[Pressure ulcers in the critical patient: detection of risk factors]

APACHE scoring system and pressure injury risk for intensive care patients: A systematic review and meta-analysis

The present study was designed to determine the association between Acute Physiology and Chronic Health Evaluation (APACHE) scale and elevated pressure injure (PI) risk in intensive care units (ICU) and also evaluate the predictive value of APACHE score in PI patients. Comprehensive strategies were used to search studies from PubMed, Web of Science, and Ovid Embase electronic databases for observational studies that provided data about APACHE scores related to PI in ICU. Eligible studies were selected based on inclusion and exclusion criteria. The pooled SMD with 95% confidence intervals were calculated. A summary ROC curve was plotted to calculate area under curve (AUC) for APACHE-II (15-20). Twenty-one studies involving 11,102 patients who met selection criteria were included. The 11.0% of patients (1229/11102) in ICU developed PIs. Overall, the PI group had a higher score compared with the non-PI group in the APACHE II (22.1 ± 8.0 vs. 14.5 ± 7.4, mean ± SD). The APACHE-III of PI patients was significantly more than that in the non-PI group (79.9 ± 25.6 vs. 59.9 ± 30.4, mean ± SD). The pooled SMD was 0.82 (95% CI: 0.58-1.06, I²  = 91.7%, p-value < 0.001). The subgroup analysis revealed that the risk of PIs did not vary with the type of APACHE score (II, III, IV) and the type of study design (case-control, cross-sectional, cohort, longitudinal study). Proportion of males (I²  = 91.68%, p value = 0.090), publish year (I²  = 91.96%, p value = 0.187) and mean age of patients (I²  = 91.96%, p value = 0.937) were not the sources of heterogeneity. APACHE-II (15-20) achieves the best predictive performance in PI, and the prediction accuracy was balanced with equal sensitivity and specificity (Sen: 0.72, 0.62-0.80; Spec: 1.72, 1.25-2.38). In conclusion, higher APACHE scores are frequently accompanied by a higher incidence of PI among critical-care patients. APACHE-II scores (15-20) satisfactorily predicted PI, and strategies to prevent PI should be aggressively implemented.

Singular Predictors of Hospital-Acquired Pressure Injuries Under Intensive Care: A Retrospective Cohort Study in a Medium-Complexity Hospital

A retrospective cohort study of hospital-acquired pressure injuries (HAPI) reported an incidence rate of 34.3% based on 582 medical records of adult patients admitted to the intensive care unit (ICU) of a medium-complexity public hospital in 2017 and 2018. Sixty percent of the patients used respirators, 49.3% presented hypotension, and 48.1% used norepinephrine. The main individual predictors of HAPI in the ICU were "days of norepinephrine" with an odds ratio (OR) of 1.625 (95% CI: 1.473-1.792) and concordance statistic (AUC) of 0.818 (95% CI: 0.779-0.857), "days of mechanical ventilation" with an OR of 1.521 (1.416-1.634) and AUC of 0.879 (0.849-0.909), "ICU stay (days)" with an OR of 1.279 (1.218-1.342) and AUC of 0.846 (0.812-0.881), and "Braden's sensory perception" with an OR of 0.345 (95% CI: 0.278-0.429) and AUC of 0.760 (0.722-0.799). The duration of mechanical ventilation, norepinephrine administration, and ICU length of stay presented significant discriminative capacity for HAPI prediction.

Nursing records, prevention measures and incidence of pressure ulcers in an Intensive Care Unit

OBJECTIVES

The aim of this paper is to determine the incidence and most incident pressure ulcers (PU) category. Establish the main clinical characteristics of these PU. Determine whether there is adequate documentation of PU and of the measures used to prevent them.

METHOD

Observational descriptive and retrospective study during 2014 at Intensive Care Unit (ICU)-University Hospital of Araba. Study sample, all patients suffering from PU at the time of the study by accidental sampling. Computerised records regarding risk assessment, clinical assessment and pressure sore treatment, provided by the 'Metavision' computer programme and descriptive statistics using SPSS version 22.0. Approval from the Ethics Committee for Clinical Research of the University Hospital of Araba was obtained.

RESULTS

The incidence of patients suffering from PU during 2014 was 6.78%. The most common locations for PU were the sacral region and the heels: the most incident pressure ulcers category was grade II, followed by grade I. Out of the 98 PU treated in our patients, 43 occurred outside the ICU and 55 in the unit itself. The lack of records, in all the variables described about PU, was 19.10%.

CONCLUSIONS

The incidence of pressure ulcers was lower than in the current literature. The most frequent category, location and clinical characteristics are comparable to previous studies. There is a high rate of failing to record the characteristics of the PU declared. Good PU prevention measures and recording were carried out.

Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit

OBJECTIVE

Contribution to validation of the Braden scale in patients admitted to the ICU, based on an analysis of its reliability and predictive validity.

DESIGN

An analytical, observational, longitudinal prospective study was carried out.

SETTING

Intensive Care Unit, Hospital Virgen del Rocío, Seville (Spain).

PATIENTS

Patients aged 18years or older and admitted for over 24hours to the ICU were included. Patients with pressure ulcers upon admission were excluded. A total of 335 patients were enrolled in two study periods of one month each.

INTERVENTIONS

None.

VARIABLES OF INTEREST

The presence of gradei-iv pressure ulcers was regarded as the main or dependent variable. Three categories were considered (demographic, clinical and prognostic) for the remaining variables.

RESULTS

The incidence of patients who developed pressure ulcers was 8.1%. The proportion of gradei andii pressure ulcer was 40.6% and 59.4% respectively, highlighting the sacrum as the most frequently affected location. Cronbach's alpha coefficient in the assessments considered indicated good to moderate reliability. In the three evaluations made, a cutoff point of 12 was presented as optimal in the assessment of the first and second days of admission. In relation to the assessment of the day with minimum score, the optimal cutoff point was 10.

CONCLUSIONS

The Braden scale shows insufficient predictive validity and poor precision for cutoff points of both 18 and 16, which are those accepted in the different clinical scenarios.

[Validation of EMINA and EVARUCI scales for assessing the risk of developing pressure ulcers in critical patients]

OBJECTIVE

To contribute to the validation of the EMINA and EVAUCI scales for assessing the risk of pressure ulcers in the critical patient and compare their predictive capacity in this same context.

METHOD

Prospective study from December 2012 until June 2013.

SETTING

Polyvalent intensive care unit of 14 beds in a reference hospital for two sanitary areas.

PATIENTS

patients of 18 years of age or older and without pressure ulcers were included. They were followed until development of a pressure ulcer of grade I or greater, medical discharge, death or 30 days.

MAIN VARIABLES

presence of ulcers, daily score of the risk of developing pressure ulcers through EMINA and EVARUCI evaluation. The validity of both scales was calculated using sensitivity, specificity, and positive and negative predictive value. The level of significance was P≤0.05.

RESULTS

A total of 189 patients were evaluated. 67.2% were male with a mean age of 59.4 (DE: 16,8) years old, 53 (28%) developed pressure ulcers, being the incidence rate of 41 ulcers per 1000 admission days. The mean day of diagnosis was 7.7 days (DE: 4,4) and the most frequent area was the sacrum. The sensitivity and specificity for the mean of observations was 94.34 (IC95% 87.17-100) and 33.33 (IC95% 25.01-41.66) for the EMINA scale for a risk>10 and 92.45 (IC95% 84.40-100) and 42.96 (IC95% 34.24-51.68) for the EVARUCI scale for a risk of>11.

CONCLUSIONS

No differences were found in predictive capacity of both scales. For sensitivities>90%the scales show to be insufficiently specific in the pressure ulcer risk detection in critical patients.