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Midrange Braden Subscale Scores Are Associated With Increased Risk for Pressure Injury Development Among Critical
Jenny Alderden1, Mollie Rebecca Cummins, Ginette Alyce Pepper
1Jenny Alderden, PhD, APRN, CCRN, CCNS, Boise State University College of Nursing, Boise, Idaho. Mollie Rebecca Cummins, PhD, RN, FAAN, University of Utah College of Nursing, Salt Lake City; and University of Utah Center for Clinical and Translational Science, Salt Lake City. Ginette Alyce Pepper, PhD, RN, FAAN, University of Utah College of Nursing, Salt Lake City. JoAnne D. Whitney, PhD, RN, FAAN, University of Washington College of Nursing, Seattle. Yingying Zhang, MS, MSTAT, Division of Epidemiology, Department of Internal Medicine, University of Utah Center Study Design and Biostatistics Center, Salt Lake City. Ryan Butcher, MS, University of Utah Center for Clinical and Translational Science, Salt Lake City. Donna Thomas, BSN, CWOCN, University Hospital, Salt Lake City, Utah.
Insights
Intermediate Braden Scale scores predict pressure injury risk in surgical ICU patients. Age influences this risk, necessitating personalized care planning for prevention efforts.
Area of Science:
- Critical Care Medicine
- Nursing Research
- Patient Safety
Background:
- Pressure injuries (PI) are a significant concern in intensive care units (ICUs).
- The Braden Scale for Pressure Sore Risk is a widely used tool for assessing PI risk.
- Understanding the nuances of risk assessment, particularly concerning age, is crucial for effective prevention.
Purpose of the Study:
- To investigate the association between Braden Scale subscale scores and pressure injury development in surgical ICU patients.
- To determine if age modifies the risk of pressure injury based on Braden Scale subscale scores.
Main Methods:
- Retrospective review of electronic medical records for 6377 surgical ICU patients.
- Analysis of Braden Scale total and subscale scores, patient age, and pressure injury incidence.
- Utilized survival analysis and time-dependent Cox regression to model risk and age interactions.
Main Results:
- Overall, 4% of patients developed a pressure injury (stages 2-4, DT, or unstageable).
- Except for friction and shear, intermediate Braden Scale subscale scores were associated with the highest likelihood of PI development, irrespective of age.
- Hospital-acquired pressure injuries occurred in 8% of patients.
Conclusions:
- The relationship between Braden Scale subscales, age, and pressure injury development is complex and varies by subscale.
- Preventive strategies should target patients with intermediate Braden Scale subscale scores.
- Age should be integrated into care planning alongside Braden Scale scores for comprehensive pressure injury risk management.
Purpose:
The purpose of the current study was to examine the relationship between pressure injury development and the Braden Scale for Pressure Sore Risk subscale scores in a surgical intensive care unit (ICU) population and to ascertain whether the risk represented by the subscale scores is different between older and younger patients.
Design:
Retrospective review of electronic medical records.
Subjects And Setting:
The sample comprised patients admitted to the ICU at an academic medical center in the Western United States (Utah) and Level 1 trauma center between January 1, 2008 and May 1, 2013. Analysis is based on data from 6377 patients.
Methods:
Retrospective chart review was used to determine Braden Scale total and subscale scores, age, and incidence of pressure injury development. We used survival analysis to determine the hazards of developing a pressure injury associated with each subscale of the Braden Scale, with the lowest-risk category as a reference. In addition, we used time-dependent Cox regression with natural cubic splines to model the interaction between age and Braden Scale scores and subscale scores in pressure injury risk.
Results:
Of the 6377 ICU patients, 214 (4%) developed a pressure injury (stages 2-4, deep tissue injury, or unstageable) and 516 (8%) developed a hospital-acquired pressure injury of any stage. With the exception of the friction and shear subscales, regardless of age, individuals with scores in the intermediate-risk levels had the highest likelihood of developing pressure injury.
Conclusion:
The relationship between age, Braden Scale subscale scores, and pressure injury development varied among subscales. Maximal preventive efforts should be extended to include individuals with intermediate Braden Scale subscale scores, and age should be considered along with the subscale scores as a factor in care planning.
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