Patient, wound, and treatment characteristics associated with healing in pressure ulcers

To examine the associations among selected patient, wound, and treatment factors and healing in pressure ulcers.

Nonexperimental, retrospective study using data extracted from charts of patients having a Stage II, III, or IV pressure ulcer between July 1994 and November 1996.

A long-term-care facility associated with a major metropolitan medical center.

Evidence of healing was significantly associated with patient weight (P < .05) and negatively associated with body temperature (P < .05), time on a pressure-relieving bed (P < .05), amount of exudate (P < .001), and stage of pressure ulcer (P < .001). In a regression analysis, pressure ulcer stage, patient weight, and mean body temperature explained 25% of the variability in healing; specifically, lower pressure ulcer stage, higher patient weight, and lower mean body temperature predicted improved healing. Healing was not predicted by chronologic age, pressure ulcer location, number of illnesses, use of tube feedings, use of pressure-relieving beds, mean arterial pressure, or Braden Scale score. In a regression analysis of patient factors alone, lower body temperature and higher weight together predicted 9% of the variance in healing. When wound variables were analyzed, 19% of the variability in healing was explained by the stage of the pressure ulcer. Of the treatment variables, only shorter time on a pressure-relieving bed predicted healing, explaining 6% of the variance.

Strategies for healing pressure ulcers in nursing home patients should include programs for early recognition of pressure injury and prevention of pressure ulcer progression to higher stages; attention to weight gain and/or weight maintenance in at-risk patients; and early recognition and treatment of infections and febrile episodes.