Risk Factors For Pressure Ulcer Development Research Articles

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

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

The relationship between common risk factors and the pathology of pressure ulcer development: a systematic review.

The aim of this systematic review was to examine the associations and relationship between commonly cited risk factors and the pathology of pressure ulcer (PU) development. Using systematic review methodology, original research studies, prospective design and human studies written in English were included. The search was conducted in March 2018, using Ovid, Ovid EMBASE and CINAHL databases. Data were extracted using a pre-designed extraction tool and all included studies were quality appraised using the evidence-based librarianship critical appraisal. A total of 382 records were identified, of which five met the inclusion criteria. The studies were conducted between 1994 and 2017. Most studies were conducted in hospital and geriatric wards. The mean sample size was 96±145.7 participants. Ischaemia, recovery of blood flow and pathological impact of pressure and shear was mainly found as the cited risk factor and PU aetiology. This review systematically analysed five papers exploring the relationship between risk factors for PU development and aetiology. It identified many risk factors and underlying pathological mechanisms that interact in the development of PU including ischaemia, stress, recovery of blood flow, tissue hypoxia and the pathological impact of pressure and shear. There are several pathways in which these pathological mechanisms contribute to PU development and identifying these could establish potential ways of preventing or treating the development of PU for patients.

Modeling A Multi-Chamber Air Cushion for Pressure Profile Distribution and Temperature Regulation

Impaired sensory perception is a risk factor for pressure ulcer development. Pain and discomfort are symptoms of excessive pressure and potential tissue damage.

Cost comparison of pressure ulcer preventive dressings: hydrocolloid dressing versus transparent polyurethane film

To evaluate and compare the costs of using a transparent polyurethane film (PF) and hydrocolloid dressing (HD) in the prevention of pressure ulcers (PUs). This descriptive, observational, longitudinal, comparative study was conducted in the intensive care units, coronary care unit and medical clinic of a charity hospital in Brazil. Data were collected during a 30-day study period, consisting of physical examination, assessment of risk factors for PU development and application of the Braden scale, which were performed at inclusion in the study and once daily during hospitalisation. Either PF or HD was applied bilaterally in the sacral and trochanteric regions for prevention of PUs in patients at a moderate to high risk of PUs according to the Braden scale, and costs of using PU preventive dressings were estimated. The mean total costs per dressing change per patient when using the HD and PF to prevent PUs were 413.60 BRL and 74.04 BRL, respectively. There were significant between-group differences in mean costs for all variables, except for saline solution and nurse-technician services. Results showed that the mean cost per dressing change per patient was lower when using the transparent PF than when using the HD.

Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: a systematic review protocol.

The objective of this review is to identify the effectiveness of pressure ulcer (PU) prevention strategies on the incidence of hospital-acquired PUs in the intensive care unit (ICU).More specifically, the objectives are to identify the effectiveness of utilizing PU prevention strategies such as risk assessment, skin assessment, skin care, nutrition, position and repositioning, education and training, medical devices care or other strategies designed to manage the risk factors for PU development and reduce the incidence of PUs in ICUs.

Incidence of pressure ulcers in cardiopulmonary intensive care unit patients.

Objective Identify and analyze the incidence coefficients of pressure ulcers (PU) and the risk factors for PU development in critical patients with cardiopulmonary diseases. Method A prospective cohort study conducted in the cardiopulmonary intensive care unit (ICU) of a large hospital in the city of São Paulo, from November 2013 to February 2014. In total, 370 patients over 18 years old who did not present PU at admission and who had been in the ICU for less than 24 hours were studied. Data were analyzed by univariate and multivariate analyses (Classification And Regression Tree - CART). Results The incidence coefficients of PU were: 11.0% for total participants, 8.0% for male and 3.0% for female patients (p=0.018); 10.0% for white patients and 6.5% for patients 60 years or older. The main risk factors were length of stay in the ICU for 9.5 days or more, age 42.5 years or older, and being of the white race. Conclusion This study was related to the epidemiology of PU in critical patients with cardiopulmonary diseases, facilitating the planning of specific preventive care for these patients.

Relationship between time in the operating room and incident pressure ulcers: a matched case-control study.

The objective was to determine the relationship between time in the operating room (OR) and hospital-acquired pressure ulcers (HAPUs), controlling for temporality. The research team identified 931 HAPUs among surgical patients and matched them to 4 controls by hospital length of stay at the time the pressure ulcer (PU) was documented. A regression model estimated the relationship between OR time and HAPU after controlling for matching, age, sex, admission and current Braden score, weight, year, and American Society of Anesthesiologists physical status score. OR time in the 24 hours prior to PU documentation was associated with PUs. Only 5% of HAPUs occurred within 24 hours of extended (>4 hours) surgery and 58% occurred after hospital day 5. Extended surgery is confirmed as a risk factor for PU development. Most PUs do not appear in the immediate postoperative period, and prevention efforts should focus on postoperative patient care, when most HAPUs develop.

Pressure ulcers from spinal immobilization in trauma patients

To protect the (possibly) injured spine, trauma patients are immobilized on backboard or vacuum mattress, with a cervical collar, lateral headblocks, and straps. Several studies identified pressure ulcer (PU) development from these devices. The aim of this literature study was to gain insight into the occurrence and development of PUs, the risk factors, and the possible interventions to prevent PUs related to spinal immobilization with devices in adult trauma patients. We systematically searched PubMed (MEDLINE), EMBASE, Cochrane, and CINAHL for the period 1970 to September 2011. Studies were included if participants were healthy volunteers under spinal immobilization or trauma patients under spinal immobilization until spine injuries were diagnosed or excluded. Outcomes of primary interest included occurrence, severity, and risk for PU development as well as prevention of PU development related to spinal immobilization devices. The results of included studies show an incidence of collar-related PUs ranging from 6.8% to 38%. Described locations are the occiput, chin, shoulders, and back. The severity of these PUs varies between Stages 1 and 3, and one study describes PUs requiring surgical debridement, indicating a Stage 4 PU. Described risk factors for PU development are high pressure and pain from immobilizing devices, the length of time in/on a device, intensive care unit admission, high Injury Severity Scores (ISSs), mechanical ventilation, and intracranial pressure monitoring. Preventive interventions for collar-related PUs include early replacement of the extrication collar and regular skin assessment, collar refit, and position change. The results from this systematic review show that immobilization with devices increases the risk for PU development. This risk is demonstrated in nine experimental studies with healthy volunteers and in four clinical studies. Systematic review, level III.

Pressure Ulcers and Risk Assessment in Severe Burns

Risk and incidence of pressure ulcers (PUs) in the burn population remain poorly understood. The purpose of this study was to determine the timing and incidence of PUs at our regional burn center and to identify early risk factors for PU development in burn patients. A retrospective review of 40 charts was performed from among the 1489 patients admitted to our regional burn center between January 2008 and December 2009. Twenty patients acquired PUs during their admission and were identified on the basis of International Classification of Diseases, ninth revision, designation, hospital stay >7 days, and thermal injury (excluding toxic epidermal necrolysis and purpura fulminans). The remaining 20 patients were matched controls based on ±5 years in age and ±8% TBSA. Patient, injury, and outcome characteristics were compared among patient groups using χ for categorical variables and Mann-Whitney for continuous variables. The incidence of PU was 1.3% of all admissions. PU most commonly occurred at the sacrum/coccyx (eight), lower extremity (seven), and occiput (six). A majority of PU presented at stage 2 (33%), stage 3 (26%), and unstageable (30%). Thirteen were splint or device related and reportable. Ninety percent of patients with PUs presented with a Braden score of 16 or less (P = .03), although 60% of controls also had admission Braden scores less than 16. On an average, PUs were acquired within 17 days of admission. Data suggest burn patients are particularly at risk of developing PU based on admission Braden scores. However, low Braden scores do not necessarily correlate with eventual development of PU. Therefore, early and aggressive PU prevention and risk assessment tools must be used to diagnose PUs at an early and reversible stage.

Prevention and Early Detection of Pressure Ulcers in Hospitalized Patients

Skin integrity is identified as a measure of nursing care quality, yet pressure ulcers (PU) are a major health problem. Increasingly, patients admitted to acute care hospitals are older and possess multiple risk factors for PU development. The primary goal of this quality improvement project was to improve PU prevention and management. A secondary goal was to improve nursing documentation of PU prevention and intervention strategies. A preintervention, intervention, postintervention design was employed; the intervention included formal and informal education. Data were collected in 2 phases; Phase I occurred in a critical care unit and Phase II occurred on a medical-surgical unit. Demographics, PU incidence, risk factors, and comorbidity data were collected, along with nursing specific data. The results of this quality improvement project suggest that educational programs improve nursing care and documentation, and they raise additional questions regarding the concept of “avoidable versus unavoidable” PU in high-risk populations. ■ Background