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

Comparison of the Predictive Validity of Norton and Braden Scales in Determining the Risk of Pressure Injury in Elderly Patients

AIM

To compare the reliability and predictive validity of Norton and Braden scales in determining the risk of pressure injury in elderly patients.

DESIGN

This research used a comparative design. One hundred thirty elderly patients participated in the study.

METHODS

The daily pressure injury risk of participants was evaluated by a researcher using both the Norton and Braden scales in a consecutive manner.

RESULTS

The mean age of patients was 75.1 ± 8.5 years, and that for those without and with pressure injury development was 75.0 ± 8.3 years and 76.1 ± 9.7 years (P < .001), respectively. The reliability coefficients of the Norton and Braden scales were .82 and .89, respectively. The sensitivity, specificity, and positive and negative predictive values of the Norton Scale were 100%, 40.7%, 20.2%, and 100%, and those of the Braden Scale were 100%, 32.7%, 18.3%, and 100%, respectively.

CONCLUSIONS

The reliability of both scales for elderly patients was found to be high, and their ability to differentiate patients at risk was comparable. However, both scales had low specificity. Further research is needed to develop scales that have higher predictive validity for the elderly population, taking into account other risk factors that influence total scale scores.

Psychometric properties of the Braden scale to assess pressure injury risk in intensive care: A systematic review

OBJECTIVE

To analyse the psychometric properties of the Braden scale to assess pressure injury risk in adults in intensive care.

DESIGN

A systematic review was conducted, with literature searches undertaken in five electronic databases. No date limits were applied. Selection, data extraction and risk of bias assessment were completed by two reviewers independently. A customised data extraction template was used, with risk of bias conducted using the COSMIN Risk of Bias checklist. Data were analysed using narrative synthesis.

RESULTS

Thirty-four studies met inclusion criteria. Two studies reported internal consistency with Cronbach's alpha ranging from poor (0.43) to good (0.85). For interrater reliability, only four studies reported intraclass correlation, ranging from 0.66 to 0.96 for Braden sum score. Three studies reported convergent validity, with strong associations found between the COMHON Index (r = 0.70), Cubbin-Jackson scale (r = 0.80), and Norton scale (r = 0.77), but contrasting associations with the Waterlow score (r = 0.22 to 0.72). A large majority of studies reported predictive validity (n = 29), with wide variability. Several studies investigated optimal cut-off scores, with the majority indicating this was in the range of 12-14.

CONCLUSIONS

This review demonstrates inconsistency in the psychometric properties of the Braden scale in ICU settings. Further research is needed to determine suitability of the Braden scale for ICU before it can be recommended as standard for clinical practice, including comparison with other ICU-specific risk assessment tools.

IMPLICATIONS FOR CLINICAL PRACTICE

When used in ICU, the reliability, validity and reported cut-off scores of the Braden scale are variable. As a predictive tool, the scale should be used cautiously. In ICU, the value of the Braden scale resides in its ability to identify patients that are most at risk of developing a pressure injury and to implement preventative measures to mitigate identified risk factors.

Prevalence of pressure injury on the medical wards of public general hospitals in Kuwait: a national cross-sectional study

BACKGROUND

Pressure injury is a severe problem that can significantly impact a patient's health, quality of life, and healthcare expenses. The prevalence of pressure injuries is a widely used clinical indicator of patient safety and quality of care. This study aims to address the research gap that exists on this topic in Kuwait by investigating the prevalence of pressure injuries and preventive measures on the medical wards of the country's public general hospitals.

METHODS

A cross-sectional research design was adopted to measure the point prevalence of pressure injuries on 54 medical wards in the public general hospitals. Data, including variables pertaining to hospitals, patients, pressure injuries and preventive practices, were collected using an online form. The data were processed and analysed using Microsoft Excel and SPSS 23 (α level = 0.05). Analysis provided an overview of patient, pressure injury characteristics and preventive measures, and the relationships between the patient and pressure injury characteristics and the prevalence of pressure injuries. A model for predicting the determinants of pressure injury prevalence was constructed from a linear regression analysis.

RESULTS

The mean national prevalence of pressure injury was 17.6% (95% CI: 11.3-23.8). Purely community-acquired pressure injuries represent the majority of pressure injuries nationally (58.1%). Regarding preventive measures, "pressure injury assessment on admission" has been provided to 65.5% of patients. Correlation analysis revealed that the only statistically significant correlation with the prevalence of hospital-acquired pressure injury was "pressure injury assessment on admission", which was strongly negative (ρ = -0.857). Therefore, this was the only variable included in the regression analysis as a predictor of pressure injury prevalence (Beta = 0.839). The results showed many statistically significant differences between hospitals with respect to the variables studied.

CONCLUSIONS

The national pressure injury prevalence is high compared to the global rate. The higher percentage of purely community-acquired pressure injuries requires particular attention. Many risk factors for the development of pressure injuries are public health concerns, and effective mitigating strategies are needed. Further research is required to assess the knowledge, attitude, and behaviour of nurses with respect to pressure injuries, and to evaluate preventive and management practices.

The Topical Formulation of Whey Protein for the Prevention of Pressure Ulcers in Critically Ill Patients: A Novel Intervention in a Randomized-Controlled Clinical Trial

Background

High prevalence of pressure ulcers (PUs) and their complications are important dilemmas in the intensive care unit (ICU). Therefore this study was designed to evaluate the effectiveness of topical whey protein formulation in preventing PUs in patients admitted to the ICU.

Materials and Methods

In this randomized placebo-controlled clinical trial under registration number [IRCTdeted for blinded article], 80 eligible ICU patients were randomly allocated to receive topical ointment of whey protein or placebo on the sacrum with a diameter of 15 cm twice daily for seven days, in addition to the routine care. The mean risk score for developing PUs was calculated at baseline using the Braden tool, and the PUSH score was used to assess PUs on days 4, 7, and 14. Patients' related demographic and clinical variables were also collected using a medical record for more evaluation.

Results

Our results showed that demographic characteristics and the Braden scores' baseline mean were not significantly different between groups (P > 0.05). The repeated measures ANOVA test revealed that the mean scores of PUs at various times were markedly lower in the whey protein than in the placebo group (P < 0.001).

Conclusion

This intervention can be routinely added as effective, safe, inexpensive, and accessible care to reduce the incidence of PUs for patients at risk of developing this injury.

Braden scale has low reliability in different patients under care in intensive care unit

OBJECTIVE

The aim of this study was to assess the inter-reliability of the Braden scale and its subscales for different patients assisted in the intensive care unit. We hypothesized that the Braden scale has low reliability in different populations.

METHODS

This reliability study involved the Braden scale in intensive care unit of a hospital. A total of 200 patients were admitted to the intensive care unit in four different groups: neurological patients, sepsis, elderly, and adults affected by trauma. The Braden scale is a tool composed of six subscales for patient assessment: sensory perception, humidity, activity, mobility, nutrition, and friction. The total score was also calculated. The Braden scale was applied by two different nurses with an interval of 20-30 min between applications.

RESULTS

For all populations, kappa values considered unsuitable were observed for most categories of the Braden scale, ranging from 0.06-0.25. Only for the total Braden scale score was moderate reliability identified in all groups evaluated, with intraclass correlation coefficient values ranging from 0.48-0.75.

CONCLUSIONS

Braden scale is not a reliable tool to be used in the intensive care unit, and we do not recommend the use of this scale to assess the risk of developing pressure injury.

Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit

BACKGROUND

Patients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury.

METHODS

Braden Scale predictive validity was compared between patients with and without COVID-19, and a logistic regression model was developed to identify risk factors for device-related pressure injury.

RESULTS

A total of 1920 patients were included in the study sample, including 407 with COVID-19. Among the latter group, at least 1 hospital-acquired pressure injury developed in each of 120 patients (29%); of those, device-related pressure injury developed in 55 patients (46%). The Braden Scale score area under the receiver operating characteristic curve was 0.72 in patients without COVID-19 and 0.71 in patients with COVID-19, indicating fair to poor discrimination.

CONCLUSIONS

Fragile skin and prone positioning during mechanical ventilatory support were risk factors for device-related pressure injury. Clinicians may consider incorporating factors not included in the Braden Scale (eg, oxygenation and perfusion) in routine risk assessment and should maintain vigilance in their efforts to protect patients with COVID-19 from device-related pressure injury.

Comparative Evaluation of the Effect of Aloe Vera Gel, Olive Oil, and Compound Aloe Vera Gel-Olive Oil on Prevention of Pressure Ulcer: A Randomized Controlled Trial

Background

One of the most common problems in the intensive care units (ICUs) is pressure ulcers (PUs). The present study aimed to evaluate the effectiveness of aloe vera gel, olive oil, and compound aloe vera gel-olive oil in the prevention of PUs.

Materials and Methods

This randomized clinical trial was conducted on 240 patients. They were randomly divided into four groups, aloe vera gel (n = 60), olive oil (n = 60), aloe vera gel-olive oil combination (n = 60), and control (n = 60). Braden scale and National Pressure Ulcer Advisory Panel scale were used to collect data. The intervention was performed for 30 days. In the intervention and control groups, the patient received routine care. In each intervention group, 10-15 ml of olive oil or aloe vera gel or a combination of olive oil and aloe vera was rubbed into body areas under pressure.

Results

There were no PUs detected in all groups before the intervention; after the intervention, 12 patients in the olive group, 20 patients in the aloe vera group, 10 patients in the aloe vera-olive combination group, and 22 patients in the control group developed PUs. The results reported 40% of the patients with stage 1 PU and 10% of them with stage 2.

Conclusion

Due to the effectiveness of olive oil and aloe vera-olive oil combination in preventing PU, it is recommended to use these herbal compounds in preventing PU on ICU patients.

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.

Risk Factors for Hospital-Acquired Pressure Injury in Adult Critical Care Patients

BACKGROUND

Accurately measuring the risk of pressure injury remains the most important step for effective prevention and intervention. Relative contributions of risk factors for the incidence of pressure injury in adult critical care patients are not well understood.

OBJECTIVE

To develop and validate a model to identify risk factors associated with hospital-acquired pressure injuries among adult critical care patients.

METHODS

This retrospective cohort study included 23 806 adult patients (28 480 encounters) with an intensive care unit stay at an academic quaternary care center. Patient encounters were randomly split (7:3) into training and validation sets. The training set was used to develop a multivariable logistic regression model using the least absolute shrinkage and selection operator method. The model's performance was evaluated with the validation set.

RESULTS

Independent risk factors identified by logistic regression were length of hospital stay, preexisting diabetes, preexisting renal failure, maximum arterial carbon dioxide pressure, minimum arterial oxygen pressure, hypotension, gastrointestinal bleeding, cellulitis, and minimum Braden Scale score of 14 or less. On validation, the model differentiated between patients with and without pressure injury, with area under the receiver operating characteristic curve of 0.85, and performed better than a model with Braden Scale score alone (P < .001).

CONCLUSIONS

A model that identified risk factors for hospital-acquired pressure injury among adult critical care patients was developed and validated using a large data set of clinical variables. This model may aid in selecting high-risk patients for focused interventions to prevent formation of hospital-acquired pressure injuries.

Dynamic Risk Prediction for Hospital-Acquired Pressure Injury in Adult Critical Care Patients

Supplemental Digital Content is available in the text.

Accurately measuring the risk of pressure injury remains the most important step for effective prevention and intervention. Time-dependent risk factors for pressure injury development in the adult intensive care unit setting are not well understood.

Face validity of standardized assessments for wheeled mobility & seating evaluations

A problem in the Complex Rehabilitation Technology industry is the lack of standardization in the assessment for wheeled mobility and seating (WMS). The aim of this paper was to identify assessment tools commonly used by clinicians during WMS evaluations. After the tools were identified by a panel of 12 subject matter experts, a presentation at the 2018 International Seating Symposium in Vancouver, Canada and the 2018 European Seating Symposium in Dublin, Ireland polled attendees via the Sli.do polling application to determine professional opinions of each tool, resulting in face validity for use in wheelchair evaluations. The Lawshe Content Validity Ratio was used to convert this anecdotal data into numerical data, indicating which tools were most and least used by attendees. Finally, a literature search was conducted to determine the reliability, validity, and International Classification of Functioning, Disability, & Health domain for each measure. The findings indicate that while there are many standardized and reliable assessment tools available for wheeled mobility and seating evaluations, most clinicians use only a few standardized assessment tools during WMS evaluations.

A nomogram prediction of pressure injury in critical ill patients: A retrospective cohort study

Pressure injury (PI) is still a significant public health problem to be solved. Accurate prediction can lead to timely prophylaxis and therapy. However, the currently used Braden score shows insufficient predictive validity. We aimed to develop a nomogram to predict PI development in critically ill patients. We extracted data from Medical Information Mart for Intensive Care-IV v1.0. Variable selection was based on univariate logistic regression and all-subset regression. The area under the receiver operating characteristic curve (AUC) was used to assess the performance of the nomogram and Braden score. Decision curve analysis (DCA) was performed to identify and compare the clinical usefulness between the nomogram model and Braden score. We have developed a novel and practical nomogram that accurately predicts pressure ulcers. The AUC of the new model was better than that of the Braden score (P < .001). DCA showed that the nomogram model had a better net benefit than the Braden score at any given threshold. This finding needs to be confirmed by external validation as well as multicentre prospective studies.

Risk Factors for Pressure Injury Development Among Critical Care Patients

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.

Value of pressure injury assessment scales for patients in the intensive care unit: Systematic review and diagnostic test accuracy meta-analysis

OBJECTIVES

To review and examine the evidence of the value of pressure injury risk assessment scales in intensive care patients.

RESEARCH METHODOLOGY

We searched MEDLINE, Embase, CINAHL, Web of Science, the Cochrane Library, China Biomedical Literature Service System, VIP Database and CNIK from inception to February 2019. Two reviewers independently assessed articles' eligibility and risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-II (QUADAS-2). We used a hierarchical summary receiver operating characteristics (HSROC) model to conduct the meta-analysis of diagnostic accuracy.

RESULT

Twenty-four studies were included, involving 16 scales and 15,199 patients in intensive care settings. Results indicated that the top four risk assessment scales were the Cubbin & Jackson Index (SEN = 0.84, SPE = 0.84, AUC = 0.90), the EVRUCI scale (SEN = 0.84, SPE = 0.68, AUC = 0.82), the Braden scale (SEN = 0.78, SPE = 0.61, AUC = 0.78), the Waterlow scale (SEN = 0.63, SPE = 0.46, AUC = 0.56). The Norton scale and the other eleven scales were tested in less than two studies and need to be further researched.

CONCLUSION

The Braden scale, most frequently used in hospitals, is not the best risk assessment tool for critically ill patients. The Cubbin & Jackson Index has good diagnostic test accuracy. However, low quality of evidence and important heterogeneity were observed.

Predictive validity of the braden scale for pressure injury risk assessment in adults: A systematic review and meta-analysis

AIM

Pressure injuries are common adverse events in clinical practice, affecting the well-being of patients and causing considerable financial burden to healthcare systems. It is therefore essential to use reliable assessment tools to identify pressure injuries for early prevention. The Braden Scale is a widely used tool to assess pressure injury risk, but the literature is currently lacking in determining its accuracy. This study aimed to evaluate the accuracy of the Braden Scale in assessing pressure injury risk.

DESIGN

Systematic review and meta-analysis.

METHODS

Articles published between 1973-2020 from periodicals indexed in the PubMed, EMBASE, CINAHL, Web of Science and the Cochrane Library were selected. Two reviewers independently selected the relevant studies for inclusion. Data were analysed by the STATA 15.0 and the RevMan 5.3 software.

RESULTS

In total, 60 studies involving 49,326 individuals were eligible for this meta-analysis. The pooled SEN, SPE, PLR, NLR, DOR and AUC were 0.78 (95% CI: 0.74 to 0.82), 0.72 (95% CI: 0.66 to 0.78), 2.80 (95% CI: 2.30 to 3.50), 0.30 (95% CI: 0.26 to 0.35), 9.00 (95% CI: 7.00 to 13.00) and 0.82 (95% CI: 0.79 to 0.85), respectively. Subgroup analyses indicated that the AUC was higher for prospective design (0.84, 95% CI: 0.81 to 0.87), mean age <60 years (0.87, 95% CI: 0.84 to 0.90), hospital (0.82, 95% CI: 0.79 to 0.86) and Caucasian population (0.86, 95% CI: 0.82 to 0.88). In addition, 18 was found to be the optimal cut-off value.

CONCLUSION

The evidence indicated that the Braden Scale had a moderate predictive validity. It was more suitable for mean age <60 years, hospitalized patients and the Caucasian population, and the cut-off value of 18 might be used for the risk assessment of pressure injuries in clinical practice. However, due to the different cut-off values used among included studies, the results had a significant heterogeneity. Future studies should explore the optimal cut-off value in the same clinical environment.

Evaluation of ML-Based Clinical Decision Support Tool to Replace an Existing Tool in an Academic Health System: Lessons Learned

There is increasing application of machine learning tools to problems in healthcare, with an ultimate goal to improve patient safety and health outcomes. When applied appropriately, machine learning tools can augment clinical care provided to patients. However, even if a model has impressive performance characteristics, prospectively evaluating and effectively implementing models into clinical care remains difficult. The primary objective of this paper is to recount our experiences and challenges in comparing a novel machine learning-based clinical decision support tool to legacy, non-machine learning tools addressing potential safety events in the hospitals and to summarize the obstacles which prevented evaluation of clinical efficacy of tools prior to widespread institutional use. We collected and compared safety events data, specifically patient falls and pressure injuries, between the standard of care approach and machine learning (ML)-based clinical decision support (CDS). Our assessment was limited to performance of the model rather than the workflow due to challenges in directly comparing both approaches. We did note a modest improvement in falls with ML-based CDS; however, it was not possible to determine that overall improvement was due to model characteristics.

Development and validation of CAVE score in predicting presence of pressure ulcer in intensive care patients

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.

The Effect of a Skin Barrier Film on the Incidence of Dressing-Related Skin Blisters After Spine Surgery

Tension blisters from adhesive dressings may lead to pain and delayed surgical wound healing for surgical patients and cause an institutional cost burden. Commercial skin barrier film products may reduce dressing-related postoperative skin blistering in surgical patients. Project investigators at an orthopedic specialty hospital randomized 185 surgical spine patients to receive either a standard wound dressing (ie, control group) or a dressing with the addition of a skin barrier film applied beneath it (eg, treatment group). During the first postoperative dressing change, the participants' skin was assessed for redness, soreness, blistering, or tearing. Approximately 15% of participants in the treatment group and 15% of participants in the control group developed a postoperative skin injury (P = .98). Multivariable analyses did not indicate the skin barrier film provided a protective effect. Additionally, there was no association between patient-specific characteristics and skin blisters among the participants. These results do not support the use of a skin barrier film in surgical spine patients.

Comparison of four pressure ulcer risk assessment tools in critically ill patients

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.

Monitoring Immobilized Elderly Patients Using a Public Provider Online System for Pressure Ulcer Information and Registration (SIRUPP): Protocol for a Health Care Impact Study

BACKGROUND

Pressure ulcers represent a major challenge to patient safety in the health care context, presenting high incidence (from 7% to 14% in Spain) and increased financial costs (€400-600 million/year) in medical treatment. Moreover, they are a significant predictor of mortality. The prevention of pressure ulcers in long-term care centers and patients' own homes is proposed as a priority indicator of health care quality. Early stage risk assessment and database recording are both crucial aspects of prevention, classification, diagnosis, and treatment.

OBJECTIVE

This project proposes a 3-year study of immobilized patients residing in the Granada-Metropolitan Primary Healthcare District (DSGM) and monitored via the Pressure Ulcer Information and Registration System (SIRUPP, Spanish initials). The project aims to estimate the incidence of PUs among immobilized elderly patients, analyze the health-related quality of life of these patients by using the Pressure Ulcer Quality of Life (PU-QoL) instrument in a sample of 250 patients, determine the average time to complete wound healing, estimate the rate of pressure ulcers-associated mortality, and assess the predictive value of the Braden and Mini Nutritional Assessment risk measurement scales in a sample of 1700 patients.

METHODS

The DSGM runs SIRUPP, which is linked to patients' electronic health records. Currently, 17,104 immobilized patients are monitored under this system. Health-related quality of life will be measured by patient self-reports using the Spanish Pressure Ulcer Quality of Life questionnaire, following cross-cultural adaptation and psychometric validation with respect to the English-language version.

RESULTS

The project commenced in June 2017 and is expected to conclude in April 2020.

CONCLUSIONS

This study addresses two main health outcomes-the time needed for wound healing and the mortality associated with pressure ulcers-both of which might be accounted for by variations in clinical practice and the health-related quality of life of patients with pressure ulcers.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/13701.

Outcomes Associated With Stage 1 Pressure Injuries: A Retrospective Cohort Study

BACKGROUND

Approximately half of hospital-acquired pressure injuries identified among critical care patients are stage 1. Although stage 1 injuries are common, outcomes associated with them among critical care patients have not been examined.

OBJECTIVES

To examine the outcomes of stage 1 pressure injuries among critical care patients and to identify factors associated with worsening of pressure injuries.

METHODS

Electronic health records were used to determine which surgical critical care patients at a level I trauma center and academic medical center had stage 1 pressure injuries. Competing risk survival analysis was used to identify factors associated with worsening of pressure injuries.

RESULTS

Review of 6377 patient records indicated that 259 patients (4.1%) experienced stage 1 injuries. The injuries persisted until discharge from the hospital in 92 patients (35.5%), worsened into injuries of stage 2 or greater in 84 (32.4%), and healed in 83 (32.0%). Patients whose pressure injuries worsened were more likely to be older (subdistribution hazard ratio [SHR], 1.02; 95% CI, 1.01-1.03; P = .002), or to have higher levels of serum lactate (SHR, 1.06; 95% CI, 1.02-1.10; P = .007), lower levels of hemoglobin (SHR, 0.82; 95% CI, 0.71-0.96; P = .01), or decreased oxygen saturation by pulse oximetry (< 90%; SHR, 1.50; 95% CI, 1.00-2.25; P = .05).

CONCLUSIONS

Stage 1 pressure injuries worsen in about one-third of patients (32.4%). Nurses should consider maximal treatment for patients who are older or who experience alterations in oxygen delivery or perfusion.