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Risk assessment study of the pressure ulcers in intensive care unit patients
Hakan Terekeci1, Yasar Kucukardali, Cihan Top
1Department of Internal Medicine, Gulhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey.
Insights
Intensive care unit (ICU) patients with pressure ulcers (PU) can be identified through early screening and risk factor assessment. Implementing strict National Pressure Ulcer Advisory Panel (NPUAP) guidelines may reduce PU incidence.
Area of Science:
- Critical Care Medicine
- Dermatology
- Gerontology
Background:
- Pressure ulcers (PU) are a significant concern in intensive care units (ICUs).
- Early identification of risk factors and patient screening are crucial for prevention.
- The incidence and associated factors of PU in ICU patients require further investigation.
Purpose of the Study:
- To determine the incidence of pressure ulcers in ICU patients.
- To identify risk factors associated with PU development in this population.
- To evaluate the effectiveness of early screening and adherence to NPUAP guidelines.
Main Methods:
- A prospective study of 142 ICU patients was conducted.
- Patients were screened for PU on admission using the National Pressure Ulcer Advisory Panel (NPUAP) guidelines.
- Risk assessment included the Norton Scale and Nutritional Risk Screening 2002 (NRS-2002); demographic, clinical, and laboratory data were collected.
Main Results:
- Prevalence of PU on admission was 9.8%.
- Incidence of new PU during ICU stay was 7.8%.
- Significant risk factors for PU included lower NRS-2002 and Norton scores, hypoalbuminemia, higher APACHE-II scores, longer hospitalization, hypotension, and comorbidities.
Conclusions:
- Early PU screening and strict adherence to NPUAP guidelines may lower PU incidence in ICUs.
- Key modifiable risk factors include malnutrition, hypoalbuminemia, and hemodynamic instability.
- Further research is needed on optimizing interventions for these factors from admission.
Abstract:
In this research, we studied the incidence of pressure ulcer and risk factors and screening of the patients for pressure ulcers at intensive care unit on the first day of admission in 142 patients. All patients were evaluated according to National Pressure Ulcer Advisory Panel during the ICU period strictly. Pressure ulcer risk evaluation was performed according to Norton Scale. Nutritional state was evaluated according to nutritional risk screening 2002. Age, hospitalization period, mean arterial pressure, pressure ulcer degree, hemoglobin and albumin levels, body mass index, APACHE-II scores and comorbidities were evaluated. In the following parameters, first value represents PU (+) cases, and second value represents PU (-) cases. On the admittance: 14 (9.8%) patients had PU (prevalence). NRS-2002: 5.4+/-1.9 and 4.3+/-2.1 (p<0.05), Norton score: 8.4+/-4.7 and 13.9+/-4.6 (p<0.05), albumin 2.7+/-0.7 g/dl and 3.2+/-0.8 g/dl (p<0.05). MAP and hemoglobin levels were not different (p>0.05). Mean pressure ulcer degree was 2.15. On the discharge: first values represent new developed PU (+) patients and second values represent PU (-) cases. 25 (17.6%) patients had PU. Incidence was 7.8%. NRS-2002: 6.4 and 3.6 (p<0.05), Norton score: 7.1 and 14.4 (p<0.05), albumin 2.2 g/dl and 3.0 g/dl (p<0.05). MAP 55.15+/-24.10 mm Hg and 79.76+/-18.12 mm Hg (p<0.05), APACHE-II score 22.3+/-4.2 and 18.2+/-6.2 (p<0.05). Hospitalization period: 18.3+/-10.3 days and 6.6+/-4.3 days (p<0.05) respectively. BMI and hemoglobin levels were not different (p>0.05). Two or more co morbidity, neurophyschiatric disorders, infections and medications were more prevalent in PU (+) group (p<0.05). Results of this study show us the PU incidence of ICU patients may be low if we perform PU screening all patients at the admission and put into practice NPUAP strictly. Age, low Norton score, hospitalization period, high APACHE-II score, hypotension, malnutrition and hypoalbuminemia were significant in patients with PU; however, BMI and hemoglobin were not significant. The studies focusing on the relation between the effect of optimization of these parameters from the first day of admittance and pressure ulcer are required.
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