1
|
Duchesne GA, Waller JL, Baer SL, Young L, Bollag WB. Pressure Ulcer Diagnosis Is Associated with Increased Mortality in Patients with End-Stage Renal Disease: A Retrospective Study. Life (Basel) 2023; 13:1713. [PMID: 37629570 PMCID: PMC10456114 DOI: 10.3390/life13081713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Gabriela A. Duchesne
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (G.A.D.); (S.L.B.)
| | - Jennifer L. Waller
- Department of Population Health Sciences, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA;
| | - Stephanie L. Baer
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (G.A.D.); (S.L.B.)
- Charlie Norwood VA Medical Center, Augusta, GA 30904, USA
| | - Lufei Young
- Department of Physiological and Technological Nursing, Augusta University, Augusta, GA 30912, USA
| | - Wendy B. Bollag
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (G.A.D.); (S.L.B.)
- Charlie Norwood VA Medical Center, Augusta, GA 30904, USA
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA
| |
Collapse
|
2
|
Elsorady KE, Nouh AH. Biomarkers and clinical features associated with pressure injury among geriatric patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
<b>Purpose:</b> The study aims to identify biomarkers and clinical features associated with pressure injury (PI) among geriatric patients.<br />
<b>Methods:</b> A cross-sectional study including 191 patients aged ≥60 years. Patients were classified into those with and without PI. Assessing the risk of PI was performed on admission by applying the Braden scale (BS) for predicting pressure sore risk. Clinical history, baseline hematology, and biochemistry results were obtained. C-reactive protein to albumin ratio (CAR) and Charlson comorbidity index (CCI) were calculated. Statistical analyses were performed.<br />
<b>Results: </b>43 (22.5%) patients had PI. PI was significantly associated with higher CCI, total leukocyte count, and CAR, besides lower BS scores, serum albumin, and total proteins. Significant comorbidities were diabetes mellitus, stroke/transient ischemic attack, dementia, incontinence, and chronic kidney disease. The optimal cut-offs for PI occurrence were ≤14, ≤3.1 g/dl and >1.27 for BS, albumin, and CAR, respectively.
Collapse
Affiliation(s)
- Khalid Elsayed Elsorady
- Department of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, EGYPT
- Geriatrics Hospital, Ain Shams University Hospitals, Abbasia, Cairo, EGYPT
| | - Ahmed Hassan Nouh
- Department of Dermatology and Venereology, Al Azhar University, Cairo, EGYPT
| |
Collapse
|
3
|
Mobayen M, Karkhah S, Bagheri P, Feizkhah A, Moghadam MT, Mohmmadnia H, Sadeghi M. Hospital-acquired Pressure Ulcers in Trauma Patients: A Retrospective Study of 410 Patients at a Referral Trauma Center in the North of Iran. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2209200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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<0.001). The mean age of patients with PU was higher than patients without PU (61.73 vs. 47.71 years, P<0.001). The mean hemoglobin level of patients with PU was lower than patients without PU (9.93 vs. 12.25, P<0.001). PUs were more common in smokers compared to non-smokers (P<0.001), with a history of PU (P<0.001), a history of diabetes mellitus (P<0.001), and a history of hypertension (P<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<0.001). 74.3% of people with PUs were completely immobile (P<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<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.
Collapse
|
4
|
Wei Y, Pei J, Yang Q, Zhang H, Cui Y, Guo J, Guo X, Ma Y, Han L. The prevalence and risk factors of facial pressure injuries related to adult non-invasive ventilation equipment: A systematic review and meta-analysis. Int Wound J 2022; 20:621-632. [PMID: 35899399 PMCID: PMC9927905 DOI: 10.1111/iwj.13903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/05/2022] [Indexed: 01/16/2023] Open
Abstract
To systematically assess the prevalence of facial pressure injuries related to adult non-invasive ventilation equipment, and risk factors of facial pressure injuries. PubMed, Cochrane Library, Web of Science, Embase, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database and Weipu Database were comprehensively searched for observational studies investigating the prevalence and risk factors of facial pressure injuries related to adult non-invasive ventilation equipment from inception to May 16th, 2022. Filter articles based on inclusion and exclusion criteria. The quality of the included studies was evaluated independently by two investigators. Meta-analysis was conducted using Stata 16.0 software package. In total, 2835 articles were screened and data from 12 studies were used in meta-analysis. The prevalence of facial pressure injuries related to adult non-invasive ventilation equipment was 25% (95% confidence interval, CI:15% to 37%, I2 = 97.34%, P < 0.0001). After controlling for confounding variables, the following risk factors of facial pressure injuries: use equipment form, with diabetes, fever, cumulative time of using equipment, facial skin oedema and Glasgow score. Understanding the risk factors of facial pressure injuries can provide the healthcare personnel with the theoretical basis for the management and treatment of the patients.
Collapse
Affiliation(s)
- Yuting Wei
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina
| | - Juhong Pei
- First Clinical School of MedicineLanzhou UniversityLanzhouChina
| | - Qiuxia Yang
- First Clinical School of MedicineLanzhou UniversityLanzhouChina
| | - Hongyan Zhang
- Department of NursingGansu Provincial HospitalLanzhouChina
| | - Yutong Cui
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina
| | - Jiali Guo
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina
| | - Xiaojing Guo
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina
| | - Yuxia Ma
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina
| | - Lin Han
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina,Department of NursingGansu Provincial HospitalLanzhouChina
| |
Collapse
|
5
|
Ateeq I, kennedy L, Baby T, Amer I, Chehab F, Salim NA. Associated Risk Factors and Barriers of Pressure Injury Wound Healing Process: A Retrospective Study of Single-Center Experience. DUBAI MEDICAL JOURNAL 2022. [DOI: 10.1159/000525202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Pressure injuries, particularly those involving dressings, are associated with high rates of morbidity, mortality, and costs. Furthermore, it has a significant impact on patients, family members, and health care systems, increasing pain symptoms, wound odor, hospital stay duration, and even mortality, all of which have a negative impact on quality of life. In the medical literature, a number of variables have been identified that predispose patients to poor wound healing. Diabetes mellitus, venous insufficiency, peripheral artery disease, tobacco smoking, low serum albumin, and inflammatory disorders are among the causes. <b><i>Objectives:</i></b> The main aim of this study was to identify risk factors and barriers that may confer on poor wound healing. <b><i>Methods:</i></b> This is a retrospective study, which was carried out in Dubai Hospital, Dubai Health Authority (DHA), for the period June 2020 until December 2020. <b><i>Result:</i></b> The present study consisted of 146 patients. Paired <i>t</i> test revealed statistically significant improvement in pressure injury healing in terms of length and width at discharge compared to pressure injury (<i>p</i>< 0.05). On the other hand, depth improvement was not statistically significant (<i>p</i>> 0.05). χ<sup>2</sup> test revealed a statistically significant relationship between pressure injury healing and low albumin levels, diabetes, and advanced age (<i>p</i> < 0.05), while there was no statistically significant association between the location of the pressure injury and the healing process (<i>p</i>> 0.05). Furthermore, there was no statistically significant relationship between Braden category, length of stay, or patient hospitalization and pressure injury healing (<i>p</i>> 0.05). <b><i>Conclusion:</i></b> The healing process might be influenced by single or multiple factors. The findings of this retrospective study revealed that low albumin levels, diabetes patients, and age all had an impact on the healing of pressure injuries. When planning and implementing a complete pressure injury treatment strategy, health care practitioners should keep these things under consideration. On the other hand, pressure injury’s location, Braden category, length of stay, and patient hospitalization did not reveal a significant effect on wound healing, despite the fact that other studies showed an effect of these factors on the healing process.
Collapse
|
6
|
de Bengy AF, Lamartine J, Sigaudo-Roussel D, Fromy B. Newborn and elderly skin: two fragile skins at higher risk of pressure injury. Biol Rev Camb Philos Soc 2022; 97:874-895. [PMID: 34913582 DOI: 10.1111/brv.12827] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
Skin is a key organ maintaining internal homeostasis by performing many functions such as water loss prevention, body temperature regulation and protection from noxious substance absorption, microorganism intrusion and physical trauma. Skin ageing has been well studied and it is well known that physiological changes in the elderly result in higher skin fragility favouring the onset of skin diseases. For example, prolonged and/or high-intensity pressure may suppress local blood flow more easily, disturbing cell metabolism and inducing pressure injury (PI) formation. Pressure injuries (PIs) represent a significant problem worldwide and their prevalence remains too high. A higher PI prevalence is correlated with an elderly population. Newborn skin evolution has been less studied, but some data also report a higher PI prevalence in this population compared to older children, and several authors also consider this skin as physiologically fragile. In this review, we compare the characteristics of newborn and elderly skin in order to determine common features that may explain their fragility, especially regarding PI risk. We show that, despite differences in appearance, they share many common features leading to higher fragility to shear and pressure forces, not only at the structural level but also at the cellular and molecular level and in terms of physiology. Both newborn and elderly skin have: (i) a thinner epidermis; (ii) a thinner dermis containing a less-resistant collagen network, a higher collagen III:collagen I ratio and less elastin; (iii) a flatter dermal-epidermal junction (DEJ) with lower anchoring systems; and (iv) a thinner hypodermis, resulting in lower mechanical resistance to skin damage when pressure or shear forces are applied. At the molecular level, reduced expression of transforming growth factor β (TGFβ) and its receptor TGFβ receptor II (TβRII) is involved in the decreased production and/or increased degradation of various dermal extracellular matrix (ECM) components. Epidermal fragility also involves a higher skin pH which decreases the activity of key enzymes inducing ceramide deficiency and reduced barrier protection. This seems to be correlated with higher PI prevalence in some situations. Some data also suggest that stratum corneum (SC) dryness, which may disturb cell metabolism, also increases the risk of PI formation. Besides this structural fragility, several skin functions are also less efficient. Low applied pressures induce skin vessel vasodilation via a mechanism called pressure-induced vasodilation (PIV). Individuals lacking a normal PIV response show an early decrease in cutaneous blood flow in response to the application of very low pressures, reflecting vascular fragility of the skin that increases the risk of ulceration. Due to changes in endothelial function, skin PIV ability decreases during skin ageing, putting it at higher risk of PI formation. In newborns, some data lead us to hypothesize that the nitric oxide (NO) pathway is not fully functional at birth, which may partly explain the higher risk of PI formation in newborns. In the elderly, a lower PIV ability results from impaired functionality of skin innervation, in particular that of C-fibres which are involved in both touch and pain sensation and the PIV mechanism. In newborns, skin sensitivity differs from adults due to nerve system immaturity, but the role of this in PIV remains to be determined.
Collapse
Affiliation(s)
| | - Jérôme Lamartine
- Univ. Lyon, Université Claude Bernard Lyon 1, CNRS, LBTI UMR5305, 7 Passage du Vercors, Lyon Cedex 7, F- 69367, France
| | - Dominique Sigaudo-Roussel
- Univ. Lyon, Université Claude Bernard Lyon 1, CNRS, LBTI UMR5305, 7 Passage du Vercors, Lyon Cedex 7, F- 69367, France
| | - Bérengère Fromy
- Univ. Lyon, Université Claude Bernard Lyon 1, CNRS, LBTI UMR5305, 7 Passage du Vercors, Lyon Cedex 7, F- 69367, France
| |
Collapse
|
7
|
Epidemiology and outcome of pressure injuries in critically ill patients with chronic obstructive pulmonary disease: A propensity score adjusted analysis. Int J Nurs Stud 2022; 129:104222. [PMID: 35344836 DOI: 10.1016/j.ijnurstu.2022.104222] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available. OBJECTIVE To assess the prevalence of ICU-acquired pressure injuries in critically ill COPD patients and to investigate associations between COPD status, presence of ICU-acquired pressure injury, and mortality. STUDY DESIGN AND METHODS This is a secondary analysis of prospectively collected data from DecubICUs, a multinational one-day point-prevalence study of pressure injuries in adult ICU patients. We generated a propensity score summarizing risk for COPD and ICU-acquired pressure injury. The propensity score was used as matching criterion (1:1-ratio) to assess the proportion of ICU-acquired pressure injury attributable to COPD. The propensity score was then used in regression modeling assessing the association of COPD with risk of ICU-acquired pressure injury, and examining variables associated with mortality (Cox proportional-hazard regression). RESULTS Of the 13,254 patients recruited to DecubICUs, 1663 (12.5%) had documented COPD. ICU-acquired pressure injury prevalence was higher in COPD patients: 22.1% (95% confidence interval [CI] 20.2 to 24.2) vs. 15.3% (95% CI 14.7 to 16.0). COPD was independently associated with developing ICU-acquired pressure injury (odds ratio 1.40, 95% CI 1.23 to 1.61); the proportion attributable to COPD was 6.4% (95% CI 5.2 to 7.6). Compared with non-COPD patients without pressure injury, mortality was no different among patients without COPD but with pressure injury (hazard ratio [HR] 1.07, 95% CI 0.97 to 1.17) or COPD patients without pressure injury (HR 1.13, 95% CI 1.00 to 1.27). Mortality was higher among COPD patients with pressure injury (HR 1.35, 95% CI 1.15 to 1.58). CONCLUSION AND IMPLICATIONS Critically ill COPD patients have a statistically significant higher risk of pressure injury. Moreover, those that develop pressure injury are at higher risk of mortality. As such, pressure injury may serve as a surrogate for poor prognostic status to help clinicians identify patients at high risk of death. Also, delivery of interventions to prevent pressure injury are paramount in critically ill COPD patients. Further studies should determine if early intervention in critically ill COPD patients can modify development of pressure injury and improve prognosis.
Collapse
|
8
|
Ding L, Hu X, Wei L, Sun M, Sun G, Jiang G, Li H. Risk factors for hospital-acquired and community-acquired pressure injuries: a multicentre mixed case-control study. BMJ Open 2022; 12:e057624. [PMID: 35437253 PMCID: PMC9016407 DOI: 10.1136/bmjopen-2021-057624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To separately examine and comprehensively compare the risk factors for hospital-acquired (HAPIs) and community-acquired pressure injuries (CAPIs). DESIGN A mixed case-control study. SETTING Four medical centres in China. PARTICIPANTS Inclusion criteria included patients who were (1) aged ≥18 years on admission; (2) admitted between January 2014 and December 2018, and (3) diagnosed with HAPIs (cases) or with no HAPIs (controls) during hospitalisation in the HAPIs study, and confirmed with CAPIs (cases) or with no PIs (controls) on admission in the CAPIs study. The exclusion criteria were as follows: (1) admitted for childbirth, psychiatric reasons or rehabilitation; (2) admitted for observation; (3) transferred from another hospital and (4) confirmed to have suffered PIs from previous hospitalisations in the CAPIs study. In total, 320 cases and 1657 controls were included in the HAPIs study, and 1763 cases and 1786 controls were included in the CAPIs study. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome variable was the occurrence of PIs. RESULTS The existence of PIs or scars from previous PIs on admission, presence of forced posture, use of medical devices and surgery during hospitalisation were found to be independent risk factors for HAPIs, as evidenced by the corresponding OR and 95% CI values of 51.931 (34.241 to 78.763), 2.006 (1.405 to 2.864), 3.226 (1.709 to 6.089) and 2.161 (1.452 to 3.215), respectively. Age, sex, Braden rating and diabetes were found to be independent risk factors for CAPIs, as evidenced by the corresponding OR and 95% CI values of 1.031 (1.026 to 1.036), 0.810 (0.698 to 0.941), 1.235 (1.167 to 1.307) and 2.059 (1.332 to 3.184), respectively. CONCLUSIONS The existence of PIs or scars from previous PIs on admission, presence of forced posture, use of medical devices and surgery during hospitalisation are suggested to be included as independent items for the risk assessment of PIs, together with the Braden scale. The Braden rating plays different roles in the development of CAPIs and HAPIs.
Collapse
Affiliation(s)
- Lei Ding
- Department of Quality Management and Evaluation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xia Hu
- Department of Human Resources, Qingdao Endocrine and Diabetes Hospital, Qingdao, Shandong, China
- Department of Disease Prevention and Health Care, Qingdao Endocrine and Diabetes Hospital, Qingdao, Shandong, China
| | - Lili Wei
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mojian Sun
- Center for Medical Record Management, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guixia Sun
- Department of Quality Management and Evaluation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangfeng Jiang
- Department of Medical Management, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Huanting Li
- Department of Medical Management, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| |
Collapse
|
9
|
Weng PW, Lin YK, Seo JD, Chang WP. Relationship between predisposing and facilitating factors: Does it influence the risk of developing peri-operative pressure injuries? Int Wound J 2022; 19:2082-2091. [PMID: 35373448 DOI: 10.1111/iwj.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022] Open
Abstract
This study examined the relationship between the personal predisposing factors of patients and the severity of pressure injuries (PIs) developed during surgery. This retrospective cohort study collected 439 cases of peri-operative PIs. Using binary logistic regression to identify the variables associated with PI severity, the effects of interactions between associated variables were then tested. The results of this study revealed that among the personal predisposing factors, only higher patient age (P = .001) and higher body mass index (P < .001) posed a greater risk of stage 2 PIs or higher. Among the surgery-related facilitating factors, only patients who were placed in the prone position during surgery and patients who lost ≥1000 mL of blood during surgery were at greater risk of stage 2 PIs or higher, compared, respectively, to those placed in the supine position and those who lost ≤100 mL of blood. Furthermore, the amount of blood lost during surgery moderated the influence of age on PI severity. For elderly patients who are expected to lose a large blood volume during surgery or lose an immeasurable amount of blood due to the use of cardiopulmonary bypass, taking more precautionary measures to prevent PIs is recommended.
Collapse
Affiliation(s)
- Pei-Wei Weng
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan City, Taiwan
| | - Jang-Dong Seo
- Department of Statistics, Indiana University, Bloomington, Indiana, USA
| | - Wen-Pei Chang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
10
|
Incidence, characteristics and risk factors of medical device-related pressure injuries: An observational cohort study. Intensive Crit Care Nurs 2022; 69:103180. [PMID: 34893393 DOI: 10.1016/j.iccn.2021.103180] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aimed to investigate the cumulative incidence, characteristics, and risk factors of medical device-related pressure injuries (MDRPIs), including patient outcomes, in the intensive care unit (ICU) of a university hospital. RESEARCH METHODOLOGY/DESIGN A prospective observational cohort study. SETTING The study was conducted in an university hospital between November 2019 and October 2020. METHODS The study included patients over the age of 18 years who had a device in situ and stayed in the ICU for more than 24 h. Each device was monitored twice a day for 15 days; the clinical assessment was performed daily until ICU discharge or death. The Case Report Form, MDRPI Monitoring Form, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE-II), Braden Scale, National Pressure Injury Advisory Panel (NPIAP) staging and categories, and Glasgow Coma Scale (GCS) were used for data collection. Patients with and without MDRPIs were compared for demographic and clinical characteristics, length of ICU stay, and mortality by using t-test and Chi-square test. Cumulative incidence was calculated. Logistic regression model was used to investigate risk factors. RESULTS The incidence rate of MDRPIs was 48.8% (84/172 patients). Most of the MDRPIs developed in the mucosa; hence, they could not be staged (63.7%). Of the remaining MDRPIs on the skin, 18.7%, 13%, and 4.6% were categorized as Stage I, II, and III, respectively. In terms of anatomical locations, most commonly occurred in the head and neck region (62.3%). Among the twelve medical devices that caused MDRPIs, endotracheal tubes (61 cases), urinary catheters (46 cases), nasogastric tubes (30 cases) and non-invasive masks (17 cases) were most commonly reported. In multivariate analysis, age (46-64 years) (p = 0.008, OR = 12.457), history of cardiovascular diseases (p = 0.021, OR = 0.044), administration of vasopressors (p = 0.013, OR = 0.089), length of ICU stay (≥22 days, p = 0.048, OR = 0.055) and requirement for mechanical ventilation (p = 0.028, OR = 10.252) were identified as independent risk factors of the occurrence of MDRPI. CONCLUSIONS This study provides a comprehensive understanding of the risk of MDRPI in critically ill adults. The incidence of MDRPIs was high and was associated with several factors. It is critical that MDRPIs are taken seriously by all members of the healthcare team, especially nurses, and that protocols should be established for improvements.
Collapse
|
11
|
Woźniak A, Smółka I, Dusińska A, Misiąg W, Chabowski M. Pressure Ulcer Incidence and Blood Lactate Levels in Intensive Care Unit Patients. J Inflamm Res 2022. [DOI: 10.2147/jir.s352402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
12
|
Abstract
Identification of the appropriate pressure injury (PI) risk factors is the first step in successful PI prevention. Measuring PI risk through formalized PI risk assessment is an essential component of any PI prevention program. Major PI risk factors identified in the empirical literature in the critical care population include age, diabetes, hypotension, mobility, prolonged intensive care unit admission, mechanical ventilation and vasopressor administration. Future risk assessment using sophisticated data analytics available in the electronic medical record may result in earlier, targeted PI prevention and will improve our understanding of risk factors that may contribute to unavoidable PIs.
Collapse
|
13
|
Abstract
GENERAL PURPOSE To outline a conceptual schema describing the relationships among the empirically supported risk factors, the etiologic factors, and the mitigating measures that influence pressure injury (PI) development in the critical care population. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Choose a static intrinsic factor that increases the risk for the development of PI. 2. List several dynamic intrinsic risk factors for developing a PI. 3. Identify dynamic extrinsic risk factors that may predispose a patient to developing a PI. 4. Explain the pathophysiology of PI development.
Collapse
|
14
|
Miranda JS, Deonizio AP, Abbade JF, Miot HA, Mbuagbaw L, Thabane L, Abbade LPF. Quality of reporting of outcomes in trials of therapeutic interventions for pressure injuries in adults: a systematic methodological survey. Int Wound J 2020; 18:147-157. [PMID: 33236852 PMCID: PMC8243995 DOI: 10.1111/iwj.13506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/08/2020] [Accepted: 09/21/2020] [Indexed: 12/26/2022] Open
Abstract
Randomised controlled trials of therapeutic interventions for pressure injuries should include a clear description of outcomes to increase transparency and replicability and improve the construction of scientific evidence. The objective of this study was to assess the completeness of the descriptions of the outcomes of therapeutic interventions in adults with pressure injury (PI) and factors associated with completeness. This was a systematic methodological survey. The completeness of the outcome was assessed according to five criteria: domain (title), specific measure (technique/instrument used), specific metric, or format of the outcome data of each participant that was used for analysis, aggregation (method data from each group were summarised), and time that was used for analysis. Sixty-eight studies were included for analysis. A total of 265 outcomes were reported, and 46 trials (67.6%) had 73 primary outcomes, which were mainly intermediates/substitutes (78.8%). The main outcome evaluated was the ulcer area reduction (36.6%). Approximately 37.2% of the outcomes were incompletely reported, and the least described element was the data aggregation method (72.8%). Only 48.4% of the outcomes with the specified technique had the same reference or validation. Poor quality of reporting outcomes was associated with studies with an older year of publication and a small sample size, single-center studies, and those sponsored by industry. PI studies use many outcomes, mostly surrogates or intermediates, and some of them are incompletely described.
Collapse
Affiliation(s)
| | - Arthur Pollo Deonizio
- São Paulo State University Julio de Mesquita Filho (Unesp) - Botucatu Medical School, undergraduate student of medicine, Botucatu, Sao Paulo, Brazil
| | - Joelcio Francisco Abbade
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University Julio de Mesquita Filho (Unesp), Botucatu, Sao Paulo, Brazil
| | - Hélio Amante Miot
- Department of Dermatology and Radiotherapy, Botucatu Medical School, São Paulo State University Julio de Mesquita Filho (Unesp), Botucatu, Sao Paulo, Brazil
| | - Lawrence Mbuagbaw
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Luciana P F Abbade
- Department of Dermatology and Radiotherapy, Botucatu Medical School, São Paulo State University Julio de Mesquita Filho (Unesp), Botucatu, Sao Paulo, Brazil
| |
Collapse
|
15
|
Moreira MGS, Simões SDM, Ribeiro CJN. Perfil clínico-laboratorial de pacientes hospitalizados acometidos por lesão por pressão. ESTIMA 2020. [DOI: 10.30886/estima.v18.885_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: Caracterizar o perfil clínico-laboratorial de pacientes hospitalizados acometidos por lesão por pressão (LP). Método: Estudo retrospectivo e descritivo, que incluiu dados de prontuários eletrônicos de 95 pacientes acometidos por LP durante a hospitalização. Resultados: Houve predomínio do sexo feminino (52,6%), média de idade 74,8 ± 14 anos, tempo médio de internação foi de 76,9 ± 88,8 dias. A maioria esteve internada na unidade de terapia intensiva, com uma média de 17,86 ± 36,58 dias. Com relação à condição clínica, 60% estavam em uso de ventilador mecânico quando desenvolveram a LP, 37,9% tinham a necessidade de hemodiálise, 30,4% foram diagnosticados com algum grau de desnutrição energético-proteica e 54,7% evoluíram para o óbito. As comorbidades mais frequentes foram hipertensão (63,16%), diabetes (43,16%) e neuropatia (33,68%). Quanto ao perfil laboratorial, hipoalbuminemia (97,3%), hiperglicemia (87,8%), anemia (84,4%) e hiperuremia (78,9%) estiveram presentes em mais de dois terços da amostra. Conclusão: Este estudo permitiu conhecer o perfil de pacientes acometidos por LP durante internação hospitalar, o que pode servir de base para desenvolver ações preventivas eficazes embasadas cientificamente.
Collapse
|
16
|
Moreira MGS, Simões SDM, Ribeiro CJN. Clinical and laboratory profile of hospitalized patients affected by pressure injury. ESTIMA 2020. [DOI: 10.30886/estima.v18.885_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To characterize the clinical and laboratory profile of hospitalized patients affected by pressure injury (PI). Method: Retrospective and descriptive study, which included data from electronic medical records of 95 patients affected by PI during hospitalization. Results: There was a predominance of females (52.6%), mean age 74.8 ± 14 years, mean hospital stay was 76.9 ± 88.8 days. Most were admitted to the intensive care unit, with an average of 17.86 ± 36.58 days. Regarding the clinical condition, 60% were using a mechanical ventilator when they developed PI, 37.9% needed hemodialysis, 30.4% were diagnosed with some degree of protein-energy malnutrition and 54.7% progressed to death. The most frequent comorbidities were hypertension (63.16%), diabetes (43.16%) and neuropathy (33.68%). As for the laboratory profile, hypoalbuminemia (97.3%), hyperglycemia (87.8%), anemia (84.4%) and hyperuremia (78.9%) were present in more than two thirds of the sample. Conclusion: This study allowed to know the profile of patients affected by PI during hospitalization, which can serve as a basis for developing scientifically based effective preventive actions.
Collapse
|
17
|
Ninbanphot S, Narawong P, Theeranut A, Sawanyawisuth K, Limpawattana P. Development and validation of CAVE score in predicting presence of pressure ulcer in intensive care patients. Heliyon 2020; 6:e04612. [PMID: 32904256 PMCID: PMC7452482 DOI: 10.1016/j.heliyon.2020.e04612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background Pressure ulcers (PUs) are one of the quality care indicators in nursing care. They are considered to primarily be preventable. Early identification of the patients most at risk particular for critically ill patients is crucial for providing prompt care. Several tools have been developed to support healthcare providers, but their validities are limited in Thailand. Development of tools with better performance is essential. Aims To develop and validate a PU risk assessment tool with good diagnostic properties in intensive care units (ICUs). Methods A prospective study was conducted in ICUs of a tertiary care hospital, Thailand from January 2019 to April 2020. Baseline data were collected at admission to the ICUs. Skin assessment was evaluated every 24 h. Data were divided into two sets: model development and model validation. Creating a risk score which was derived from multivariate methods were performed. Youden index were used to determine the optimal cut-off point. Then, the other dataset was used to validate the risk score. Receiver Operating Characteristic (ROC) curves was used to demonstrate the performance of the test. Results The study included 288 and 270 patients for development and validation models. The risk score consisted 4 clinical factors; presence of Cardiovascular disease, low serum Albumin, having Ventilated, and Edema (CAVE score). The area under the ROC curve (AUC) was 0.8 and a score at 2.5 was the best cut-off point. The AUC in the validation group was 0.6, age<60 years was 0.78, and age≥60 years was 0.57. Conclusion The predictive validity of the CAVE score is limited but comparable to the existing tools in Thailand. However, it has a good diagnostic property in young patients. The CAVE score could be considered as an alternate screening tool in critical care setting particularly for young patients.
Collapse
Affiliation(s)
- Suchada Ninbanphot
- Intensive Care Unit of Internal Medicine, Faculty of Medicine, KhonKaen University, Thailand
| | - Pinyada Narawong
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Ampornpan Theeranut
- Faculty of Nursing and Research and Training Center for Enhancing Quality of Life of Working Age People, Khon Kaen University, Thailand
| | | | - Panita Limpawattana
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| |
Collapse
|
18
|
Theeranut A, Ninbanphot S, Limpawattana P. Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nurs Crit Care 2020; 26:48-54. [PMID: 32368844 DOI: 10.1111/nicc.12511] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/16/2020] [Accepted: 04/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Critically ill patients are at a higher risk of developing pressure ulcers (PUs) than non-critically ill patients. Tools that aid in the early identification of those who are most at risk of PUs could help health care providers deliver early interventions and reduce unfavourable outcomes. AIMS To compare the validity of four PU risk tools (the Braden scale, the Braden [ALB] scale, the CALCULATE, and the COMHON index) and to demonstrate the optimal cut-off points for each tool in critically ill patients. DESIGN This was a prospective descriptive study. METHOD This study was conducted in the intensive care units (ICUs) of a tertiary care hospital in Thailand from January to April 2019. Baseline characteristics were collected at admission to the ICUs. Skin assessment was evaluated every 24 hours. PU assessment scores were collected every 72 hours. Receiver operating characteristic curves were used to compare the performance of the tests in predicting PUs. RESULTS A total of 288 patients were recruited. The incidence of PUs was 11.1%. The Braden (ALB) scale performed the best based on the area under the receiver operating characteristic curves (area under curve 0.74), followed by the CALCULATE (area under curve 0.71), the Braden (area under curve 0.67) scale, and the COMHON (area under curve 0.61) index. At the optimal cut-off point, the Braden (ALB) scale (≤13)) and the CALCULATE (≥3) were similar in terms of performance with an area under the curve of 0.69. CONCLUSION The Braden (ALB) performed the best at predicting PU development in ICU patients. RELEVANCE TO CLINICAL PRACTICE The validity of all four PU risk tools was limited in Thai patients. The scales should thus be used in conjunction with clinical judgement to provide optimal outcomes. The development of better assessment tools for the prediction of PUs is required.
Collapse
Affiliation(s)
- Ampornpan Theeranut
- Faculty of Nursing and Research and Training Center for Enhancing Quality of Life of Working Age People, Khon Kaen University, Khon Kaen, Thailand
| | - Suchada Ninbanphot
- Intensive Care Unit of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Panita Limpawattana
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| |
Collapse
|
19
|
Tschannen D, Anderson C. The pressure injury predictive model: A framework for hospital-acquired pressure injuries. J Clin Nurs 2020; 29:1398-1421. [PMID: 31889342 DOI: 10.1111/jocn.15171] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 11/19/2019] [Accepted: 12/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite decades of research, pressure injuries continue to be a source of significant pain and delayed recovery for patients and substantial quality and cost issues for hospitals. Consideration of the current thinking around pressure injury risk must be evaluated to improve risk assessments and subsequent nursing interventions aimed at reducing hospital-acquired pressure injuries. DESIGN This is a discursive paper using Walker and Avant's (2005) theory synthesis framework to examine the relevance of existing pressure injury models as they align with the current literature. METHODS PubMed and CINAHL indexes were searched, first for conceptual models and then for pressure injury research conducted on hospitalised patients for the years 2006-2016. A synthesis of the searches culminated into a new pressure injury risk model. CONCLUSIONS Gaps in previous models include lack of attention to the environment, contributing episode-of-care factors and the dynamic nature of injury risk for patients. Through theory synthesis, the need for a new model representing the full risk for pressure injury was identified. The Pressure Injury Predictive Model is a representation of the complex and dynamic nature of pressure injury risk that builds on previous models and addresses new patient, contextual and episode-of-care process influences. The Pressure Injury Predictive Model (PIPM) provides a more accurate picture of the complexity of contextual and process factors associated with pressure injury development. RELEVANCE TO CLINICAL PRACTICE Using the PIPM to determine risk can result in improved risk identification. This information can be used to implement targeted, evidence-based pressure injury prevention interventions specific to the patient risk profile, thus limiting unwarranted and unnecessary care.
Collapse
Affiliation(s)
- Dana Tschannen
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | |
Collapse
|
20
|
Zarei E, Madarshahian E, Nikkhah A, Khodakarim S. Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran. J Tissue Viability 2019; 28:70-74. [PMID: 30795879 DOI: 10.1016/j.jtv.2019.02.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/20/2018] [Accepted: 02/03/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Pressure ulcer (PU) is one of the important and frequent complications of hospitalization, associated with high treatment costs. The present study was conducted to determine the incidence of PU and its direct treatment costs for patients in intensive care unit (ICU) in Iran. MATERIAL AND METHODS In this retrospective study, medical records of 643 discharged patients from ICU of two selected hospitals were examined. The demographic and clinical data of all patients and data of resources and services usage for patients with PU were extracted through their records. Data analysis was done using logistic regression tests in SPSS 22 software. The cost of PU treatment was calculated for each grade of ulcer. RESULTS The findings showed that 8.9% of patients developed PU during their stay in ICU. Muscular paralysis (OR = 5.1), length of stay in ICU (OR = 4.0), diabetes (OR = 3.5) age (OR = 2.9), smoking (OR = 2.1) and trauma (OR = 1.4) were the most important risk factors of PU. The average cost of PU treatment varied from USD 12 for grade I PU to USD 66 834 for grade IV PUs. The total treatment costs for all studied patients with PU was estimated at USD 519 991. CONCLUSION The cost of PU treatment is significant. Since the preventive measures are more cost-effective than therapeutic measures, therefore, effective preventive interventions are recommended.
Collapse
Affiliation(s)
- Ehsan Zarei
- Department of Health Services Management, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elmira Madarshahian
- Department of Health Services Management, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adeleh Nikkhah
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- Department of Epidemiology and Biostatistics, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
21
|
Abstract
BACKGROUND 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. OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
|
22
|
Gulin FS, Menegueti MG, Auxiliadora-Martins M, de Araujo TR, Bellissimo-Rodrigues F, Nassiff A, Basile-Filho A, Laus AM. APACHE II Death Risk and Length of Stay in the ICU Are Associated With Pressure Injury in Critically Ill Patients. J Clin Med Res 2018; 10:898-903. [PMID: 30425762 PMCID: PMC6225865 DOI: 10.14740/jocmr3636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 10/16/2018] [Indexed: 11/11/2022] Open
Abstract
Background The aim of this study was to identify factors associated with pressure injury (PI) occurrence in critically ill patients. This was a retrospective cohort study conducted at a mixed intensive care unit (ICU). Methods Univariate analysis and logistic regression were used to identify which variables are associated with PI. Results Twenty-one (15%) of 142 patients developed PI. The median and the range of the variables in the groups without and with PI were as follows: Braden scale risk score, 13 (8 - 20) and 10 (8 - 14) points, respectively; Acute Physiology and Chronic Health Evaluation II (APACHE II) death risk, 39% (2 - 97%) and 75% (26 - 96%), respectively; and length of stay in the ICU, 4 (2 - 36) and 16 (5 - 29) days, respectively. The socio-demographic variables included in the logistic regression were age (P = 0.09), Braden scale risk score (P = 0.0003), APACHE II death risk (P < 0.0001), length of stay in the ICU (P < 0.0001) and reason for ICU admission (P = 0.09). Only APACHE II death risk and length of stay in the ICU presented significant differences; the odds ratios were 1.05 and 1.25, respectively, and the 95% confidence intervals were 1.01 - 1.09 and 1.12 - 1.39, respectively. Conclusion APACHE II death risk and length of stay in the ICU are probably associated with PI occurrence in the study population.
Collapse
Affiliation(s)
- Francine Sanchez Gulin
- Department of Fundamental Nursing, University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil.,Department of Surgery and Anatomy, Division of Intensive Care University of Sao Paulo at Ribeirao Preto Medical School, Ribeirao Preto, Sao Paulo, Brazil
| | - Mayra Goncalves Menegueti
- Department of Fundamental Nursing, University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil.,Department of Surgery and Anatomy, Division of Intensive Care University of Sao Paulo at Ribeirao Preto Medical School, Ribeirao Preto, Sao Paulo, Brazil
| | - Maria Auxiliadora-Martins
- Department of Surgery and Anatomy, Division of Intensive Care University of Sao Paulo at Ribeirao Preto Medical School, Ribeirao Preto, Sao Paulo, Brazil
| | - Thamiris Ricci de Araujo
- Department of Fundamental Nursing, University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | - Fernando Bellissimo-Rodrigues
- Department of Social Medicine, University of Sao Paulo at Ribeirao Preto Medical School, Ribeirao Preto, Sao Paulo, Brazil
| | - Aline Nassiff
- Department of Fundamental Nursing, University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | - Anibal Basile-Filho
- Department of Surgery and Anatomy, Division of Intensive Care University of Sao Paulo at Ribeirao Preto Medical School, Ribeirao Preto, Sao Paulo, Brazil
| | - Ana Maria Laus
- Department of Fundamental Nursing, University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| |
Collapse
|
23
|
Aloweni F, Ang SY, Fook-Chong S, Agus N, Yong P, Goh MM, Tucker-Kellogg L, Soh RC. A prediction tool for hospital-acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score. Int Wound J 2018; 16:164-175. [PMID: 30289624 DOI: 10.1111/iwj.13007] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/11/2018] [Accepted: 09/16/2018] [Indexed: 12/26/2022] Open
Abstract
Surgical patients are prone to developing hospital-acquired pressure ulcers (HAPU). Therefore, a better prediction tool is needed to predict risk using preoperative data. This study aimed to determine, from previously published HAPU risk factors, which factors are significant among our surgical population and to develop a prediction tool that identifies pressure ulcer risk before the operation. A literature review was first performed to elicit all the published HAPU risk factors before conducting a retrospective case-control study using medical records. The known HAPU risks were compared between patients with HAPU and without HAPU who underwent operations during the same period (July 2015-December 2016). A total of 80 HAPU cases and 189 controls were analysed. Multivariate logistic regression analyses identified eight significant risk factors: age ≥ 75 years, female gender, American Society of Anaesthesiologists ≥ 3, body mass index < 23, preoperative Braden score ≤ 14, anaemia, respiratory disease, and hypertension. The model had bootstrap-corrected c-statistic 0.78 indicating good discrimination. A cut-off score of ≥6 is strongly predictive, with a positive predictive value of 73.2% (confidence interval [CI]: 59.7%-84.2%) and a negative predictive value of 80.7% (CI: 74.3%-86.1%). SPURS contributes to the preoperative identification of pressure ulcer risk that could help nurses implement preventive measures earlier.
Collapse
Affiliation(s)
- Fazila Aloweni
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | | | - Nurliyana Agus
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Patricia Yong
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Meh Meh Goh
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Lisa Tucker-Kellogg
- Cancer & Stem Cell Biology, and Centre for Computational Biology Duke-NUS Medical School, Singapore, Singapore
| | - Rick Chai Soh
- Department of Anaesthesia, SGH, Singapore, Singapore
| |
Collapse
|
24
|
Otero TMN, Canales C, Yeh DD, Elsayes A, Belcher DM, Quraishi SA. Vitamin D Status Is Associated With Development of Hospital-Acquired Pressure Injuries in Critically Ill Surgical Patients. Nutr Clin Pract 2018; 34:142-147. [PMID: 30101993 DOI: 10.1002/ncp.10184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hospital-acquired pressure injuries (HAPIs) typically develop following critical illness due to immobility and suboptimal perfusion. Vitamin D helps to maintain epithelial cell integrity, particularly at barrier sites such as skin. It is unclear whether vitamin D status is a modifiable risk factor for HAPIs in critically ill patients. Our goal was to investigate the relationship between admission 25-hydroxyvitamin D (25OHD) levels with the development of HAPIs in surgical intensive care unit (ICU) patients. METHODS We performed a retrospective cohort study of patients admitted to surgical ICUs at a major teaching hospital in Boston, Massachusetts. To investigate the association of 25OHD levels with subsequent development of HAPIs, we performed logistic regression analyses, controlling for body mass index, Nutrition Risk in the Critically Ill score, ICU length of stay, and cumulative ICU caloric or protein deficit. RESULTS A total of 402 patients comprised our analytic cohort. Each unit increment in 25OHD was associated with 11% decreased odds of HAPIs (odds ratio [OR] 0.89; 95% CI 0.840.95). When vitamin D status was dichotomized, patients with 25OHD <20 ng/mL were >2 times as likely to develop HAPIs (OR 2.51; 95% CI 1.065.97) compared with patients with 25OHD >20 ng/mL. CONCLUSION In our cohort of critically ill surgical patients, vitamin D status at ICU admission was linked to subsequent development of HAPIs. Randomized, controlled trials are needed to assess whether optimizing 25OHD levels in the ICU can reduce the incidence of HAPIs and improve other clinically relevant outcomes in critically ill patients.
Collapse
Affiliation(s)
- Tiffany M N Otero
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Medicine, Tufts University, Boston, Massachusetts.,Department of Medicine, Carney Hospital, Boston, Massachusetts
| | - Cecilia Canales
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Medicine, University of California, Irvine, California
| | - D Dante Yeh
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Ali Elsayes
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
| | - Donna M Belcher
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Sadeq A Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
25
|
González-Méndez MI, Lima-Serrano M, Martín-Castaño C, Alonso-Araujo I, Lima-Rodríguez JS. Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit. J Clin Nurs 2017; 27:1028-1037. [DOI: 10.1111/jocn.14091] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 11/26/2022]
Affiliation(s)
- María Isabel González-Méndez
- UGC de Cuidados Intensivos; Hospital Virgen del Rocío; Seville Spain
- Departamento de Enfermería; Universidad de Sevilla; Sevilla España
| | | | | | | | | |
Collapse
|
26
|
Liang M, Chen Q, Zhang Y, He L, Wang J, Cai Y, Li L. Impact of diabetes on the risk of bedsore in patients undergoing surgery: an updated quantitative analysis of cohort studies. Oncotarget 2017; 8:14516-14524. [PMID: 28036285 PMCID: PMC5362422 DOI: 10.18632/oncotarget.14312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/21/2016] [Indexed: 01/21/2023] Open
Abstract
Diabetes is a major cause of morbidity for patients undergoing surgery and can increase the incidence of some postoperative complications such as bedsores. We conducted a meta-analysis of observational studies to examine whether patients with diabetes undergoing surgery had high risk of bedsore. We performed a systematic literature search in Pubmed, Embase and the Cochrane Library Central Register of Controlled Trials database from inception to November 2016. Studies were selected if they reported estimates of the relative risk (RR) for bedsore risk in postoperative diabetic patients compared with that of in non-diabetic patients. Random-effects meta-analysis was conducted to pool the estimates. A total of 16 studies with 24,112 individuals were included in our meta-analysis. The pooled RR of bedsore development for patients with diatetes was 1.77 (95% CI 1.45 to 2.16). The results of subgroup analyses were consistent when stratified by surgery type, study design, research region, sample size, inclusion period, analysis method and study quality. There was evidence of publication bias among studies and a sensitivity analysis using the Duval and Tweedie “trim-and-fill” method did not significantly alter the pooled results (adjusted RR 1.17, 95% CI 1.02 to 1.36).This meta-analysis provides indications that diabetic patients undergoing surgery could have a higher risk of developing bedsores. Further large-scale prospective trials should be implemented to comfirm the association.
Collapse
Affiliation(s)
- Mining Liang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Qiongni Chen
- Department of Nursing, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, China
| | - Yang Zhang
- Nursing Teaching and Research Institute, Medical College of Guangxi University of Science and Technology, Liuzhou, Guangxi Province, China
| | - Li He
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jianjian Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yiwen Cai
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lezhi Li
- Department of Nursing, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, China
| |
Collapse
|
27
|
Lima Serrano M, González Méndez M, Carrasco Cebollero F, Lima Rodríguez J. Factores de riesgo asociados al desarrollo de úlceras por presión en unidades de cuidados intensivos de adultos: revisión sistemática. Med Intensiva 2017; 41:339-346. [DOI: 10.1016/j.medin.2016.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
|
28
|
Risk factors for pressure ulcer development in Intensive Care Units: A systematic review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medine.2017.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
29
|
Campanili TCGF, Santos VLCDG, Strazzieri-Pulido KC, Thomaz PDBM, Nogueira PC. Incidence of pressure ulcers in cardiopulmonary intensive care unit patients. Rev Esc Enferm USP 2015; 49 Spec No:7-14. [PMID: 26761686 DOI: 10.1590/s0080-623420150000700002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/14/2015] [Indexed: 11/22/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | | | | | - Paula Cristina Nogueira
- Departamento de Enfermagem Medico-Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|