risk scales such as the Norden, Braden, Waterlow, and Jackson-Cubbin scales used to determine the risk of pressure ulcers in critical care patients, and prevention of device-related pressure ulcers in patients in the critical care unit.

Clinical Parameters Associated With Pressure Ulcer Healing in Patients With Advanced Illness

ContextPressure ulcers are the most prevalent wounds affecting patients with advanced illness. Although complete wound healing is the most desired outcome, it remains unlikely in the setting of patients with limited life expectancy. Realistic goal setting may be enabled using objective clinical parameters. ObjectivesTo identify clinical parameters associated with complete healing of Stage II pressure ulcers. MethodsUnivariable and multivariable competing risk analyses were used to assess the association of complete healing with the following six clinical parameters, namely gender, age, total number of pressure ulcers, total number of other wounds, number of failing organ systems, and Palliative Performance Scale (PPS) scores. ResultsA total of 147 patients with 245 Stage II pressure ulcers were followed until death; 9.4% of Stage II pressure ulcers achieved complete healing. Univariable analyses showed hazard ratios (HRs) for complete healing in favor of higher levels of PPS scores (HR 1.82–5.99, P<0.001) and age younger than 80 years (HR 3.28, P=0.031). Multivariable analyses showed HRs for complete healing in favor of higher levels of PPS scores (HR 1.49–3.34, P=0.003). ConclusionHigher levels of PPS scores are associated with complete healing of Stage II pressure ulcers in patients with advanced illness.

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

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.

Albumin administration prevents the onset of pressure ulcers in intensive care unit patients

Pressure ulcers (PUs) are a common problem in critically ill patients admitted to the intensive care units (ICUs) and they account for more than 70% of patients with low serum albumin at admission. The aim of this study was to test the efficacy of intravenous administration of albumin in patients with low serum albumin < 3·3 g/dl. In a 1-year period, a total of 73 patients were admitted to the ICU (males 45, 61·64% and females 28, 38·36%); of these, 21 patients were admitted with hypoalbuminaemia (serum albumin < 3·3 g/dl) and randomised into two groups: 11 patients were treated with 25 g intravenous albumin for the first 3 days within the first week of ICU stay (group A) and 10 patients did not receive albumin (group B). Three patients (27·27%) showed the onset of PUs in group A, whereas seven patients (70%) showed the onset of PUs within the first 7 days of stay in group B. Moreover, ulcers of group B were more severe than those of group A. This study shows that intravenous administration of albumin reduces the onset of PUs in patients admitted to the ICU and in some cases it also reduces the risk of progression to advanced stages of PUs.

The physiological response of skin tissues to alternating support pressures in able-bodied subjects

Prolonged mechanical loading can lead to breakdown of skin and underlying tissues which can, in turn, develop into a pressure ulcer. The benefits of pressure relief and/or redistribution to minimise risk have been well documented and these strategies can be provided by employing support mattresses in which internal air pressures can be alternated to minimise the risk of pressure ulcers in patients during prolonged periods of bed-rest. The paper describes the performance of a prototype alternating pressure air mattress (APAM), in terms of its ability to maintain skin viability in a group of healthy volunteers lying in a supine position. In particular, the mattress includes a sacral section supported with alternating low pressure (ALP), with values adjusted to subject morphology, using an in-built pressure sensor. The mattress was supported at four different head of bed (HOB) angles ranging from 0 to 60°. Internal mattress pressures and transcutaneous gas (TcPO2/TcPCO2) tensions at the sacrum and a control site, the scapula, were monitored. Interface pressures were also measured. The sensor was found to be sensitive to the BMI values of the 12 healthy volunteers. In the majority of test conditions the internal support produced sacral TcPO2 values, which either remained similar to those at the scapula or fluctuated at levels providing adequate viability. However in a few cases, associated with a raised HOB angle (≥45°), there was compromise to the skin viability at the sacrum, as reflected in depressed TcPO2 levels associated with an elevation of TcPCO2 levels above the normal range. In all cases, interface pressures at the sacrum rarely exceeded 60mmHg. Although such studies need to be extended to involve bed-bound individuals, the results offer the potential for the development of intelligent APAM systems, whose characteristics can be adjusted to an individual morphology. Such preventive strategies to maintain skin viability at loaded sites will be designed for subjects deemed to be at high risk of developing pressure ulcers.

Analysis of the predictive ability of Norton scale for pressure ulcer in patients with neurological diseases

Objective To analyze the predictive ability of single assessment by Norton scale in neurological diseases patients.Methods Totals of 82 cases of neurological diseases were selected,which were divided into pressure ulcer group and non-pressure ulcer group.The parameter and total score of Norton scale were analyzed by t-test.Logistic regression analysis was used for Norton score and the receiver operating characteristic curve (ROC) was performed.The sensitivity,specificity and Youden' s index of different cutoff points were calculated.Results The total score in the pressure ulcer group was lower than that of non-pressure ulcer group [(17.11 ± 4.71) vs (24.33 ± 4.16)],and there was significant difference (t =7.13,P ＜0.01).Among the nine parameters,the age,skin status and body status were of no difference statistically between two groups,while the other six parameters in pressure group was significantly lower than those of nonpressure ulcer group (t =6.35,7.3,6.58,7.85,4.33,5.49 ;P ＜ 0.01).Logistic analysis revealed that Norton score had predictive value,the odd ratio of which was 0.713 (z =-4.6,P ＜ 0.01).The area of the ROC curve was 0.87,the 95％ confidence interval of which was 0.784-0.944.Conclusions Single assessment of Norton scale has certain predictive ability of pressure ulcer for the patients with neurological diseases. Key words: Pressure ulcer; Nursing; Norton scale ; Predict

Effectiveness of olive oil for the prevention of pressure ulcers caused in immobilized patients within the scope of primary health care: study protocol for a randomized controlled trial

BackgroundPressure ulcers are considered an important issue, mainly affecting immobilized older patients. These pressure ulcers increase the care burden for the professional health service staff as well as pharmaceutical expenditure. There are a number of studies on the effectiveness of different products used for the prevention of pressure ulcers; however, most of these studies were carried out at a hospital level, basically using hyperoxygenated fatty acids (HOFA). There are no studies focused specifically on the use of olive-oil-based products and therefore this research is intended to find the most cost-effective treatment and achieve an alternative treatment.Methods/designThe main objective is to assess the effectiveness of olive oil, comparing it with HOFA, to treat immobilized patients at home who are at risk of pressure ulcers. As a secondary objective, the cost-effectiveness balance of this new application with regard to the HOFA will be assessed. The study is designed as a noninferiority, triple-blinded, parallel, multi-center, randomized clinical trial. The scope of the study is the population attending primary health centers in Andalucía (Spain) in the regional areas of Malaga, Granada, Seville, and Cadiz. Immobilized patients at risk of pressure ulcers will be targeted. The target group will be treated by application of an olive-oil-based formula whereas the control group will be treated by application of HOFA to the control group. The follow-up period will be 16 weeks. The main variable will be the presence of pressure ulcers in the patient. Secondary variables include sociodemographic and clinical information, caregiver information, and whether technical support exists. Statistical analysis will include the Kolmogorov-Smirnov test, symmetry and kurtosis analysis, bivariate analysis using the Student’s t and chi-squared tests as well as the Wilcoxon and the Man-Whitney U tests, ANOVA and multivariate logistic regression analysis.DiscussionThe regular use of olive-oil-based formulas should be effective in preventing pressure ulcers in immobilized patients, thus leading to a more cost-effective product and an alternative treatment.Trial registrationClinicaltrials.gov identifier: NCT01595347.