Measuring point-prevalence: Walk in the park or bumpy road? Lessons learnt from the DecubICUs study

Heterogeneity hampers the identification of general pressure injury risk factors in intensive care populations: A predictive modelling analysis

OBJECTIVE

To determine risk factors for pressure injury in distinct intensive care subpopulations according to admission type (Medical; Surgical elective; Surgery emergency; Trauma/Burns).

METHODOLOGY/DESIGN

Predictive modelling using generalised linear mixed models with backward elimination on prospectively gathered data of 13 044 adult intensive care patients.

SETTINGS

1110 intensive care units, 89 countries worldwide.

MAIN OUTCOME MEASURES

Pressure injury risk factors.

RESULTS

A generalised linear mixed model including admission type outperformed a model without admission type (p = 0.004). Admission type Trauma/Burns was not withheld in the model and excluded from further analyses. For the other three admission types (Medical, Surgical elective, and Surgical emergency), backward elimination resulted in distinct prediction models with 23, 17, and 16 predictors, respectively, and five common predictors only. The Area Under the Receiver Operating Curve was 0.79 for Medical admissions; and 0.88 for both the Surgical elective and Surgical emergency models.

CONCLUSIONS

Risk factors for pressure injury differ according to whether intensive care patients have been admitted for medical reasons, or elective or emergency surgery. Prediction models for pressure injury should target distinct subpopulations with differing pressure injury risk profiles. Type of intensive care admission is a simple and easily retrievable parameter to distinguish between such subgroups.

Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi-centre prospective point prevalence study

Despite increasing preventive efforts, pressure injury still occurs in intensive care patients. This study was aimed to describe pressure injury prevalence, risk factors, and prevention practices in adult intensive care patients. This was a multi-centre, one-day, prospective point prevalence study in which a total of 198 intensive care units from 21 provinces in China participated. Overall and ICU-acquired prevalence in intensive care patients were 12.26% and 4.31%, respectively. Consistent with earlier reports, almost half of the ICU-acquired pressure injuries were at stage I, one-fourth were at stage 2, and the most common body sites for pressure injuries were sacral and heel region. Risk factors identified were consistent with prior studies. Repositioning was the most commonly used pressure injury prevention strategy, followed by alternating pressure mattresses/overlays, floating heels, and air-filled mattresses/overlays. These reflect a good level of adherence to recommended international pressure injury prevention clinical practice guidelines. The results provide a baseline reference for overall and ICU-acquired prevalence among adult intensive care patients in China. Future research on what contributed to the lower pressure injury incidence in China needs to be conducted to inform healthcare organisations on their future preventive strategies for pressure injury prevention.