Risk Factors For Pressure Ulcers Research Articles

Risk Factors for Pressure Ulcer by Electrodes in Long-term Electroencephalography Monitoring

Background: Although electroencephalography is known as non-invasive, long-term electroencephalography monitoring has a significant risk of pressure ulcers caused by electrodes. We investigated the incidence and risk factors of pressure ulcers in long-term electroencephalography monitoring for more than 24 hours.Methods: All patients who underwent long-term electroencephalography monitoring for more than 24 hours from January 2020 to December 2021 were reviewed. Their medical records were reviewed to evaluate the risk factors for pressure ulcers by electroencephalography electrodes. All patients were divided into the presence (lesion positive) and absence (lesion negative) of pressure ulcers confirmed by a clinician.Results: A total of 541 patients were analyzed in this study. Their mean age was 56.0±21.5, and the average duration of the long-term electroencephalography monitoring was 118.0±68.6 hours. Pressure ulcers were identified in 49 patients (9.1%). The odds ratios of age and recording time were 1.032 (95% confidence interval [CI], 1.008-1.056, <i>p</i>=0.009) and 1.022 (95% CI, 1.015-1.029, <i>p</i><0.001), respectively. The odds ratio of pressure ulcer was 2.702 (95% CI, 1.461-4.999, <i>p</i>=0.002) in patients with comatose mentality (1 point for eye response of Glasgow coma scale).Conclusions: The pressure ulcers caused by electrodes in long-term electroencephalography monitoring can be preventable with due diligence in clinical settings. Risk factor control to prevent pressure ulcers due to electroencephalography electrodes is needed.

Risk Factors Associated with Pressure Ulcers among Home Health Care Patients; Riyadh, Saudi Arabia

Background: Patients, professionals, and health care systems are faced with a serious problem of pressure ulcers. They represent a significant occurrence and prevalence throughout the world. Their character iatrogenic states that its appearance is preventable, and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. Surgery may be necessary to accelerate the healing process, although most pressure ulcers are usually treated with debridement and conservative therapy. Their reported incidence and prevalence are significant worldwide. Objectives: The study's objectives are to identify the pressure ulcer risk factors in patients getting home health care, as well as to look at the quantity, type, and characteristics of pressure ulcers as well as patient comorbidities. Methods: Cross-sectional study, Home Care Nursing personnel questionnaire to determine the Risk Factors of Pressure Ulcers, patient comorbidities, and the number, and characteristics of pressure ulcers among patients receiving home care in Riyadh, Saudi Arabia. Results: PU is prevalent among the studied participants in Saudi Arabia, about 55% of these ulcers showed noticeable distraction of skin and/or deeper soft tissue against a bony prominence. We have also found a significant relationship between PU and gender, diabetes mellitus, hypertension, incontinence issues, nutritional status, and physical status, cerebrovascular accidents, trauma, and chronic kidney disease. Conclusion: Different risk factors are associated with PU such as diabetes mellitus, hypertension, and nutritional, and physical status. To monitor and promote best practices in skin care for highly dependent patients, continued measurement and evaluation of PU incidence, it is recommended more research of risk factors of PU development be assessed at home Health care Centers.

Comparative analysis of pressure ulcer development in stroke patients within and outside healthcare facilities: A systematic review and meta-analysis.

The risk of pressure ulcers in stroke patients is a significant concern, impacting their recovery and quality of life. This systematic review and meta-analysis investigate the prevalence and risk factors of pressure ulcers in stroke patients, comparing those in healthcare facilities with those in home-based or non-clinical environments. The study aims to elucidate how different care settings affect the development of pressure ulcers, serving as a crucial indicator of patient care quality and management across diverse healthcare contexts. Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Embase, Web of Science and the Cochrane Library. Inclusion criteria encompassed studies on stroke patients in various settings, reporting on the incidence or prevalence of pressure ulcers. Exclusion criteria included non-stroke patients, non-original research and studies with incomplete data. The Newcastle-Ottawa scale was used for quality assessment, and statistical analyses involved both fixed-effect and random-effects models, depending on the heterogeneity observed. A total of 1542 articles were initially identified, with 11 studies meeting the inclusion criteria. The studies exhibited significant heterogeneity, necessitating the use of a random-effects model. The pooled prevalence of pressure injuries was 9.53% in patients without family medical services and 2.64% in patients with medical services. Sensitivity analysis confirmed the stability of these results, and no significant publication bias was detected through funnel plot analysis and Egger's linear regression test. The meta-analysis underscores the heightened risk of pressure injuries in stroke patients, especially post-discharge. It calls for concerted efforts among healthcare providers, policymakers and caregivers to implement targeted strategies tailored to the specific needs of different care environments. Future research should focus on developing and evaluating interventions to effectively integrate into routine care and reduce the incidence of pressure injuries in stroke patients.

The prevalence and risk factors of pressure ulcers among residents of long-term care institutions: a case study of Kazakhstan

Limited information is available regarding the prevalence of pressure ulcers (PUs) in residential homes in Central Asia. Therefore, the aim of this study was to identify the prevalence rates and risk factors associated with PUs among residents of long-term care medical institutions in the Republic of Kazakhstan. This cross-sectional study was conducted in four long-term care institutions in Kazakhstan. The study sample consisted of 640 patients who were assessed for the presence of PUs and associated risk factors. The evaluation was performed using the International Prevalence Measurement of Care Quality (Landelijke Prevalentiemeting Zorgkwaliteit, LPZ), the Braden scale, and the Care Dependency Score (CDS). The overall prevalence of PUs, classified as categories I–IV, was found to be 37%. When excluding category I PUs, the prevalence decreased to 35.6%. The odds ratios (ORs) for presenting with PUs were as follows: history of stroke (OR 5.22), diseases of the digestive system (OR 10.01), presence of spinal cord lesions/paraplegia (OR 20.50), recent reported confusion within the last 7 days (OR 184.00), and limited extent dependency according to the CDS (OR 4.44; 95%CI 1.31–16.1). It is imperative to establish specialized training programs aimed at equipping medical personnel, relatives, and patients themselves with the necessary skills to provide optimal care for individuals affected by PUs.

Prediction Pressure Ulcers in High Care Unit Patients: Evaluating Risk Factors and Predictive Scale Using a Prospective Cross-Sectional Study.

Background The incidence of ulcer pressure in the high care unit (HCU) was relatively high and could be reliably predicted using tools such as the Norton and Jackson/Cubbin scales. However, other risk factors, such as age, gender, consciousness, systemic condition, duration of treatment, and use of restraint, may contribute to the occurrence of ulcer pressure. This study was conducted to analyze the relationship of various risk factors for pressure ulcers and prediction of ulcer pressure, using Norton and Jackson/Cubbin scale, to incident pressure ulcers in HCU patient. Methods This study utilized a prospective cross-sectional study design to analyze various risk factors for ulcer pressure development in a patient admitted to the HCU, including age, gender, blood profile, consciousness, duration of treatment, and use of restraint. The Norton and Jackson/Cubbin scale was employed to predict pressure ulcers. The relationship between the risk factors and the prediction of pressure ulcer incidents was evaluated using multiple logistic binary regression analysis. Result Both the Norton and Jackson/Cubbin scales predicted a lower risk of pressure ulcer development (60.98 and 99.02%, respectively). This prediction is consistent with the low incidence of pressure injuries found, which is only 4.39%. Furthermore, the relationship between the identified risk factor (gender, duration of treatment in HCU and use of restraint) and the prediction and incident of pressure ulcer was not significant ( p > 0.05). Thus, it is suggested that these risk factors may not strong predictors of pressure ulcer development. Conclusion This study's result indicated no significant relationship exists between possible identified risk factors and the development of pressure ulcers in HCU patients. However, the Norton and Jackson/Cubbin scales were reliable predictors of pressure ulcer occurrence, with both scales predicting a lower risk of pressure ulcer development.

The prognostic effect of lymphocyte, monocyte, and platelet counts, mean platelet volume, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio on different stages of pressure ulcers

Background/Aim: Pressure ulcers (PU) pose a significant problem for patients in intensive care. Various factors contribute to the development of pressure sores. The primary focus of treatment is to implement measures that prevent factors such as nutrition and positioning, which can lead to PUs. Therefore, it is crucial to identify parameters that can serve as warning signals for the formation and progression of PU. This study investigates the potential use of hematological parameters as warning signals. Methods: Demographic data, co-morbidities, PU stages, and laboratory parameters of 158 patients hospitalized in the intensive care unit who developed pressure ulcers during their hospital stay were recorded and analyzed. Results: Among the 158 cases included in the study, PUs were more prevalent in patients of advanced age, those with pneumonia, chronic obstructive pulmonary disease (COPD), coronary diseases, and neurodegenerative diseases. Mean platelet volume (MPV) was significantly higher in PU stages 2 and 3 compared to stage 1. However, age, lymphocyte count, monocyte count, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) did not exhibit significant differences among the stages of PU (P<0.05). Conclusion: Advanced age, pneumonia, COPD, coronary diseases, and neurodegenerative diseases are identified as risk factors for PU. Although MPV was initially considered a potential, stimulating parameter, the evidence was insufficient. Further research is required to explore this issue. The impact of parameters other than MPV did not show any excitatory signal in this study.

Pressure Ulcer Diagnosis Is Associated with Increased Mortality in Patients with End-Stage Renal Disease: A Retrospective Study.

Pressure ulcers are associated with multiple comorbidities and annually affect approximately 3 million Americans, directly accounting for approximately 60,000 deaths per year. Because patients with end-stage renal disease (ESRD) are known to present with unique factors which impair wound healing, pressure ulcers diagnosed in ESRD patients might independently increase the risk of mortality. To investigate the association between pressure ulcer diagnosis and mortality risk in the ESRD population, a retrospective analysis of the United States Renal Data System (USRDS) database was performed. The records of 1,526,366 dialysis patients who began therapy between 1 January 2005 and 31 December 2018 were included. Our analysis showed that the diagnosis of pressure ulcers in this population was independently associated with mortality even after controlling for confounding factors (p < 0.001). A Kaplan-Meier survival analysis demonstrated reduced survival in patients with a pressure ulcer diagnosis compared to those without a pressure ulcer diagnosis. These results establish pressure ulcers as a significant independent risk factor for mortality, as well as suggesting several comorbidities as potential risk factors for pressure ulcers in the ESRD population.

Characteristics and Risk Factors for Pressure Ulcers in Severe Trauma Patients Admitted to the Trauma Intensive Care Unit

Purpose: A retrospective descriptive study was performed to develop strategies to manage or prevent pressure ulcers in patients with severe trauma being cared for in the trauma intensive care unit (TICU).Methods: Study data was compiled from 315 patients with severe trauma (injury severity score ≥ 15) who were admitted to a general hospital from January 1, 2020, to February 28, 2021 and were being cared for in the TICU. For patients with pressure ulcers, the characteristics and associated factors of pressure ulcers were examined.Results: There were 42 severe trauma patients (13.3%) with pressure ulcers, of which, 50.0% of cases occurred at the site of the coccyx. In 50% of patients, Stage 2 pressure ulcers were observed. The mean onset day of pressure ulcers was 9.74 days after admission. The occurrence of diabetes, critical care triage score, length of stay in intensive care, death, shock, dialysis, ventilator application, endotracheal intubation, peripheral insertion central catheter insertion, A-line insertion, body protector application, sedatives, blood pressure boosters, nasal cannula, high-flow oxygenators, oxygen tip application, drainage insertion, nasogastric tube nutrition, and ventilator application period were investigated. Logistic regression analysis revealed that the influencing factors for the development of pressure ulcers were endotracheal intubation, length of stay in the TICU, and age, in that order.Conclusion: By identifying the characteristics and risk factors associated with pressure ulcers in patients with severe trauma, strategies can be developed to better prevent or manage pressure ulcers in the future.

Prone positioning in COVID-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation

ObjectiveTo identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. MethodsRetrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. ResultsA total of 139 proning cycles were performed. The mean number of cycles were 2 [1–3] and the mean duration per cycle was of 22h [15–24]. The prevalence of adverse events this population was 84.9 %, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin <21mg/dl, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. ConclusionsThere is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.

Prevalence of Pressure Ulcers among patients in Ibn e Sina Hospital

Background: Pressure is a localized injury to the skin and underlying tissue usually over a bony prominence, as a result of pressure, or pressure contributing to shear. Objective: The main objective was to determine the prevalence of pressure ulcers in the patients of Ibn e Sina hospital Multan and to determine the risk factors contributing to pressure ulcers by using Braden Scale. Methodology: It was a cross-sectional observational study conducted on 246 patients of Ibn e Sina hospital Multan. During the 6 months of the study, patients were interviewed regarding their demographics and risk factors for pressure ulcers according to the Braden scale. Spss21 was used to analyze the data. Results: Out of 246 patients, 74.8% of male patients had pressure ulcers. The patients were from 25 to 85 years old. The pressure ulcers were more frequent among the 45 to 65 years age group (i.e., 44.7%) and married patients (95.5%). Among 246 patients only 4.5% patients were at extra high risk and most of the patients were at low risk (69.5%) by using the Braden scale. This data will help physicians, researchers, and policymakers in Pakistan and other nations advocate for the needs of pressure ulcer patients. Conclusion: According to this study pressure ulcers were more frequent in male married patients of the middle age group. Most of the patients were at low risk of developing pressure ulcers on the Braden Scale. Keywords: Pressure ulcer PU, Pressure sores, Pressure Injuries, Prevalence, Risk factors, Braden Scale, Braden score, Hospitals, Intensive care units

Risk factors for recurrent pressure ulcers after reconstructive surgery: A retrospective study in a single medical centre.

Recurrence of pressure ulcers following reconstructive surgery occurs frequently, causing a significant burden on the patient and the public health care system. We assessed risk factors for the recurrence of pressure ulcers based on the experience of a single surgeon at our medical centre. We retrospectively analysed patients admitted to our medical centre with stage III and IV pressure ulcers who underwent reconstructive surgery. The hospital database was searched for patients diagnosed with pressure ulcers who underwent reconstructive surgery. Patient characteristics analysed included age, sex, cause and location of defect, comorbidities, lesion size, wound reconstruction methods, operation time, debridement times, duration of hospital stay, and wound complications. Recurrence and mortality rates were retrospectively examined. One hundred and eighty-nine patients were enrolled, and 166 patients with 176 pressure ulcers met our inclusion criteria. All 14 recurrences (7.95%) were followed for at least 1year. Logistic regression analysis indicated that recurrence was associated with albumin levels (P=0.001) and wound size (P=0.043); however, no association was found for body mass index, bacterial profile, comorbidities, localisation, previous surgery, operation time, or time to admission for reconstruction. In conclusion, higher albumin levels were associated with lower recurrence rates in patients who underwent reconstructive surgery.

Hospital-acquired Pressure Ulcers in Trauma Patients: A Retrospective Study of 410 Patients at a Referral Trauma Center in the North of Iran

Background: Pressure ulcers (PUs) are among the most common chronic ulcers and complications of hospitalization. Objective: The present study aims to evaluate the prevalence of hospital-acquired PUs and their grades in trauma patients, comparing demographic characteristics, clinical features, and outcomes among patients without and with PUs referred to a trauma center in the North of Iran. Methods: In a retrospective study, 410 patients with trauma referred to a trauma center in the North of Iran were enrolled. Data were collected using a simple random sampling from March 2019 to September 2019. Results: The prevalence of PU in patients with trauma was 27.6%. Grade III (35.5%) and grade I (3.5%) wounds had the highest and lowest frequency of PU, respectively (P&lt;0.001). The mean age of patients with PU was higher than patients without PU (61.73 vs. 47.71 years, P&lt;0.001). The mean hemoglobin level of patients with PU was lower than patients without PU (9.93 vs. 12.25, P&lt;0.001). PUs were more common in smokers compared to non-smokers (P&lt;0.001), with a history of PU (P&lt;0.001), a history of diabetes mellitus (P&lt;0.001), and a history of hypertension (P&lt;0.001). The mean length of stay in the hospital for patients with PU was higher than for patients without PU (13.02 vs. 5.54 days, P&lt;0.001). 74.3% of people with PUs were completely immobile (P&lt;0.001), and 60% of them had mild brain damage (GCS of 13 to 15). Also, the number of people with severe and moderate brain injury among PUs patients was 15% and 24.7%, respectively (P&lt;0.001). Mobility, brain damage, Hemoglobin rate and smoking status were risk factors for pressure ulcers. Conclusion: Therefore, it is recommended that health managers and policymakers develop care and treatment plans by considering these risk factors.

Decúbito prono en pacientes COVID-19 con síndrome de distrés respiratorio agudo y ventilación mecánica invasiva

ObjectiveTo identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. MethodsRetrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. ResultsA total of 139 proning cycles were performed. The mean number of cycles were 2 [1-3] and the mean duration per cycle was of 22 hours [15-24]. The prevalence of adverse events this population was 84.9%, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin < 21 mg/dL, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. ConclusionsThere is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.

Evaluation of pressure ulcer risk and development in operating rooms

AimThis study aimed to determine the risk and development of pressure ulcers in operating rooms. Materials and methodsThe sample of the study included a total of 250 patients. In the study, the risk of pressure ulcers was assessed before the operation, and the development of pressure ulcers was evaluated within 24 h after the operation. ResultsThe risk of pressure ulcers was low before the operation, and Stage I pressure ulcer developed in 12.8% of the patients within 24 h after the operation. The patients had pressure ulcers mostly in their sacrum. Their mean 3S Intraoperative Risk Assessment Scale of Pressure Sore score was 15.68 ± 4.84, suggesting that they were not at risk of developing pressure ulcers. Having a chronic disease (OR = 8.986; 95% CI = 3.697–21.845), undergoing general anesthesia (OR = 3.084; 95% CI = 1.323–7.194), and orthopedic surgery (OR = 10.172; 95% CI = 3.121–33.155) were statistically significant risk factors for pressure ulcers (p < 0.001). Additionally, moderately edematous skin (OR = 3.838; 95% CI = 1.024–14.386), overweight/underweight (OR = 16.333; 95% CI = 3.779–70.602), intraoperative bleeding greater than 800 ml (OR = 13.000; 95% CI = 3.451–48.969), operation time longer than 5 h (OR = 21.667; 95% CI = 2.122–221.223), moderate intraoperative stress (OR = 4.917; 95% CI = 0.425–56.916), body temperature higher than 38.3 °C or lower than 36.1 °C (OR = 5.462; 95% CI = 2.161–13.805), and intraoperative prone position (OR = 3.354; 95% CI = 1.386–8.115) were statistically significant risk factors for the development of pressure ulcers. ConclusionAccording to our preoperative pressure ulcer risk assessment, it is very important to take additional protective measures both during and after surgical operations to prevent pressure ulcers.

Decubitus Ulcer Patients Profile in Department of Plastic Surgery Dr. Soetomo General Hospital Surabaya from January to December 2018

Highlights:1. Decubitus ulcers can be caused by prolonged immobilization and constant pressure on the body.2. Decubitus ulcer patients were dominated by females, aged 46-65 years old, and the most common comorbidity history was patients with limb weakness. AbstractIntroduction: Continuous pressure on the area of the skin, especially in areas with bone protrusion can cause decubitus ulcers. Decubitus ulcers can occur to anyone, both children and adults, male or female, especially in people who experience daily immobility in a bed or wheelchair. Many treatments are performed in order to prevent decubitus ulcers to not becoming a more dangerous condition. This study aimed to determine the profile of pressure ulcers in Dr. Soetomo General Hospital Surabaya.Methods: This was a cross-sectional descriptive retrospective study. Secondary data were collected from 25 medical records of pressure ulcer patients in the Outpatient Clinic Department of Plastic Surgery Dr. Soetomo General Hospital Surabaya from January to December 2018. The data such as age, gender, risk factors, comorbidities history, and management were taken. The calculation was performed using Microsoft Excel.Results: The majority of patients with pressure sores at the Outpatient Clinic Department of Plastic Surgery Dr. Soetomo General Hospital Surabaya from January to December 2018 were dominated by female patients aged 46-65 years old (24%), with the most common risk factor being immobilization (96%). Patients’ history showed that most patients with decubitus ulcers suffered from a weakness in the limbs (13%). The most common treatment was wound bed preparation (46%) and education (46%).Conclusion: Pressure ulcers most often occurred in women aged 41-65 years or the elderly. Most patients experienced immobilization as a risk factor for pressure ulcers. These patients were dominated by those who had a history of illness with limb weakness. The therapy applied to patients with pressure sores was the preparation of wound beds and education to the patient.

Evaluation of Pressure Ulcer Frequency and Risk Factors in Pediatric Intensive Care Units: A Multicenter Study

Evaluation of Pressure Ulcer Frequency and Risk Factors in Pediatric Intensive Care Units: A Multicenter Study

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

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

Risk factors for pressure ulcers in adult patients: A meta-analysis on sociodemographic factors and the Braden scale.

Providing the first meta-analysis of risk factors for pressure ulcer development in adult patients. Pressure ulcers remain a serious health complication for patients and nursing staff. However, there is a lack of statistical evidence for risk factors as previous research did not include any quantitative synthesis. Meta-analysis, using PRISMA guidelines. Studies from PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews and sources were screened and checked against the inclusion criteria. The risk of bias was evaluated using a slightly modified QUIPS tool. Data regarding population, design, statistical analysis and risk factors were extracted. Meta-analysis with comparable studies was conducted for age, sex, and Braden scale. The sub-group analysis was used to account for heterogeneity. 28studies with 570,162 patients were entered in meta-analysis. Older age and a low total Braden scale score increased the risk for pressure ulcers. All subscales excluding 'moisture' reached significance in meta-analysis based only on few studies, however, limiting overall evidence. Male sex achieved mixed results, too. The first meta-analytic analysis shows evidence for age and Braden scale as risk factors for pressure ulcer development. Limitations regarding study quality and heterogeneity must be considered, highlighting the need for unifying certain conditions in risk factor research. Patients at risk for new pressure ulcers can be identified by their total Braden score and age, whereas the latter is also connected to deeper pressure ulcers. Nurses and health personnel should pay great attention to patients in older age and undergo specific training to utilise and evaluate the Braden scale effectively, if necessary.

The skin microbiome of infected pressure ulcers: A review and implications for health professionals.

Pressure ulcers (PUs) are injuries resulting from ischaemia caused by prolonged compression or shear forces on the skin, adjacent tissues and bones. Advanced stages of PUs are associated with infectious complications and constitute a major clinical challenge, with high social and economic impacts in health care. This study aims to identify and describe the relationship between PU risk factors, stages and anatomical locations, and the relevance of microbial cohabitation and biofilm growth. The narrative review method to advocating a critical and objective analysis of the current knowledge on the topic was performed. Indexed databases and direct consultation to specialized and high-impact journals on the subject were used to extract relevant information, guided by co-authors. The Medical Subject Headings of pressure ulcer (or injury), biofilms, infection and other analogues terms were used. Development of PUs and consequent infection depends on several direct and indirect risk factors, including cutaneous/PU microbiome, microclimate and behavioural factors. Infected PUs are polymicrobial and characterized by biofilm-associated infection, phenotypic hypervariability of species and inherent resistance to antimicrobials. The different stages and anatomical locations also play an important role in their colonization. The prevention and monitoring of PUs remain crucial for avoiding the emergence of systemic infections and reducing health care-associated costs, improve the quality of life of patients and reduce the mortality-associated infected PUs.

Risk factors of Pressure Ulcers in hospitalized elderly Egyptian people

Background: Pressure ulcers affect a large scale of elderly people. Despite advances in technology, the rate continues to increase. This increases morbidity, health care costs and mortality. Aim: searching for risk factors of pressure ulcers in elderly patients admitted to acute geriatric care units. Methods: A case control study was conducted recruiting100 elderly male and female patients above the age of six ty. History and physical examination were done, as well as nutritional and functional assessment. Nursing care was assessed using a checklist and Braden scale was done as a risk assessment scale for pressure ulcers. Blood samples were collected for laboratory measures. Results: pressure ulcers result from contribution of many factors as cardiovascular and cerebrovascular diseases, urinary incontinence, poor nutrition, immobility. Patients free from pressure ulcers had better nursing care with more frequent repositioning and use of air mattress (in more than 80%, compared use of air mattress in about 40% only of patients acquiring pressure ulcers). Braden scale was highly sensitive for the occurrence of pressure ulcers (cutoff point ≤ 17) with 77.4% positive predictive value and 97.3% negative predictive value. Conclusion: Pressure ulcers are multifactorial in origin. Nursing care is of utmost importance for their prevention. Braden scale should be applied to elderly pa tients upon admission to hospitals