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Pressure Ulcer Surveillance in Neurotrauma Patients at a Level One Trauma Centre in India
Annu Babu1, Kumar Madhavan1, Maneesh Singhal1
1Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Insights
A Wound Care Surveillance Program effectively prevented and managed pressure ulcers. The Braden scale predicted healing outcomes, with higher-stage ulcers showing poorer prognoses.
Area of Science:
- Medical Science
- Wound Care Management
- Public Health
Background:
- Pressure ulcers represent a significant, preventable health burden with substantial financial and emotional costs.
- Effective prevention and early detection are crucial due to the challenges in treating established pressure ulcers.
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary Wound Care Surveillance Program in preventing and managing pressure ulcers.
- To assess the utility of the Braden scale in risk stratification and predicting healing outcomes.
Main Methods:
- Implementation of a Wound Care Surveillance Program involving nurses, physiotherapists, and doctors since 2012.
- Utilized the Braden scale for patient risk stratification.
- Observed 2,974 patients over a one-year period.
Main Results:
- A pressure ulcer prevalence of 3.1% was recorded, with younger and middle-aged patients most affected.
- Road traffic accidents were the most common cause of injury, often affecting the sacrum.
- Healing rates varied by stage: 29% for stage one, 17% for stage two, 6% for stage three, and 0% for stage four at two months.
Conclusions:
- The Wound Care Surveillance Program proved highly effective in pressure ulcer prevention and management.
- The Braden scale demonstrated predictive and prognostic value for pressure ulcer healing.
- Higher ulcer stages, spinal/organ injuries, and tracheostomy needs correlated with poorer healing; home care deficiencies were noted.
Objectives:
Pressure ulcers are a multifactorial, prevalent, and preventable morbidity. They cause a burden both financially and emotionally, to the individual, their family and doctor, and to society as a whole. Pressure ulcers are extremely difficult to treat; therefore, prevention is key.
Methods:
We started a Wound Care Surveillance Program in 2012 involving nurses, physiotherapists, and doctors. We intended to prevent the occurrence of pressure ulcers, ensure early detection, and facilitate the healing process. The Braden scale was used to stratify patients' risk. The number of patients observed in our study was 2,974 over a one-year period.
Results:
The pressure sore prevalence was 3.1%. Younger and middle-aged patients were most commonly affected; 27% of these patients did not survive. Mortality was not attributed to the pressure ulcer directly. The most common mode of injury was road traffic accidents. Most of our patients had just a single pressure area affected, most commonly the sacrum. Most patients were managed with debridement and dressings while 12% received surgical treatment. Of those with stage one ulcers, 29% healed completely at two months. In stage two and three patients, 17% and 6% healed in two months, respectively, and this number was zero in stage four patients.
Conclusion:
The Wound Care Surveillance Program has been a very effective strategy for the prevention and management of pressure ulcers. Stage two ulcers were the most common in our setup. Braden scoring, traditionally used to screen these ulcers, can be used as a predictive and prognostic tool to predict healing of pressure ulcers. Poor healing is expected in higher staged ulcers and patients with spinal injury and major solid organ injury and those who need a tracheostomy. Home-based care is not up to mark in our society and accounts for most of the cases in the follow-up.
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