Risk Factors for Hospital-Acquired Pressure Injury in Adult Critical Care Patients

2022 ◽  
Vol 31 (1) ◽  
pp. 42-50
Author(s):  
Phillip Kim ◽  
Vamsi K. Aribindi ◽  
Amy M. Shui ◽  
Sharvari S. Deshpande ◽  
Sachin Rangarajan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Scale Score ◽  
Arterial Oxygen ◽  
Effective Prevention ◽  
Braden Scale ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

Background Accurately measuring the risk of pressure injury remains the most important step for effective prevention and intervention. Relative contributions of risk factors for the incidence of pressure injury in adult critical care patients are not well understood. Objective To develop and validate a model to identify risk factors associated with hospital-acquired pressure injuries among adult critical care patients. Methods This retrospective cohort study included 23 806 adult patients (28 480 encounters) with an intensive care unit stay at an academic quaternary care center. Patient encounters were randomly split (7:3) into training and validation sets. The training set was used to develop a multivariable logistic regression model using the least absolute shrinkage and selection operator method. The model’s performance was evaluated with the validation set. Results Independent risk factors identified by logistic regression were length of hospital stay, preexisting diabetes, preexisting renal failure, maximum arterial carbon dioxide pressure, minimum arterial oxygen pressure, hypotension, gastrointestinal bleeding, cellulitis, and minimum Braden Scale score of 14 or less. On validation, the model differentiated between patients with and without pressure injury, with area under the receiver operating characteristic curve of 0.85, and performed better than a model with Braden Scale score alone (P < .001). Conclusions A model that identified risk factors for hospital-acquired pressure injury among adult critical care patients was developed and validated using a large data set of clinical variables. This model may aid in selecting high-risk patients for focused interventions to prevent formation of hospital-acquired pressure injuries.

Identifying Risk Factors for Pressure Injury in Adult Critical Care Patients

2020 ◽  
Vol 29 (3) ◽  
pp. 204-213 ◽  
Author(s):  
Jill Cox ◽  
Marilyn Schallom ◽  
Christy Jung
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Intensive Care ◽  
Decision Tree ◽  
Scale Score ◽  
Critically Ill Patients ◽  
Braden Scale ◽  
Pressure Injury ◽  
Critical Care Patients

Background Critically ill patients have a variety of unique risk factors for pressure injury. Identification of these risk factors is essential to prevent pressure injury in this population. Objective To identify factors predicting the development of pressure injury in critical care patients using a large data set from the PhysioNet MIMIC-III (Medical Information Mart for Intensive Care) clinical database. Methods Data for 1460 patients were extracted from the database. Variables that were significant in bivariate analyses were used in a final logistic regression model. A final set of significant variables from the logistic regression was used to develop a decision tree model. Results In regression analysis, cardiovascular disease, peripheral vascular disease, pneumonia or influenza, cardiovascular surgery, hemodialysis, norepinephrine administration, hypotension, septic shock, moderate to severe malnutrition, sex, age, and Braden Scale score on admission to the intensive care unit were all predictive of pressure injury. Decision tree analysis revealed that patients who received norepinephrine, were older than 65 years, had a length of stay of 10 days or less, and had a Braden Scale score of 15 or less had a 63.6% risk of pressure injury. Conclusion Determining pressure injury risk in critically ill patients is complex and challenging. One common pathophysiological factor is impaired tissue oxygenation and perfusion, which may be nonmodifiable. Improved risk quantification is needed and may be realized in the near future by leveraging the clinical information available in the electronic medical record through the power of predictive analytics.

scholarly journals Risk Factors for Hospital-Acquired Pressure Injury in Surgical Critical Care Patients

2020 ◽  
Vol 29 (6) ◽  
pp. e128-e134
Author(s):  
Jenny Alderden ◽  
Linda J. Cowan ◽  
Jonathan B. Dimas ◽  
Danli Chen ◽  
Yue Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Odds Ratio ◽  
Academic Medical Center ◽  
Skin Irritation ◽  
Surgical Critical Care ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

Background Hospital-acquired pressure injuries disproportionately affect critical care patients. Although risk factors such as moisture, illness severity, and inadequate perfusion have been recognized, nursing skin assessment data remain unexamined in relation to the risk for hospital-acquired pressure injuries. Objective To identify factors associated with hospital-acquired pressure injuries among surgical critical care patients. The specific aim was to analyze data obtained from routine nursing skin assessments alongside other potential risk factors identified in the literature. Methods This retrospective cohort study included 5101 surgical critical care patients at a level I trauma center and academic medical center. Multivariate logistic regression using the least absolute shrinkage and selection operator method identified important predictors with parsimonious representation. Use of specialty pressure redistribution beds was included in the model as a known predictive factor because specialty beds are a common preventive intervention. Results Independent risk factors identified by logistic regression were skin irritation (rash or diffuse, nonlocalized redness) (odds ratio, 1.788; 95% CI, 1.404-2.274; P < .001), minimum Braden Scale score (odds ratio, 0.858; 95% CI, 0.818-0.899; P < .001), and duration of intensive care unit stay before the hospital-acquired pressure injury developed (odds ratio, 1.003; 95% CI, 1.003-1.004; P < .001). Conclusions The strongest predictor was irritated skin, a potentially modifiable risk factor. Irritated skin should be treated and closely monitored, and the cause should be eliminated to allow the skin to heal.

scholarly journals Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients

2017 ◽  
Vol 37 (4) ◽  
pp. e1-e11 ◽  
Author(s):  
Xiaohong Deng ◽  
Ting Yu ◽  
Ailing Hu
Keyword(s):  
Logistic Regression ◽  
Critical Care ◽  
Intensive Care ◽  
Decision Tree ◽  
Pressure Ulcers ◽  
Prediction Models ◽  
Risk Prediction Models ◽  
Braden Scale ◽  
Hospital Acquired ◽  
Critical Care Patients

BACKGROUND Assessments of risk for pressure ulcers in critical care patients may not include important predictors. OBJECTIVE To construct risk-prediction models of hospital-acquired pressure ulcers in intensive care patients and compare the models’ predictive validities with validity of the Braden Scale. METHODS Data were collected retrospectively on patients admitted to intensive care from October 2011 through October 2013. Logistic regression and decision trees were used to construct the risk-prediction models. Predictive validity was measured by using sensitivity, specificity, positive and negative predictive values, and area under the curve. RESULTS With logistic regression analysis, 6 factors were significant independent predictors. With the decision tree, 4 types of high-risk populations were identified. Predictive validity of Braden Scale scores was lower than the validities of the logistic regression and the decision tree models. CONCLUSION Risk for hospital-acquired pressure ulcers is overpredicted with the Braden Scale, with low specificity and low positive predictive value

Subsequent Pressure Injury Development in Mechanically Ventilated Critical Care Patients with Hospital-Acquired Pressure Injury

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jenny Alderden ◽  
Allen Cadavero ◽  
Yunchuan “Lucy” Zhao ◽  
Desiree Dougherty ◽  
Se-Hee Jung ◽  
...  
Keyword(s):  
Critical Care ◽  
Mechanically Ventilated ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

scholarly journals Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted With Community-Acquired Pressure Injury

2020 ◽  
Vol 47 (5) ◽  
pp. 470-476
Author(s):  
Jenny Alderden ◽  
Mollie Cummins ◽  
Sunniva Zaratkiewicz ◽  
Yunchuan ‘Lucy’ Zhao ◽  
Kathryn Drake ◽  
...  
Keyword(s):  
Critical Care ◽  
Surgical Critical Care ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

scholarly journals Dynamic Risk Prediction for Hospital-Acquired Pressure Injury in Adult Critical Care Patients

2021 ◽  
Vol 3 (11) ◽  
pp. e0580
Author(s):  
Amy M. Shui ◽  
Phillip Kim ◽  
Vamsi Aribindi ◽  
Chiung-Yu Huang ◽  
Mi-Ok Kim ◽  
...  
Keyword(s):  
Critical Care ◽  
Risk Prediction ◽  
Dynamic Risk ◽  
Pressure Injury ◽  
Dynamic Risk Prediction ◽  
Hospital Acquired ◽  
Critical Care Patients

Pressure Injury Risk Factors in Critical Care Patients

2018 ◽  
Vol 31 (7) ◽  
pp. 328-334 ◽  
Author(s):  
Jill Cox ◽  
Sharon Roche ◽  
Virginia Murphy
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Injury Risk ◽  
Pressure Injury ◽  
Injury Risk Factors ◽  
Critical Care Patients

scholarly journals Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study (Preprint)

2021 ◽  
Author(s):  
Jenny Alderden ◽  
Linda Amoafo ◽  
Yue Zhang ◽  
Caroline Fife ◽  
David Yap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Critical Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort ◽  
Deep Tissue ◽  
Risk Profiles ◽  
Pressure Injury ◽  
Critical Care Patients

BACKGROUND Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the “outside in” as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the “inside out” due to inadequate perfusion to the deeper tissues causing tissue ischemia. OBJECTIVE The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. METHODS This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the <i>χ<sup>2</sup></i> test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. RESULTS A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device–related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, <i>χ</i><sup>2</sup><sub>1</sub>=8.43, <i>P</i>=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, <i>P</i>=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure &lt;50 mmHg (OR 0.179, 95% CI 0.072-0.416, <i>P</i>&lt;.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, <i>P</i>=.008). CONCLUSIONS Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.

Comparing the Braden and Jackson/Cubbin Pressure Injury Risk Scales in Trauma-Surgery ICU Patients

2020 ◽  
Vol 40 (6) ◽  
pp. 52-61
Author(s):  
Jacob Higgins ◽  
Sherri Casey ◽  
Erin Taylor ◽  
Riley Wilson ◽  
Paula Halcomb
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Predictive Value ◽  
Injury Risk ◽  
Area Under The Curve ◽  
Surgical Patients ◽  
Braden Scale ◽  
Surgical Critical Care ◽  
Pressure Injury ◽  
Critical Care Patients

Background The occurrence of pressure injury in the critical care environment has multiple risk factors. Prevention requires reliable assessment tools to help predict injury risk. The Braden scale, a commonly used risk assessment tool, has been shown to have poor predictive properties in critical care patients. The Jackson/Cubbin scale was developed specifically for pressure injury risk stratification in critically ill patients and has demonstrated acceptable predictive properties in the general critical care population but has not been examined in critically ill trauma-surgical patients. Objective To compare the predictive properties of the Braden and Jackson/Cubbin scales in a trauma-surgical critical care population. Methods A retrospective medical records review was performed to evaluate the clinical characteristics of 366 trauma-surgical critical care patients. Additionally, the negative predictive value, positive predictive value, sensitivity, specificity, and receiver operating characteristic curve with area under the curve of the Braden and Jackson/Cubbin scales were determined. Results The sample consisted of primarily middle-aged (mean [SD], 56 [19] years) men (64%) admitted after trauma (71%). The participants who developed pressure injuries were older, more often required vasopressors and mechanical ventilation, and were less mobile. Predictive properties for the Braden and Jackson/Cubbin scales, respectively, were as follows: negative predictive value, 78% versus 87%; positive predictive value, 53% versus 66%; sensitivity, 17% versus 54%; specificity, 95% versus 92%; and area under the curve, 0.710 versus 0.793. Conclusion The Jackson/Cubbin scale demonstrated superior predictive properties and discrimination compared with the Braden scale for pressure injury risk prediction in critically ill trauma-surgical patients.

scholarly journals Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study

10.2196/29757 ◽  
2021 ◽  
Vol 4 (2) ◽  
pp. e29757
Author(s):  
Jenny Alderden ◽  
Linda Amoafo ◽  
Yue Zhang ◽  
Caroline Fife ◽  
David Yap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Critical Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort ◽  
Deep Tissue ◽  
Risk Profiles ◽  
Pressure Injury ◽  
Critical Care Patients

Background Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the “outside in” as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the “inside out” due to inadequate perfusion to the deeper tissues causing tissue ischemia. Objective The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. Methods This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the χ2 test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. Results A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device–related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, χ21=8.43, P=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, P=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure <50 mmHg (OR 0.179, 95% CI 0.072-0.416, P<.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, P=.008). Conclusions Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.

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