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Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit

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  • María Isabel González‐Méndez
  • Marta Lima‐Serrano
  • Catalina Martín‐Castaño
  • Inmaculada Alonso‐Araujo
  • Joaquín Salvador Lima‐Rodríguez

Abstract

Aims and objectives To determinate the incidence, incidence rate and risk factors of pressure ulcers in critical care patients. Background Pressure ulcers represent one of the most frequent health problems in clinical practice. Specifically, critical patients who are hospitalised in intensive care units have a higher risk of developing a pressure ulcer, with an incidence that fluctuates between 3.3–39.3% according to previous studies. Design Prospective cohort study. Methods Three hundred and thirty‐five adult patients (over 18 years old) who were hospitalised in intensive care units for at least 24 hr were monitored for a maximum of 32 days. They were excluded if they had a pressure ulcers at admission. The survival rate for pressure ulcers, from stages I–IV, was calculated using the Kaplan–Meier method. A multivariate Cox regression model was adjusted to identify the main risk factors for pressure ulcers: demographic, clinical, prognostic and therapeutic variables. Results The incidence of pressure ulcers in critical patients was 8.1%, and the incidence rate was 11.72 pressure ulcers for 1,000 days of intensive care units stay; 40.6% of pressure ulcers were of stage I and 59.4% of stage II, mainly in the sacrum. According to the Cox model, the main risk factors for pressure ulcers were in‐hospital complications, prognostic scoring system (SAPS III) and length of immobilisation. Conclusions The incidence of pressure ulcers is lower than that shown in recent studies. Complications on the unit and the prognosis score were risk factors associated with pressure ulcers but, surprisingly, length of immobilisation was a protective factor. Relevance to clinical practice Survival analysis of pressure ulcer allows for identification of risk factors associated with this health problem in the intensive care units. Identifying these factors can help nurses establish interventions to prevent pressure ulcers in this healthcare scenario, given that pressure ulcers prevention is an indicator of nursing quality.

Suggested Citation

  • María Isabel González‐Méndez & Marta Lima‐Serrano & Catalina Martín‐Castaño & Inmaculada Alonso‐Araujo & Joaquín Salvador Lima‐Rodríguez, 2018. "Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(5-6), pages 1028-1037, March.
    • Handle: RePEc:wly:jocnur:v:27:y:2018:i:5-6:p:1028-1037
    DOI: 10.1111/jocn.14091
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    References listed on IDEAS

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    1. Patrick J. Heagerty & Yingye Zheng, 2005. "Survival Model Predictive Accuracy and ROC Curves," Biometrics, The International Biometric Society, vol. 61(1), pages 92-105, March.
    2. Ami Hommel & Lena Gunningberg & Ewa Idvall & Carina Bååth, 2017. "Successful factors to prevent pressure ulcers – an interview study," Journal of Clinical Nursing, John Wiley & Sons, vol. 26(1-2), pages 182-189, January.
    3. Toshiko Kaitani & Keiko Tokunaga & Noriko Matsui & Hiromi Sanada, 2010. "Risk factors related to the development of pressure ulcers in the critical care setting," Journal of Clinical Nursing, John Wiley & Sons, vol. 19(3‐4), pages 414-421, February.
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