Pressure Injuries and the Waterlow Subscales in the Intensive Care Unit: A Multicentre Study
Hongxia Tao1, Hongyan Zhang2, Xinmian Kang3
1The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
Background:
Pressure injuries (PIs) impose a significant burden on patients in the intensive care unit (ICU) and the healthcare system. Assessing the risk of developing PIs is crucial for prevention. However, it is unclear whether all subscales of the Waterlow scale can be used to assess PIs risk in ICU.
Objectives:
To assess whether all subscales of the Waterlow scale can predict PIs risk in ICU.
Design:
Multicentre prospective study.
Methods:
A total of 18,503 patients from ICUs in 40 tertiary-level hospitals in Gansu province of China were enrolled from April 2021 to August 2023. The incidence and characteristics of PIs were recorded. Univariate Cox regression analyses were performed for each subscale as a predictor of PIs development, followed by multivariate Cox regression with covariates for each subscale separately.
Results:
Out of 17,720 patients included, the incidence of PIs was 1.1%. Multivariate analysis revealed skin type (HR: 1.468, 95% CI: 1.229, 1.758), sex (HR: 0.655, 95% CI: 0.472, 0.908), advanced age (HR: 1.263, 95% CI: 1.106, 1.442), continence (HR: 1.245, 95% CI: 1.052, 1.473), tissue malnutrition (HR: 1.070, 95% CI: 1.007, 1.136) and neurological deficit (HR: 1.153, 95% CI: 1.062, 1.251) were independently predictive of PIs development for all participants. Skin type (HR: 2.326, 95% CI: 1.153, 3.010) (HR: 2.217, 95% CI: 1.804, 2.573) independently predicted PIs occurrence for high-risk and very high-risk group, respectively, while sex (HR: 0.634, 95% CI: 0.431, 0.931) and age (HR: 1.269, 95% CI: 1.083, 1.487) predicted PIs development for very high-risk group.
Conclusions:
This study found that not all subscales of the Waterlow scale are associated with the PIs development in patients in ICU, highlighting the importance of the skin type subscale in predicting PI risk across all patient groups.
Implications For Clinical Practice:
Nurses need to focus on patient's skin and related (moisture, pain and pressure) conditions and take measures to promote skin health and avoid the occurrence of PI.
Patient Or Public Contribution:
None.
