PREDIÇÃO DE RISCO DE LESÃO POR PRESSÃO EM PACIENTES DE UNIDADE DE TERAPIA INTENSIVA: REVISÃO INTEGRATIVA

Risk prediction tools for pressure injury occurrence: an umbrella review of systematic reviews reporting model development and validation methods

BACKGROUND

Pressure injuries (PIs) place a substantial burden on healthcare systems worldwide. Risk stratification of those who are at risk of developing PIs allows preventive interventions to be focused on patients who are at the highest risk. The considerable number of risk assessment scales and prediction models available underscores the need for a thorough evaluation of their development, validation, and clinical utility. Our objectives were to identify and describe available risk prediction tools for PI occurrence, their content and the development and validation methods used.

METHODS

The umbrella review was conducted according to Cochrane guidance. MEDLINE, Embase, CINAHL, EPISTEMONIKOS, Google Scholar, and reference lists were searched to identify relevant systematic reviews. The risk of bias was assessed using adapted AMSTAR-2 criteria. Results were described narratively. All included reviews contributed to building a comprehensive list of risk prediction tools.

RESULTS

We identified 32 eligible systematic reviews only seven of which described the development and validation of risk prediction tools for PI. Nineteen reviews assessed the prognostic accuracy of the tools and 11 assessed clinical effectiveness. Of the seven reviews reporting model development and validation, six included only machine learning models. Two reviews included external validations of models, although only one review reported any details on external validation methods or results. This was also the only review to report measures of both discrimination and calibration. Five reviews presented measures of discrimination, such as the area under the curve (AUC), sensitivities, specificities, F1 scores, and G-means. For the four reviews that assessed the risk of bias assessment using the PROBAST tool, all models but one were found to be at high or unclear risk of bias.

CONCLUSIONS

Available tools do not meet current standards for the development or reporting of risk prediction models. The majority of tools have not been externally validated. Standardised and rigorous approaches to risk prediction model development and validation are needed.

TRIAL REGISTRATION

The protocol was registered on the Open Science Framework ( https://osf.io/tepyk ).

Incidence of hospital acquired pressure injury in critically ill patients with COVID-19 in prone position admitted to the intensive care unit

Critical patients have conditions that may favor the occurrence of hospital-acquired pressure injury (HAPI). The objective of this study was to identify the incidence and factors associated with the occurrence of HAPI in patients with coronavirus disease 2019 admitted to the intensive care unit (ICU) who used the prone position. Retrospective cohort study carried out in an ICU of a tertiary university hospital. Two hundred four patients with positive real-time polymerase chain reactions were evaluated, of which 84 were placed in the prone position. All patients were sedated and submitted to invasive mechanical ventilation. Of the prone patients, 52 (62%) developed some type of HAPI during hospitalization. The main place of occurrence of HAPI was the sacral region, followed by the gluteus and thorax. Of the patients who developed HAPI, 26 (50%) had this event in places possibly associated with the prone position. The factors associated with the occurrence of HAPI in patients prone to coronavirus disease 2019 were the Braden Scale and the length of stay in the ICU. The incidence of HAPI in prone patients was extremely high (62%), which denotes the need to implement protocols in order to prevent the occurrence of these events.

INCIDÊNCIA E FATORES RELACIONADOS AO APARECIMENTO DE LESÕES POR PRESSÃO EM UNIDADE DE TERAPIA INTENSIVA

Objetivos:identificar a incidência e caracterizar as lesões por pressão em unidade de terapia intensiva adulta quanto à ocorrência, locais e fatores de risco, e verificar se há associação entre esses e o surgimento das lesões. Método: estudo observacional, coorte, prospectivo, desenvolvido em unidade de terapia intensiva de hospital terciário, de outubro a dezembro de 2019. A população constitui-se de adultos em primeiro dia de internação na unidade, sem lesão por pressão na admissão. Os participantes foram acompanhados durante a internação e variáveis sociodemográficas e clínicas, assim como avaliação do risco de desenvolver lesão por pressão, avaliação da pele e escala de Braden foram coletadas diariamente. Empregaram-se testes de Qui-quadrado de Pearsone teste t de student para avaliar as relações entre variáveis e lesões. Para as análises foi considerado nível de significância (α) de 5%. Resultados: foram incluídos 40 participantes, 20% apresentaram lesão por pressão com predominância dos estágios 1 e 2; os principais locais afetados foram a região sacral seguida pelo calcâneo. O tempo médio de internação foi 23,38 dias para o grupo com lesão e 5,77 dias para o grupo sem lesão; o tempo apresentou relação significativa com o surgimento das lesões (p=0,002). Conclusão: conclui-se que o local mais acometido foi a região sacral e grau 1 o estadiamento mais frequente; o tempo de internação foi a variável que influenciou o surgimento de lesões.

INCIDENCE AND FACTORS RELATED TO THE APPEARANCE OF PRESSURE INJURIES IN AN INTENSIVE CARE UNIT

Objectives: identify the incidence and characterize pressure injuries in an adult intensive care unit regarding the occurrence, locations and risk factors, and verify whether there is an association between these and the appearance of the injuries. Method: observational, cohort, prospective study, developed in an intensive care unit of a tertiary hospital, from October to December 2019. The population consists of adults on the first day of admission to the unit, without pressure injury at admission. Participants were monitored during hospitalization, sociodemographic and clinical variables, and risk assessment of developing a pressure injury, skin assessment and Braden scale were collected daily. Pearson’s chi-square tests and student’s t-test were used to assessing the relationship between variables and injuries. For the analyzes, a significance level (α) of 5% was considered. Results: 40 participants were included, 20% had pressure injuries with a predominance of stages 1 and 2; the main affected sites were the sacral region followed by the calcaneus. The average hospital stay was 23.38 days for the injured group and 5.77 days for the non-injured group; time showed a significant relationship with the appearance of lesions (p = 0.002). Conclusion: it was concluded that the most affected site was the sacral region and grade 1 was the most frequent staging; length of stay was the variable that influenced the appearance of injuries.