Risk factors related to the development of pressure ulcers in the critical care setting

Abstract

Aim: This study identified risk factors for pressure ulcer development early in the admission stage to determine what appropriate interventions might be conducted early in the admission stage to decrease the risk of pressure ulcer development.

Background: Among patients who develop pressure ulcers, 8-40% of them occur in a critical care setting. Therefore, the development of pressure ulcers is a common problem.

Design: Prospective cohort study.

Methods: The study facility was a 606-bed tertiary care hospital. Ninety eight patients admitted to the intensive care unit (ICU) or the high care unit (HCU) from 16 April 2003-15 July 2003 were evaluated in the final analysis.

Results: The mean patient age was 62.3 (SD 16.1) years, and the incidence of pressure ulcers in this study was 11.2% during the observation period. Multivariate analysis showed that 'emergency ICU/HCU patients' and 'infrequent turning' were related to pressure ulcer development. Patients with pressure ulcers experienced significantly fewer turns and repositionings (OR = 0.452, 95% CI: 0.212-0.966], p < 0.05. Fewer pressure ulcers developed in scheduled ICU/HCU patients than in emergency ICU/HCU patients (OR = 0.041 [95% CI: 0.004-0.470], p < 0.01).

Conclusion: There was no relationship between pressure ulcer development and APACHE II score, or any medication that affected skin integrity. The frequency of turning and repositioning and patients with an emergency admission to the ICU/HCU can be the prognostic indicators for developing scoring system in critical care settings.

Relevance to clinical practice: These patients admitted directly to ICU or HCU were in a high risk group, further preventive strategies will be required.