Risk Factors for Incontinence-Associated Dermatitis in Adults: A Systematic Review and Meta-Analysis

Abstract

Purpose: A meta-analysis was conducted to comprehensively identify risk factors of incontinence-associated dermatitis (IAD) in adults and provide evidence-based support for healthcare professionals to formulate IAD preventive interventions and bundled interventions.

Methods: Systematic review and meta-analysis of pooled findings.

Search strategy: Two researchers independently searched databases PubMed, EBSCO, Cochrane Library, Embase, Medline, Web of Science and Scopus and 4 Chinese databases (CNKI, Wanfang Data, VIP and CBM) for relevant studies published from their inception to March 15, 2023. Two researchers independently extracted relevant data and literature characteristics and evaluated the quality of the included studies.

Findings: Twenty-seven studies that collectively enrolled 4046 participants were included in our systematic review. Five were written in English, 1 was written in Spanish, and the other 21 were written in Chinese. The odds ratios (ORs) and 95% confidence intervals (CIs) of the risk factors for IAD were determined. Fecal incontinence, an etiologic factor (OR = 5.79; 95% CI = [1.88-17.87]), stool characteristics (OR = 5.28; 95% CI = [2.51-11.07]), and daily frequency of bowel movements (OR = 5.76; 95% CI = [4.48-7.42]) were associated with an increased likelihood of IAD. The following risk factors: fever (OR = 4.23; 95% CI = [1.89-9.46]), age (OR = 1.04; 95% CI = [1.01-1.09]), hypoproteinemia (OR = 3.30; 95% CI = [1.90-5.72]), impaired consciousness (OR = 2.43; 95% CI = [1.66-3.54]), days of antibiotic use (OR = 4.13; 95% CI = [3.11-5.49]), diabetes mellitus (OR = 2.90; 95% CI = [1.73-4.86]), and a higher overall Perineal Assessment Tool (PAT) score (OR = 2.56; 95% CI = [1.23-5.30]) emerged as independent risk factors for IAD in adult patients. In contrast, a higher serum albumin level (OR = 0.88; 95% CI = [0.84-0.93]), a higher Braden Scale for Predicting Pressure Score Risk (Braden Scale) score (OR = 0.66; 95% CI = [0.56-0.77]), and a higher Braden Scale mobility subscale score (OR = 0.86; 95% CI = [0.74-1.00]) were protective factors that reduced the likelihood of IAD.

Implications: Identification of risk factors for IAD may be used to identify patients at risk and in need of preventive interventions. Identification of modifiable risk factors may be used to design novel preventive interventions.