Predictors of Pressure Ulcers in Adult Critical Care Patients

TLDR

Pressure ulcers are an underestimated and increasingly prevalent problem in critically ill patients, with no consensus on key risk factors or a dedicated assessment scale. The study aimed to identify the most predictive risk factors for pressure ulcers in adult critical care patients and to develop a specific risk assessment model. A retrospective correlational analysis of 347 ICU patients evaluated Braden Scale scores, mobility, friction/shear, age, length of stay, vasopressor use, cardiovascular disease, and other clinical variables for their predictive value. Logistic regression revealed that age, ICU length of stay, mobility, friction/shear, norepinephrine infusion, and cardiovascular disease explained most of the variance in pressure ulcer development, highlighting gaps in current assessment tools.

Abstract

Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate. Currently, consensus is lacking on the most important risk factors for pressure ulcers in critically ill patients, and no risk assessment scale exclusively for pressure ulcers in these patients is available.To determine which risk factors are most predictive of pressure ulcers in adult critical care patients. Risk factors investigated included total score on the Braden Scale, mobility, activity, sensory perception, moisture, friction/shear, nutrition, age, blood pressure, length of stay in the intensive care unit, score on the Acute Physiology and Chronic Health Evaluation II, vasopressor administration, and comorbid conditions.A retrospective, correlational design was used to examine 347 patients admitted to a medical-surgical intensive care unit from October 2008 through May 2009.According to direct logistic regression analyses, age, length of stay, mobility, friction/shear, norepinephrine infusion, and cardiovascular disease explained a major part of the variance in pressure ulcers.Current risk assessment scales for development of pressure ulcers may not include risk factors common in critically ill adults. Development of a risk assessment model for pressure ulcers in these patients is warranted and could be the foundation for development of a risk assessment tool.