Risk Factors For Pressure Injury Research Articles

Frequency and risk factors of pressure injuries in clinical settings of affiliated to Tabriz University of Medical Sciences.

AimPressure injuries are considered a common and costly problem in the care of patients. Prevention and identification of risk factors for pressure injuries are very important due to the high cost of treatment and the adverse consequences of pressure injuries. This study aimed to assess the prevalence of pressure injuries and its risk factors in clinical settings of affiliated to Tabriz University of Medical Sciences.DesignA descriptive‐analytical study.MethodsThis study was performed on 200 patients who were selected by random sampling. The data collection tool was a 3‐part questionnaire. Data were analysed using a t test, chi‐square, Fisher's exact test and logistic regression in SPSS v. 24.ResultsThe mean age of the participants was 51.93 (SD 14.99) years. The rate of pressure injuries in this study was 19.5%. The most susceptible area for pressure injuries were sacral (35.89%) and gluteal (20.51%), respectively. The pressure injuries was significantly associated with Braden's criteria, age, disease diagnosis and length of hospital stay (p < .05). But there was no statistically significant difference between sex and incidence of pressure injuries (p > .05).

An exploratory study of risk factors for pressure injury in patients undergoing spine surgery.

BackgroundPerioperative patients are potentially at risk for pressure injuries due to anesthetic agents and surgical positioning. Pressure injury increases discomfort and pain in patients and causes complications, which lead to an increase in mortality and hospitalization duration. Most previous studies did not focus on specific types of surgery or surgical positioning. We tried to identify the incidence of perioperative pressure injury during spinal surgery and perioperative risk factors that contribute to pressure injury.MethodsWe retrospectively analyzed electronic medical records of 663 patients who underwent spinal surgery between March 2016 and May 2018. The primary outcome was occurrence of pressure injury. Potential risk factors of pressure injury were selected based on previous studies and expert opinion, and divided into two sub-categories: preoperative and intraoperative risk factors. We compared the clinical characteristics of patients in the pressure injury and non-injury groups. Perioperative risk factors for pressure injury were analyzed by logistic regression.ResultsAmong 663 patients, the incidence of all stages of pressure injury was 5.9%. The face and inguinal regions were the most injured sites (both 28.6%). The pressure injury group showed a 13% longer hospitalization period. Preoperative plasma concentration of protein was associated with 0.5-fold lower pressure injury (OR: 0.50; 95% CI: 0.27 to 0.95; P = 0.034).ConclusionsThe incidence of pressure injury was similar to that previously reported and occurred in the direct weight-bearing areas, which led to longer hospitalization. We found that a lower preoperative serum protein level is significantly associated with intraoperative pressure injury occurrence during spinal surgery.

Results of Laboratory Testing for Immersion, Envelopment, and Horizontal Stiffness on Turn and Position Devices to Manage Pressure Injury

A continuing complication, pressure injuries are due to sustained mechanical loading and tissue deformations, which can then be exacerbated by additional intrinsic and extrinsic risk factors. Although support surfaces are designed to mitigate risk factors for pressure injuries, the presence of a turn and position device (TPD) between the patient and support surface may interfere with how support surfaces affect these risk factors. Report the use of the NPIAP's S3I standard test methods to characterize the performance of a support surface when used in conjunction with three different TPDs. Laboratory testing compared three TPDs for Immersion, Envelopment, and Horizontal Stiffness in each of five surface combinations. Immersion test measures how far mannequin indenter immerses into surface. Envelopment test measures immersion and pressure distribution with hemispherical-indenter with mounted sensor rings. Horizontal Stiffness test measures the shear modulus of the support surface with epicondyle indenter. For the specific TPDs tested here, the one with an adjustable integrated air bladder improved rather than compromised both the envelopment and the immersion of the support surface alone. Additionally, this TPD provided potential protection against sliding and the associated frictional shear forces. This paper describes how TPDs should perform in order to help establish which features are needed in a new medical device of this type. Laboratory testing demonstrates it is possible to improve performance of a support surface by applying a TPD as an add-on, thus relieving tissue deformation exposure through more effective pressure redistribution.

Constructing Inpatient Pressure Injury Prediction Models Using Machine Learning Techniques.

The incidence rate of pressure injury is a critical nursing quality indicator in clinic care; consequently, factors causing pressure injury are diverse and complex. The early prevention of pressure injury and monitoring of these complex high-risk factors are critical to reduce the patients' pain, prevent further surgical treatment, avoid prolonged hospital stay, decrease the risk of wound infection, and lower associated medical costs and expenses. Although a number of risk assessment scales of pressure injury have been adopted in various countries, their criteria are set for specific populations, which may not be suitable for the medical care systems of other countries. This study constructs three prediction models of inpatient pressure injury using machine learning techniques, including decision tree, logistic regression, and random forest. A total of 11 838 inpatient records were collected, and 30 sets of training samples were adopted for data analysis in the experiment. The experimental results and evaluations of the models suggest that the prediction model built using random forest had most favorable classification performance of 0.845. The critical risk factors for pressure injury identified in this study were skin integrity, systolic blood pressure, expression ability, capillary refill time, and level of consciousness.

Identifying Risk Factors for Pressure Injury in Adult Critical Care Patients.

Critically ill patients have a variety of unique risk factors for pressure injury. Identification of these risk factors is essential to prevent pressure injury in this population. To identify factors predicting the development of pressure injury in critical care patients using a large data set from the PhysioNet MIMIC-III (Medical Information Mart for Intensive Care) clinical database. Data for 1460 patients were extracted from the database. Variables that were significant in bivariate analyses were used in a final logistic regression model. A final set of significant variables from the logistic regression was used to develop a decision tree model. In regression analysis, cardiovascular disease, peripheral vascular disease, pneumonia or influenza, cardiovascular surgery, hemodialysis, norepinephrine administration, hypotension, septic shock, moderate to severe malnutrition, sex, age, and Braden Scale score on admission to the intensive care unit were all predictive of pressure injury. Decision tree analysis revealed that patients who received norepinephrine, were older than 65 years, had a length of stay of 10 days or less, and had a Braden Scale score of 15 or less had a 63.6% risk of pressure injury. Determining pressure injury risk in critically ill patients is complex and challenging. One common pathophysiological factor is impaired tissue oxygenation and perfusion, which may be nonmodifiable. Improved risk quantification is needed and may be realized in the near future by leveraging the clinical information available in the electronic medical record through the power of predictive analytics.

Incidence and risk factors associated with pressure injury in patients with traumatic brain injury.

AimTo identify the prevalence of pressure injury in patients diagnosed with traumatic brain injury and analyse the risk factors involved during hospitalization.MethodsThis was a prospective study evaluating patients who were diagnosed with traumatic brain injury between November 2013 and September 2014. Patient characteristics, clinical and metabolic factors and therapeutic interventions, were evaluated within 30 days of hospital admission.ResultsMost of the 240 patients included in the study were male, young, and non‐Caucasian. The incidence of pressure injury was 18.8%. In terms of severity classification, the incidence of pressure injury was 2.7%, 23.2%, and 42.6% in mild, moderate, and severe traumatic brain injury, respectively. Pressure injury development was more likely in the first 10 days of hospitalization. A moderate or severe traumatic brain injury classification, the use of noradrenaline, and older age were pressure injury risk factors. The presence of pressure injury was associated with mortality within 30 days of hospitalization (P < .001).ConclusionThe incidence of pressure injury was high in patients diagnosed with traumatic brain injury, especially in those whose injury was classified as severe. Older age, noradrenaline use, and a classification of moderate or severe traumatic brain injury were identified as pressure injury risk factors.

Hemşirelik Öğrencilerinin Basınç Yaralanması Risk Faktörlerini Belirleyebilme Durumları

Objective: To explore the status of nursing students about identifying the pressure injury risk factors in a case scenario. Material and Methods: This descriptive study was carried out with 489 volunteered nursing students of a university between 5-26 May, 2017. For data collection, student information form including a case scenario was used. Students were instructed to read the case scenario carefully and write down the case-related pressure injury risk factors that they noticed. The data were evaluated using the mean, percentage, Standard deviation, Mann-Whitney U, Kruskal-Wallis H and Chi-square tests. Results: The rate of students who wrote case-related risk factors was 97.75% and the mean number of case-related risk factors written by nursing students was 7.40±3.83 among 20 risk factors. Students who had additional education and training experience on pressure injury care had written significantly more case-related risk factors than who had not (p<0.05). Conclusion: Although the rate of students who wrote risk factors was high, number of case-related risk factors identified by students was found to be insufficient. Taking additional education and training about pressure injury care helped students to identify pressure injury risk factors. It is recommended to reinforce the theoretical knowledge of especially 1st and 2nd years nursing students about pressure injury risk factors with clinical practices.

Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis.

Pressure injuries (PIs) are a common quality indicator for hospital care, and preventing PIs often requires patient engagement; as such, Australian consensus research has recommended that high-quality education materials be made to patients for PIs via hospital networks. The purpose of the present study was to assess the availability and accuracy of patient education materials on PIs in publicly available hospital websites in Victoria, Australia. Two independent coders assessed 212 websites for content on PI prevention and management, analysing availability and accuracy of PI definitions, risk factors, preventive strategies, referral, visual tools, consumer endorsement, information for family/carers, and translation on community languages. A greater proportion of hospitals did not have any patient education materials on PI prevention publicly available, with private hospitals (compared with public) and metropolitan hospitals (compared to rural) more likely to have materials available on their sites. The available materials contained accurate messages on PI defining characteristics and risk factors for PIs, although there was considerable variability on the availability of other information. Our findings suggest a significant deficit in the availability of educational materials for acute care patients and their families. There is a need for evidence-based, consumer-endorsed, uniform materials on all hospital websites to prevent PIs in acute care.

The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review

BackgroundPressure injuries are potentially preventable but frequently occurring adverse events. Intensive care patients have major risk factors for pressure injury with a reported pressure injury prevalence of 12–33%. Multi-faceted interventions, also known as programs or care bundles, are recommended to prevent pressure injuries. AimThis systematic review evaluated the effectiveness of pressure injury prevention programs in reducing pressure injury prevalence and incidence in the adult intensive care population. It also critically appraised the program components and strategies used to implement these programs. MethodWe searched PubMed, EMBASE (embase.com), Ovid MEDLINE, EBSCOhost CINAHL, and Cochrane Library databases separately for papers published in English and Chinese from the year of 2000 to May 2018. After removing duplicates, two authors independently screened the title and abstracts, then full-text against the inclusion and exclusion criteria. Data was extracted by one author and checked by a second author. Quality appraisal was conducted by two authors by using the Quality Improvement Minimum Quality Criteria Set, and the Mixed Methods Appraisal Tool. Content analysis was used to categorise program components. Implementation strategies were grouped into six classifications: dissemination strategies, implementation process strategies, integration strategies, capacity building strategies, sustainability strategies, and scale up strategies. ResultsTwenty-one peer reviewed papers (12 quality improvement projects, and 9 research papers from 8 studies) were included. Pressure injury prevention programs with 2–11 components were commonly implemented. Common components of the programs included: clarification of staff roles, introducing new roles, repositioning, staff and patient education, support surfaces use, pressure injury risk assessment, skin assessment, nutrition needs assessment, documentation, multidisciplinary team involvement, and mobilisation. Implementation strategies commonly used were education, audit and feedback, and standardising documentation. Five of the eight research studies and one of the quality improvement projects reported significant decrease in pressure injury prevalence, and/or increase in compliance to pressure injury prevention protocols and strategies. Two quality improvement papers reported cost savings of $1 million and £2.6 million respectively after the implementation of the programs. ConclusionMuch of the work on multicomponent pressure injury prevention programs has been undertaken as quality improvement projects and before and after research studies with limited rigour. However, positive outcomes and strong theoretical rationales for the components in the programs suggest that they are beneficial. This calls for future high-quality research such as randomised controlled trials to test the effectiveness of multicomponent interventions and their implementation strategies.Tweetable abstract: Some multicomponent pressure injury prevention programs were found to be effective; however, higher level of research evidence is needed.

Intraoperative use of low-profile alternating pressure mattress for prevention of hospital acquired pressure injury

BackgroundFacility acquired pressure injury is a problem in all care settings. Further work is necessary to better understand and intervene in specific scenarios. The operating room has not been well studied with respect to pressure injury prevention. Our purpose was to study the efficacy of a low profile alternating pressure (AP) overlay to prevent operating room associated pressure injuries. MethodsThis was a prospective case control study conducted in the operating room and critical care unit of an urban quaternary care hospital in the United States. Neurosurgery patients undergoing surgery for 2 hours or longer in the supine position were included in the study and assigned to receive the AP overlay in the operating room and in the Neurosurgical Intensive Care Unit (NICU) or standard treatment (control). The patients were then followed daily until discharge. Standard protocols for pressure injury prevention were maintained. Demographic data, details of the operation, pressure injury risk factors and presence of hospital acquired pressure injuries (HAPI) were recorded. The primary outcome of interest was the incidence of HAPI in the AP group compared to the control group. Results212 patients were enrolled into the study. 104 received the AP system whereas 108 did not. The average length of stay in the NICU for the AP group was 2.2+/− 1.6 days and 2.4 +/−0.5 days for the control group (p =0.078). The average OR case length was 4.5+/− 0.8 hours for the AP group and 3.9+/−1.2 hours for the controls (p = 0.014). In the AP group, 1 patient out of 104 (0.96%) developed a pressure injury whereas 7 patients out of 108 (6.48%) developed a pressure injury in the control group (p =0.014). There were no adverse events or unintended consequences resulting from use of the AP overlays in the operating room or NICU ConclusionsLow Profile Alternating Pressure mats are a safe and effective way to prevent hospital acquired pressure injuries and should be considered in patients undergoing complex procedures with increased operative time.

Refining Heel Pressure Injury Risk Factors in the Hospitalized Patient.

To replicate previous research that found four independent and significant predictors of heel pressure injuries (HPIs) in hospitalized patients using a larger and more diverse patient population. Researchers conducted a retrospective, case-control study with a main and a validation analysis (N = 1,937). The main analysis had 1,697 patients: 323 patients who had HPIs and 1,374 who did not. The validation analysis had 240 patients: 80 patients who developed HPIs and 160 who did not. Researchers used a series of diagnosis codes to define variables associated with an HPI. Data were extracted from the New York Statewide Planning and Research Cooperative System for January 2014 to June 2015. Study authors conducted a series of forward stepwise logistic regression analyses for both samples to select the variables that were significantly and independently associated with the development of an HPI in a multivariable setting. Researchers generated a receiver operating characteristic curve using the final model to assess the regression model's ability to predict HPI development. Seven variables were significant and independent predictors associated with HPIs: diabetes mellitus, vascular disease, perfusion issues, impaired nutrition, age, mechanical ventilation, and surgery. The receiver operating characteristic curve demonstrated predictive accuracy of the model. Beyond a risk assessment scale, providers should consider other factors, such as comorbidities, which can predispose patients to HPI development.

Evidence-Based Review and Discussion Points

Evidence-Based Review and Discussion Points

Abordagem do enfermeiro na prevenção de feridas em pacientes hospitalizados

Objetivos: Identificar os fatores de riscos para a lesão por pressão e descrever os cuidados de enfermagem em relação à prevenção da lesão por pressão em pacientes hospitalizados. Metodologia: O presente estudo refere-se a uma revisão integrativa da literatura de natureza descritiva e exploratória com uma abordagem qualitativa. A busca pelas informações ocorreu através do levantamento bibliográfico na Biblioteca Virtual em Saúde (BVS), onde foi selecionado a base de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Resultados: Essa pesquisa conseguiu identificar que as doenças do sistema nervoso, cardiovascular, sedentarismo e a idade são fatores de riscos para a lesão por pressão e os principais cuidados de enfermagem consistem em realizar mudança de decúbito, realização da escala de Braden e identificação dos fatores de riscos. Conclusão: os cuidados realizados pelo profissional enfermeiro são indispensáveis para a prevenção de lesões e manutenção da saúde dos pacientes.

Patients and Caregivers’ Understanding of Pressure Injury Risk Factors and Their Participation in Care

Background: Recommendations to prevent pressure injuries (PI) consistently emphasize patients’ participation in care, without which interventions are less likely to be effective. Aim: To examine patients and/or their caregivers’ knowledge of risk factors and participation in PI preventive interventions.Subjects and Methods: This descriptive study was conducted among 70 patients in neurological and orthopaedic wards in the University College Hospital in Nigeria. The patients were purposively selected. Knowledge about risk factors for PI, level of participation in care and perceived barriers were examined using structured questionnaire.Findings: Mean age was age 49± 18years; 37(66.1%) did not consider they were at risk for PI. Poor knowledge of risk factors: incontinence (59.3%), dragging self out of bed (56.5%), loss of sensation (58.3), when the nurse drags than lifts (66.7%) was found. Mean knowledge of risk factors was 1.42±0.49 and level of participation (1.31± 0.47). Barriers to participation included inadequate instruction from nurses about what they or their caregivers needed to do (2.41±1.16); pain during repositioning (3.58±1.16); feeling incompetent to turn (3.10±1.27; caregivers not allowed to stay on the ward (3.47±1.12). Only education was significantly associated with level of participation (P= 0.002&lt; 0.05). However, no significant association existed between the medical diagnosis of the patients and their level of participation (P = 0.347 &gt;0.05). Conclusion: Patients’ knowledge of risk factors was poor and participation was also low. Well defined instructions should be provided during hospitalization to improve patient’s participation in care.

Lesão por pressão: análise de prontuários e notificações do evento adverso

Introduction: The movement for patient safety seems increasingly globalized. Thus, strategies to leverage patient safety are necessary for this asset to be consolidated in the healthcare dynamics of health organizations. Objective: Evaluate in parallel the records of reports on pressure injuries with reports of adverse events in a public university hospital. Method: Descriptive study, from a documentary source. It was developed with patient records and reports of pressure injury in the Intensive Care Unit for adults and neurology and orthopedics unit of a hospital in Parana. Variables of clinical and demographic characterization of the sample were extracted; intrinsic and extrinsic risk factors for pressure injury, in addition to comparative incidence in documentary records in medical records and reports. Descriptive statistical analysis was performed. Results: A total of 658 medical records were analyzed, predominantly of men (62.0%), hospitalized in the non-critical sector (69.7%). It was found 91 (13.8%) records of incidence of pressure-related injuries in the medical records. Several intrinsic and extrinsic risk factors were raised. There were three reports of the adverse event in the same period, revealing that 96.7% of the injuries identified in the medical records were not properly reported. Conclusions: There is a clear discrepancy between the incidence of pressure injury observed in medical records and reports of adverse events.

Alternating Pressure Overlay for Prevention of Intraoperative Pressure Injury

The purpose of this study was to evaluate the effect of a low-profile alternating pressure (AP) overlay system on hospital-acquired pressure injuries (HAPIs). Prospective case series with historical controls. The study setting was the operating room and critical care unit of an urban quaternary care hospital in the Midwestern United States. One hundred neurosurgery patients undergoing surgery for 2 hours or longer in supine position were included in the study (AP group). The outcomes for the AP group were compared to a historical control group of 292 patients. A group of 100 patients were prospectively placed on the AP overlay during surgery. Participants were enrolled preoperatively and tracked by the research team during their hospital stay. Demographic data, details of the operation, and pressure injury risk factors were recorded. Following surgery, AP group patients were evaluated daily and continued on standard protocol for pressure injury prevention. The primary study outcome was HAPI rate during the perioperative period (up to 5 days postsurgery) for the AP group (plus standard of care) compared to the standard of care alone (historical control). Control group data were extracted from electronic health records for the prior 2 years. A written questionnaire was given to the care team that used the AP technology; items queried the degree of acceptance of the overlay by surgeons and the operating room and intensive care unit (ICU) staff. None of the patients in the AP group developed perioperative pressure injuries. Review of historical control group revealed a 6% perioperative pressure injury incidence (18 pressure injuries in a group of 292 patients). Responses on the written questionnaire indicated that the AP technology was well accepted by surgeons and the operating room and ICU staff. There were no adverse events. Study findings suggest that AP overlay system can safely and reliably be used during neurological surgeries. Findings further suggest that using the AP product may improve outcomes with respect to perioperative HAPIs, including patients deemed at high risk for pressure injury development. Further studies are underway to evaluate the use of this AP overlay system beyond the operating room for more comprehensive care.

Individualized Clinical Practice Guidelines for Pressure Injury Management: Development of an Integrated Multi-Modal Biomedical Information Resource.

BackgroundPressure ulcers (PU) and deep tissue injuries (DTI), collectively known as pressure injuries are serious complications causing staggering costs and human suffering with over 200 reported risk factors from many domains. Primary pressure injury prevention seeks to prevent the first incidence, while secondary PU/DTI prevention aims to decrease chronic recurrence. Clinical practice guidelines (CPG) combine evidence-based practice and expert opinion to aid clinicians in the goal of achieving best practices for primary and secondary prevention. The correction of all risk factors can be both overwhelming and impractical to implement in clinical practice. There is a need to develop practical clinical tools to prioritize the multiple recommendations of CPG, but there is limited guidance on how to prioritize based on individual cases. Bioinformatics platforms enable data management to support clinical decision support and user-interface development for complex clinical challenges such as pressure injury prevention care planning.ObjectiveThe central hypothesis of the study is that the individual’s risk factor profile can provide the basis for adaptive, personalized care planning for PU prevention based on CPG prioritization. The study objective is to develop the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury (SCIPUD+) Resource to support personalized care planning for primary and secondary PU/DTI prevention.MethodsThe study is employing a retrospective electronic health record (EHR) chart review of over 75 factors known to be relevant for pressure injury risk in individuals with a spinal cord injury (SCI) and routinely recorded in the EHR. We also perform tissue health assessments of a selected sub-group. A systems approach is being used to develop and validate the SCIPUD+ Resource incorporating the many risk factor domains associated with PU/DTI primary and secondary prevention, ranging from the individual’s environment to local tissue health. Our multiscale approach will leverage the strength of bioinformatics applied to an established national EHR system. A comprehensive model is being used to relate the primary outcome of interest (PU/DTI development) with over 75 PU/DTI risk factors using a retrospective chart review of 5000 individuals selected from the study cohort of more than 36,000 persons with SCI. A Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) is being developed to enable robust text-mining for data extraction from free-form notes.ResultsThe results from this study are pending.ConclusionsPU/DTI remains a highly significant source of morbidity for individuals with SCI. Personalized interactive care plans may decrease both initial PU formation and readmission rates for high-risk individuals. The project is using established EHR data to build a comprehensive, structured model of environmental, social and clinical pressure injury risk factors. The comprehensive SCIPUD+ health care tool will be used to relate the primary outcome of interest (pressure injury development) with covariates including environmental, social, clinical, personal and tissue health profiles as well as possible interactions among some of these covariates. The study will result in a validated tool for personalized implementation of CPG recommendations and has great potential to change the standard of care for PrI clinical practice by enabling clinicians to provide personalized application of CPG priorities tailored to the needs of each at-risk individual with SCI.Registered Report IdentifierRR1-10.2196/10871

Pressure Injury Risk Factors in Critical Care Patients: A Descriptive Analysis.

Pressure injury (PI) development in the critical care population is multifactorial. Despite the application of evidence-based prevention strategies, PIs do occur and may be unavoidable in some patients. To describe the risk factors associated with PI development in a sample of medical-surgical intensive care unit patients and determine whether these risk factors were congruent with the risk factors proposed in the work of the National Pressure Ulcer Advisory Panel on unavoidable PIs. A retrospective, descriptive design was used to determine the PI risk factors present in a sample of 57 critically ill patients admitted to the medical-surgical intensive care unit for more than 24 hours and who acquired a PI during their admission. The most frequently identified risk factors were immobility (n = 57 [100%]), septic shock (n = 31 [54%]), vasopressor use (n = 37 [65%]), head-of-bed elevation greater than 30° (n = 53 [93%]), sedation (n = 50 [87.7%]), and mechanical ventilation for more than 72 hours (n = 46 [81%]). The most common PI location was the sacrum (n = 32 [56%]), and the most common stage reported was deep-tissue PI (n = 39 [68%]). The mean number of days to PI development was reported at 7.5 (SD, 7.2) days. Results of this descriptive study were congruent with the literature surrounding the clinical situations that predispose patients to unavoidable PIs. While the implementation of aggressive PI prevention strategies is essential to reducing PI rates, it is important to recognize that in certain populations, such as the critically ill, exposure to certain risk factors may potentially escalate PI risk beyond the scope of prevention and result in an unavoidable PI. Recognizing these risk factors is significant in the journey to differentiate PIs that result from a lack of preventive care from those that may be prevention immune.

Pressure Injury Development in Patients Treated by Critical Care Air Transport Teams: A Case-Control Study.

The US Air Force transports critically ill patients from all over the world, with transport times commonly ranging from 6 to 11 hours. Few outcome measures have been tracked for these patients. Traditional methods to prevent pressure injuries in civilian hospitals are often not feasible in the military transport environment. The incidence rate and risk factors are described of en route-related pressure injuries for patients overseen by the Critical Care Air Transport Team. This retrospective, case-control, medical records review investigated risk factors for pressure injury in patients who developed a pressure injury after their transport flight compared with those with no documented pressure injuries. The pressure injury rate was 4.9%. Between 2008 and 2012, 141 patients in whom pressure injuries developed and who had received care by the team were matched with 141 patients cared for by the team but did not have pressure injury. According to regression analysis, body mass index and 2 or more Critical Care Air Transport Team transports per patient were associated with pressure injury development. Although the pressure injury rate of 4.9% in this cohort of patients is consistent with that reported by civilian critical care units, the rate must be interpreted with caution, because civilian study data frequently represent the entire intensive care unit length of stay. Targeted interventions for patients with increased body mass index and 2 or more critical care air transports per patient may help decrease the development of pressure injury in these patients.

Predictors of Pressure Injuries in a Critical Care Unit in Lebanon: Prevalence, Characteristics, and Associated Factors.

The purpose of this study was to identify factors associated with pressure injury in a medical-surgical intensive care unit (MSICU). Retrospective review of medical records. We reviewed the medical records of 145 patients who developed a new pressure injury in the MSICU of a 420-bed university medical center in Lebanon. Medical records of all patients cared for in the MSICU from December 2014 to June 2017 were reviewed by a research assistant using a standardized form. We extracted potential risk factors for pressure injury including sex, age, weight upon admission, weight at discharge, length of MSICU stay, episodes of hypotension, administration of inotropes/vasopressors, admitting diagnosis, comorbid conditions, and cumulative scores on the Braden Scale for Pressure Sore Risk. The outcome variable was development of any new pressure injury during their stay in our intensive care unit. Forty-nine patents (33.7%) developed a new pressure injury. Bivariate analysis found statistically significant associations between pressure injury occurrences and administration of vasopressors (odds ratio [OR] = 0.42; 95% confidence interval = 0.29-0.87; P = .02), the administration of dopamine (OR = 0.20; 95% confidence interval = 0.04-0.94; P = .04), and hospital-acquired pressure injury. Among the continuous variables, analysis revealed significant relationships between weight at discharge (t = 2.31, P = .02), MSICU length of stay (t = 5.30; P = .000), cumulative Braden Scale score (t = 3.06; P = .002), hypotension (t =-2.74; P = .007), and development a new pressure injury. Multivariate analysis indicated that length of stay (β= -.110; P = .002), administration of vasopressors (β=-.266; P = .029), and total hours of hypotension (β=-.53; P = .041) were significant predictors of pressure injury. Vasopressor use, hypotension, and length of stay were associated with an increased likelihood of pressure injury in adults managed in an MSICU. None of these factors is specifically evaluated during completion of the Braden Scale for Pressure Sore Risk. Based on these findings we recommend development of a pressure injury scale specific to critically ill adults.