Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study

A Feasibility Study of Thermography for Detecting Pressure Injuries Across Diverse Skin Tones

Pressure injury (PI) detection is challenging, especially in dark skin tones, due to the unreliability of visual inspection. Thermography may serve as a viable alternative as temperature differences in the skin can indicate impending tissue damage. Although deep learning models hold considerable promise toward reliably detecting PI, existing work fails to evaluate performance on diverse skin tones and varying data collection protocols. We collected a new dataset of 35 participants focused on darker skin tones where temperature differences are induced through cooling and cupping protocols. The dataset includes different cameras, lighting, patient pose, and camera distance. We compare the performance of three convolutional neural network (CNN) models trained on either the thermal or the optical images on all skin tones. Our results suggest thermography-based CNN is robust to data collection protocols. Moreover, the visual explanation often captures the region of interest without requiring explicit bounding box labels.

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.

Comparing the Waterlow and Jackson/Cubbin pressure injury risk scales in intensive care units: A multi‐centre study

To compare the predictive properties of the Jackson/Cubbin scale and Waterlow scales in intensive care unit patients. A multi‐centre study. This study was conducted between April 2021 and February 2023 in 72 intensive care units of 38 tertiary hospitals in Gansu Province, China. All adults admitted to the intensive care unit for 24 hours or more without pressure injury on admission were screened using the Waterlow scale and Jackson/Cubbin scales in intensive care. Additionally, the negative predictive value, positive predictive value, sensitivity, specificity and receiver operating characteristic curve with area under the curve of the Waterlow scale and Cubbin/Jackson scales were determined. The participant population for this study included 6203 patients. Predictive properties for the Jackson/Cubbin scales and Waterlow scales, respectively, were as follows: Cut‐off scores, 28 versus 22; AUC, 0.859 versus 0.64; sensitivity, 92.4% versus 51.9%; specificity, 67.26% versus 71.46%; positive predictive value, 35% versus 23%; negative predictive value, 99.9% versus 99.1%. Both Waterlow scales and Jackson/Cubbin scales could predict pressure injury risk for patients in the intensive care unit. However, the Jackson/Cubbin scale demonstrated superior predictive properties than the Waterlow scale.

Pressure injury prevention measures: overview of systematic reviews

OBJECTIVE

Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries.

METHOD

Overview of systematic reviews conducted in accordance with Cochrane guidelines. A search was performed in databases, repositories and systematic review registration sites.

RESULTS

15 reviews were included in this overview. The sensitivity analysis showed a reduction in the incidence of pressure injuries with nutritional supplementation compared to the standard hospital diet (Relative Risk (RR) = 0.83; 95% Confidence Interval (CI): 0.72-0.95). There was evidence of the superiority of constant low-pressure surfaces (RR = 0.38; 95% CI;0.24-0.61), alternating pressure devices (RR = 0.31; 95% CI:0.17-0.58) and alternative foams (RR = 0.40; 95% CI:0.21-0.74) when compared to the standard hospital mattress or standard foam. The use of a silicone cover reduced the incidence of pressure injuries by 75% (RR = 0.25; 95%CI:0.16-0.41) when compared to no cover.

CONCLUSION

Although some interventions have been shown to be effective in reducing the incidence of pressure injury, the evidence is limited or very limited and subject to change. Registration CRD42017064586.

Risk assessment instruments for pressure ulcer in adults in critical situation: a scoping review

OBJECTIVE

to map the instruments for risk assessment of pressure ulcers in adults in critical situation in intensive care units; identify performance indicators of the instrument, and the appreciation of users regarding the instruments' use/limitations.

METHOD

a scoping review. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews in the writing of the study. We carried out the searches in the EBSCOhost search tool for 8 databases, resulting in 1846 studies, of which 22 studies compose the sample.

RESULTS

we identified two big instrument groups: generalist [Braden, Braden (ALB), Emina, Norton-MI, RAPS, and Waterlow]; and specific (CALCULATE, Cubbin & Jackson, EVARUCI, RAPS-ICU, Song & Choi, Suriaidi and Sanada, and COMHON index). Regarding the predictive value, EVARUCI and CALCULATE presented better results for performance indicators. Concerning appreciation/limitations indicated by users, we highlight the CALCULATE scale, followed by EVARUCI and RAPS-ICU, although they still need future adjustments.

CONCLUSION

the mapping of the literature showed that the evidence is sufficient to indicate one or more instruments for the risk assessment of pressure ulcers for adults in critical situation in intensive care units. (1) The risk assessment instrument must be applied to the patient's specificities. (2) The instruments are divided into two groups: generalist and specific. (3) The EVARUCI and CALCULATE instruments presented better results. (4) The EVARACI presented better results in terms of performance indicators. (5) The CALCULATE highlights itself for being recent scale, appropriate, simple, and easy to use.

Predictive validity of the EVARUCI scale to evaluate risk for pressure injury in critical care patients

OBJECTIVE

To compare the predictive capacity of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI), translated into Brazilian Portuguese, using the Braden scale.

METHOD

This cross-sectional study collected prospective data from adult patients in three intensive care units. The receiver operating characteristic (ROC) and precision-recall curve (PR curve) were used to analyse the predictive capacity for pressure injury (PI) using both predictive values and odds ratios (ORs).

RESULTS

The incidence of PIs in the study sample of 324 patients was 14.2%. The area under the ROC curve was 0.807 for EVARUCI and 0.798 for the Braden scale. At a cutoff point of 10 on the EVARUCI scale, sensitivity was 69.6%; specificity 78.4%; positive predictive value 34.8%; and OR 8.3. At a cutoff point of 11 on the Braden scale, sensitivity was 76.1%; specificity 75.9%; positive predictive value 34.3%; and OR 10. The area under the PR curve was 0.396 for the EVARUCI scale and 0.348 for the Braden scale, reflecting a smaller area for both. The F1 score value was 0.476 with 37.5% precision and 65.2% recall for the EVARUCI scale, and 0.473 with 34.3% precision and 76.1% recall for the Braden scale.

CONCLUSION

The EVARUCI scale predictive capacity was similar to that of the Braden scale. However, the precision of both scales was low for the accurate prediction of patients at risk of developing PIs.

Biomarkers and clinical features associated with pressure injury among geriatric patients

<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 &gt;1.27 for BS, albumin, and CAR, respectively.

Singular Predictors of Hospital-Acquired Pressure Injuries Under Intensive Care: A Retrospective Cohort Study in a Medium-Complexity Hospital

A retrospective cohort study of hospital-acquired pressure injuries (HAPI) reported an incidence rate of 34.3% based on 582 medical records of adult patients admitted to the intensive care unit (ICU) of a medium-complexity public hospital in 2017 and 2018. Sixty percent of the patients used respirators, 49.3% presented hypotension, and 48.1% used norepinephrine. The main individual predictors of HAPI in the ICU were "days of norepinephrine" with an odds ratio (OR) of 1.625 (95% CI: 1.473-1.792) and concordance statistic (AUC) of 0.818 (95% CI: 0.779-0.857), "days of mechanical ventilation" with an OR of 1.521 (1.416-1.634) and AUC of 0.879 (0.849-0.909), "ICU stay (days)" with an OR of 1.279 (1.218-1.342) and AUC of 0.846 (0.812-0.881), and "Braden's sensory perception" with an OR of 0.345 (95% CI: 0.278-0.429) and AUC of 0.760 (0.722-0.799). The duration of mechanical ventilation, norepinephrine administration, and ICU length of stay presented significant discriminative capacity for HAPI prediction.

MEDICAL DEVICE-RELATED PRESSURE INJURY: FREQUENCY AND ASSOCIATED FACTORS

Objective: to analyze the occurrence of pressure injuries related to medical devices in patients admitted to an intensive care unit. Method: quantitative, observational, descriptive, prospective cohort study, carried out with 171 patients, from May 15 to August 31, 2018 in the intensive care units of a public hospital in the Federal District. Results: the main risk factors were the presence of pressure injuries at admission, with a significant association for the formation of pressure injuries related to medical devices (p=0.002), and patients who progressed to death, with an association for the formation of pressure injuries related to medical devices (p=0.012); medical device-related pressure injury incidence rate of 40.35%. Conclusion: the use of medical devices has grown, as well as the appropriation of these technologies in the critical care environment. The multidisciplinary team should be aware of the formation of pressure injuries related to medical devices that can affect hospitalized patients.

LESÃO POR PRESSÃO RELACIONADA A DISPOSITIVOS MÉDICOS: FREQUÊNCIA E FATORES ASSOCIADOS

Objetivo:analisar a ocorrência de lesões por pressão relacionadas a dispositivos médicos em pacientes internados em unidade de terapia intensiva. Método: estudo quantitativo, de caráter observacional descritivo, do tipo coorte prospectivo, realizado com 171 pacientes, no período de 15 de maio a 31 de agosto de 2018 nas unidades de terapia intensiva de um hospital público do Distrito Federal. Resultados: os principais fatores de risco foram presença de lesões por pressão na admissão, com associação significativa para a formação de lesão por pressão relacionada a dispositivos médicos (p=0,002), e pacientes que evoluíam ao desfecho óbito, com associação para formação de lesão por pressão relacionada a dispositivos médicos (p=0,012); taxa de incidência de lesão por pressão relacionada a dispositivos médicos de 40,35%. Conclusão: o uso de dispositivo médico tem crescido, bem como a apropriação dessas tecnologias no ambiente de cuidados críticos. A equipe multiprofissional deve ficar atenta para a formação das lesões por pressão relacionadas a dispositivos médicos que podem acometer os pacientes internados.

A Study on Pressure Ulcer: Influencing Factors and Diagnostic Techniques

Pressure ulcer (PU) is one of the most common occurrences in bedridden subjects. Despite the standard of care, there is a huge challenge in monitoring immobile subjects in all the bodily pressure points. This increases the chance of onset of PU which in turn increases the expenditure for treating and managing the PU. Hence, we made a study on the biological and physiological factors that are responsible for the formation of PU and also on various techniques used for diagnosis. Thus, we have summarised the efficacy of various advanced diagnostic procedures with their limitations. Though there are advanced imaging techniques, risk assessment tools based on the visual inspection are widely followed in hospitals. Based on our observation, we here have identified three major areas; one being the development of mathematical modeling, the second is towards the development of non-invasive devices and finally to automate cot facility. We have also provided possible suggestions as to solutions that could be useful to researchers and for society. Thus, this review covers the present difficulty faced by bedridden subjects and respective care-takers along with the knowledge gap and a few suggestions as to future scope.

Pressure injuries in surgical patients: a comparison of Norton, Braden and Waterlow risk assessment scales

OBJECTIVE

This study aims to determine the predictive power of the Norton, Braden and Waterlow scales in determining risk of pressure injury (PI) in surgical patients.

METHOD

This prospective study was carried out in the surgery clinic of a training and research hospital in Istanbul, Turkey between January and April 2017. The study sample consisted of adult patients aged ≥18 years and who did not have PI on admission to the clinic, had abdominal surgery under general anaesthesia and who stayed in the clinic for at least 48 hours. The data were collected using the Turkish versions of the Norton, Braden and Waterlow risk assessment scales. The predictive validity of PI risk assessment tools was assessed based on their sensitivity, specificity, positive and negative predictive values and the area under the receiver operating characteristic (ROC) curve. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals (CI).

RESULTS

The study sample included 250 patients, and the incidence of PI was 12%. The sensitivity, specificity, positive predictive value and negative predictive value were: 83.3%, 45.4%, 17.2% and 95.2%, respectively, for the Norton scale (a cut-off point of 14); 100%, 40.4%, 18.6% and 100%, respectively, for the Braden scale (a cut-off point of 16); and 100%, 48.1%, 20.8% and 100%, respectively, for the Waterlow scale (a cut-off point of 10). The areas under the ROC curve were 0.749 for the Norton, 0.771 for the Braden and 0.971 for the Waterlow scales. This study's findings produced the following predictive capacity indicators: Norton (RR=3.62; 95%CI=1.43-9.14), Braden (RR=33.88; 95%CI=2.09-547.66); and Waterlow (RR=45.01; 95%CI=2.78-727.97).

CONCLUSION

In this study, the Waterlow scale demonstrated the best values of predictive validity among the three scales in the assessment of PI risk. However, all three scales had low specificity despite high sensitivity in terms of a good risk prediction. No definitive decision could be reached on the predictive capacities of the scales because of wide CIs.

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.

Clinical consequences of contaminated blood cultures in adult hospitalized patients at an institution utilizing a rapid blood-culture identification system

OBJECTIVE

To assess the clinical impact of contaminated blood cultures in hospitalized patients during a period when rapid diagnostic testing using a FilmArray Blood Culture Identification (BCID) panel was in use.

DESIGN

Retrospective cohort study.

SETTING

Single academic medical center.

PARTICIPANTS

Patients who had blood culture(s) performed during an admission between June 2014 and December 2016.

METHODS

Length of hospital stay and days of antibiotic therapy were assessed in relation to blood-culture contamination using generalized linear models with univariable and multivariable analyses.

RESULTS

Among 11,474 patients who had blood cultures performed, the adjusted mean length of hospital stay for patients with contaminated blood-culture episodes (N = 464) was 12.3 days (95% confidence interval [CI], 11.4-13.2) compared to 11.5 days (95% CI, 11.0-11.9) for patients (N = 11,010) with negative blood-culture episodes (P = .032). The adjusted mean durations of antibiotic therapy for patients with contaminated and negative blood-culture episodes were 6.0 days (95% CI, 5.3-6.7) and 5.2 days (95% CI, 4.9-5.4), respectively (P = .011).

CONCLUSIONS

Despite the use of molecular-based, rapid blood-culture identification, contamination of blood cultures continues to result in prolonged hospital stay and unnecessary antibiotic therapy in hospitalized patients.

Risk for undernutrition and development of pressure injury in hospitalised patients in Brazil: Multicentre prospective cohort study

Although pressure injury (PI) is preventable, the number of patients developing this type of injury is still high. In this prospective cohort study, we aimed to assess whether high risk for undernutrition was a risk factor for PI in 1937 patients aged ≥18 at six hospitals in Sao Paulo, Brazil. Patients' risk for undernutrition was assessed using three unique screening tools. Risk for PI was assessed using the Braden Scale. Data were analysed using Poisson regression with robust variance (95% CI, P ≤ .05). While 57.1% of patients were at risk for undernutrition in the Nutritional Risk Screening (NRS 2002), only 36.8% and 2.6% were at risk in the Braden Scale Nutrition Subscale (BSNS) and Subjective Global Assessment of Nutritional Status (SGANS), respectively. The cumulative incidence rate was 5.9%. Of those who developed PI, 91.2%, 56.2%, and 18.4% were at risk for undernutrition in the NRS 2002, BSNS, and SGANS scales, respectively. We found a significantly higher risk for PI in patients who were at risk for undernutrition compared with those who were not at risk, supporting previous evidence about the role of undernutrition as a key risk factor for PI in hospitalised patients.

Management tools in nursing care for children with pressure injury

ABSTRACT Objectives: to develop and validate management tools for the systematization of nursing care for children with pressure injuries. Methods: methodological study in which the focus group technique was used for validation of tools in three different groups of 17 nurses. Conducted in April and May 2018 at a large pediatric hospital. Results: two management tools were developed. The first was the Nursing care systematization instrument for children with pressure injury with three parts: a) risk factors; b) Psychobiological Basic Human Needs; c) signs of wound infection. The second was the Flowchart of pressure injury risk and prevention in pediatric patients with three categories: a) risk factors; b) Braden Q scale; c) nursing care. Final Considerations: the tools will support nurses in the care of children with pressure injuries by aiming at an individualized and systematized assessment based on a theoretical framework.

Using the Braden subscales to assess risk of pressure injuries in adult patients: A retrospective case-control study

The aim of this study was to compare the pressure injury risk predictability between the individual Braden subscales and the total Braden scale in adult inpatients in Singapore. A retrospective 1:1 case-control design was used from a sample of 199 patient medical records. Clinical data were collected from a local university hospital's medical records database. The results showed that, among the six subscales, the activity subscale was the most sensitive and specific in predicting pressure injury (PI). However, the overall results showed that the Braden scale remained the most predictive of PI development in comparison with the individual subscales. The study also found that, among the Singaporean patients, the Braden cut-off score for PI risk was 17 compared with the current cut-off score of 18. Therefore, it may be relevant for local tertiary hospitals to review their respective Braden cut-off scores as the study results indicate an over-prediction of PI risk, which leads to unnecessary utilisation of resources. The hospital may also consider developing a PI prevention bundle comprising commonly used preventive interventions when at least one Braden subscale reflects a suboptimal score.

Scale for measurement of healthcare-associated infection risk in adult patients: development and content validation

Introduction: Hospital settings involve several risk factors related to healthcare-associated infections (HAIs). A method that contributes to prevention and control is identification of risks to enable implementation of preventative measures. It is believed that this identification can be accomplished using scales. The present study attempts to develop and validate the face and content of a new scale for measuring HAIs risk in hospitalized adults. Materials and Methods: A methodological study conducted to develop and validate the face and content of the Adult Inpatients Infection Risk Assessment scale, which underwent evaluation by a committee of 23 experts with experience in HAIs. The scale’s validity was tested using the Content Validity Index (CVI). Results: 15 items were retained in the scale, grouped into two dimensions: intrinsic and extrinsic factors. Certain minor adjustments were needed to improve the clarity of some items. Items’ CVIs ranged from 0.83 to 1.0 and the scale’s mean CVI was 0.90. Discussion: The Adult Inpatients Infection Risk Assessment scale can be used as a technology of low cost for the measurement of the risk of infection, which allows the planning of more accurate and organized interventions of the health team targeting at preventive and safe care during hospitalization. Conclusions: The findings supported the face and content validity of the Adult Inpatients Infection Risk Assessment Scale.

Adhesion to patient safety protocols in emergency care units

OBJECTIVE

To investigate compliance of national patient safety protocols in Emergency Care Units (UPA) of the Paraná State.

METHOD

From April until September 2016, the exploratory stage of the action research was conducted on stratified sampling with 377 patients of eight units, with use of verification instrument of basic safety actions.

RESULTS

The absence of systematic identification of patients, fall risk assessment and signaling and development of pressure injuries were evidenced. We observed that 52.8% of parenteral solutions in use were not identified and that, in only 29.4% of the cases, the allergic condition was investigated. In 80.6% of the emergency units there was availability of alcoholic solution to hand hygiene.

CONCLUSION

We concluded that the non-compliance of basic actions concerning patient safety exposes users to preventable adverse events and demands systematized actions to comply with government guidelines and promote quality of health assistance.

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

RESUMO Objetivo: identificar os instrumentos que são utilizados para avaliar o risco de lesão por pressão em pacientes críticos adultos de unidade de terapia intensiva e analisar a capacidade preditiva dos mesmos. Método: revisão integrativa observando-se os critérios para seleção dos estudos: avaliação do risco de lesão por pressão em pacientes internados em unidade de terapia intensiva de adultos por meio de escala ou índice; mensuração da capacidade preditiva do instrumento aplicado; idiomas inglês, português ou espanhol; período entre 1962 e 2016. Os descritores utilizados foram: pressure ulcer ou pressure sores e risk assessment. As variáveis de interesse foram: sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e área sob a curva receiver operator characteristic. Resultados: : foram identificadas 1032 publicações e deste total foram selecionados 13 estudos para análise. A predição do risco para lesão por pressão foi mensurada unicamente com escalas genéricas em sete dos 13 estudos. Nos estudos comparativos de escalas específicas de unidade de terapia intensiva com escalas genéricas, o valor preditivo negativo foi elevado e todos com área da curva receiver operator characteristic com valores acima de 0,700. Entre as escalas genéricas predominou a escala de Braden. Foram identificadas seis escalas que apresentaram boa capacidade preditiva para avaliar risco de lesão por pressão em pacientes de unidade de terapia intensiva. Conclusão: : esta revisão revelou uma variedade de escalas preditivas, genéricas e específicas, que são utilizadas para avaliação de risco de lesão por pressão no paciente de unidade de terapia intensiva.

Usefulness of the Braden Scale in Intensive Care Units: A Study Based on Electronic Health Record Data

Nurses working in intensive care units have expressed concern that some categories of the Braden scale such as activity and nutrition are not suitable for intensive care unit patients. Upon examining the validity of the Braden scale using the electronic health data, we found relatively low predictability of the tool. Risk factors from the sensory perception and activity categories were not associated with risk of pressure ulcers.

PROMOÇÃO DA SAÚDE E PREVENÇÃO DA LESÃO POR PRESSÃO: EXPECTATIVAS DO ENFERMEIRO DA ATENÇÃO PRIMÁRIA

RESUMO Objetivo: apresentar a aplicabilidade da Escala de Braden na percepção dos enfermeiros da atenção primária, e identificar as medidas de prevenção, e promoção da saúde de modo evitar o desenvolvimento da lesão por pressão. Método: pesquisa Convergente assistencial, realizada num distrito sanitário do Sul do Brasil, com 20 enfermeiros. A coleta de dados ocorreu em julho de 2014, através de entrevista e de uma prática educativa na forma de oficina temática intitulada “Diga não à lesão por pressão, prevenir é o melhor cuidado”. A análise foi através da fase de apreensão, síntese, teorização e transferência. Resultados: da prática educativa culminaram duas categorias: Percepções e expectativas quanto ao uso da Escala de Braden na atenção primária, sendo esta revelada como uma importante ferramenta no reconhecimento das pessoas vulneráveis; e Desvelar as práticas de promoção da saúde e medidas de prevenção para evitar a lesão por pressão, tendo esta as aspirações voltadas a um adequado direcionamento dos cuidados na busca por melhorar a qualidade de vida. Conclusão: conclui-se que uma avaliação adequada, um plano de cuidados que possa prevenir a lesão por pressão, assim como práticas que promovam saúde, configuram-se como possibilidades criativas versus desafios, na inclusão de um novo paradigma na atenção primária.

Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study

BACKGROUND

Hospital-acquired pressure injuries are a costly and largely preventable complication occurring in a variety of acute care settings. Patients admitted to the intensive care unit are at greater risk of developing pressure injuries.

OBJECTIVE

To determine whether the efficiency of scales to measure pressure injury risk increase when a continuously updated 3-day moving average method is used.

METHODS

With a retrospective cohort design we recruited 3085 patients treated between June 2011 and February 2015 in the intensive care unit of a tertiary level university hospital. The present study included 2777 patients admitted to the Intensive Care Unit of the Hospital Universitario de Canarias, Spain. Patients were evaluated daily with two scales to measure pressure injury risk: the Current Risk Assessment Scale for Pressure injury in Intensive Care scale (EVARUCI scale) and the Conscious level-Mobility-Haemodynamics-Oxygenation-Nutrition Index (COMHON). The moving average was used to create a series of three day averages from the complete time-data set. The moving average method was used to analyze data points by creating series of averages of three days subsets of the time-data set. We calculated the efficiency of the method as the product of positive (PPV) and negative predicted values (NPV) for each scale.

RESULTS

The efficiency using the moving average method was: PPV x NPV=0.483×0.907=0.438 (standard deviation=0.059), for EVARUCI Scale, and. PPV x NPV=0.552×0.806=0.445 (standard deviation=0.075) for COMHON Index.

CONCLUSIONS

The efficiency using the moving average method was higher, than the efficiency of other methods previously reported (0.360±0.009 on average). The present study provides a useful procedure for nurses in clinical practice to assess whether a particular patient is protected against the appearance of pressure injury. The instrument should be used focusing on negative predictive value to indicate protection against pressure injury.

Validity of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI) and the Norton-MI scale in critically ill patients

OBJECTIVE

The objective of this study was to evaluate the validity of risk detection scales EVARUCI and Norton-MI (modified by INSALUD) to detect critical adult patients with the risk of developing pressure ulcers (PU) in an intensive care unit (ICU).

DESIGN

The authors have conducted a descriptive, prospective study at the ICU in their hospital from 2008 to 2014. The evaluations of both scales were registered daily by nurses from the unit.

PATIENTS

Adult patients admitted into the ICU.

MAIN OUTCOMES MEASURE

The study measured the sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of each of the scores for both scales and areas under curve (AUC) of receiver operating characteristics (ROC).

MAIN RESULTS

The authors have evaluated a total of 2534 patients. For the cut-off point recommended by the authors in the scale Norton-MI (PC 14), a sensitivity of 94,05% (93,28-94,82) was obtained, specificity of 40,47% (39,72-41,22), VPP 26,22% and VPN 96,80%. For EVARUCI (CP 10) a sensitivity of 80,43% (79,15-81,72), specificity 64,41 (63,68-65,14), VPP 33,71% and VPN of 93,60%. The ABC-COR was 0,774 with a 95% CI of 0,766 to 0,781 for the scale of Norton-MI and 0.756 with a 95% CI of 0,749 to 0,764 for EVARUCI.

CONCLUSION

Both scales are valid to help predict the risk of developing PU in critical patients. The sensitivity and ABC-COR are very similar for EVARUCI and Norton-Mi. The authors state they do not have any financial interests linked to this article.

Pressure Ulcer Risk Evaluation in Critical Patients: Clinical and Social Characteristics

BACKGROUND

Pressure ulcers increase hospital stays and treatment costs due to their complications. Therefore, recognizing factors that contribute to pressure ulcer risk are important to patient safety.

OBJECTIVE

To evaluate the association between the scores of the Waterlow, Braden, and Norton scales and clinical and social characteristics in critically ill patients.

METHOD

A cross-sectional study of 78 patients in an adult intensive care unit of a university hospital in Northeastern Brazil was conducted from July to December 2015. Data included social and clinical information and the risk factors of the Braden, Norton and Waterlow scales. Data were analysed by the descriptive and inferential statistics.

RESULTS

Most of the participants were female, adults and elderly people with brown skin colour, low education levels and insufficient income. Most of them showed a high risk for developing pressure ulcers using the three evaluated scales. Age, smoking status, diabetes and hypertension were associated with scores on the Waterlow, Braden and Norton scales.

CONCLUSION

Age, use of the tobacco, diabetes and hypertension were associated with the risk of pressure ulcers in ICU patients.

5th Congress of WUWHS Abstract book Florence, Italy September 25–29 2016

The abstract book contains the abstracts of keynote lectures, focus sessions, symposia, workshops, AIUC annual meeting, AISLEC annual meeting, EPUAP annual meeting, ETRS special session, sponsor symposia, oral presentations, poster presentations and the subject index.

Factors associated with the incidence of pressure ulcer during hospital stay

Abstract OBJECTIVE Estimating the incidence rate of pressure ulcers and verifying factors associated with this occurrence in a cohort of hospitalized patients. METHOD This is a cohort study in which the considered outcome was the time until pressure ulcer occurrence. Estimated effect of the variables on the cumulative incidence ratio of the outcome was performed using the Cox proportional hazards model. Variable selection occurred via the Logrank hypothesis test. RESULTS The sample consisted of 442 adults, with 25 incidents of pressure ulcers. Patients with high scores on the Braden scale presented a higher risk of pressure ulcer incidence when compared to those classified into the low score category. CONCLUSION These results reinforce the importance of using the Braden Scale to assist in identifying patients more likely to develop pressure ulcers.

Costs of topical treatment of pressure ulcer patients

Abstract OBJECTIVE To evaluate the costs of a topical treatment of pressure ulcer (PU) patients in a hospital unit for treatment of chronic patients in 2014. METHOD This is an activity-based costing study. This method encompasses the identification, measurement and pricing of physical and human resources consumed for dressings. RESULTS Procedure costs varied between BRL 16.41 and BRL 260.18. For PUs of the same category, of near areas and with the same type of barrier/adjuvant, the cost varied between 3.5% and 614.6%. For most dressings, the cost increased proportionally to the increase of the area and to the development of PU category. The primary barrier accounted for a high percentage of costs among all items required to the application of dressings (human and material resources). Dressings applied in sacral PUs had longer application times. CONCLUSION This study allowed us to understand the costs involved in the treatment of PUs, and it may support decision-makers and other cost-effectiveness studies.