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Clinical and systemic factors associated with pressure ulcer development: a retrospective evaluation of 339 patients
Fatih Oner Kaya1, Selçuk Şimşek2
1Department of Internal Medicine, Maltepe University Hospital, Istanbul, Türkiye.
Insights
Pressure ulcers affect over a third of palliative care patients, with stroke and confusion being major risks. Adhering to prevention protocols significantly reduces ulcer development.
Area of Science:
- Palliative Care Medicine
- Clinical Nursing
- Gerontology
Background:
- Pressure ulcers (PUs) are a significant complication in palliative care, often stemming from immobility and systemic illness.
- Effective interventions require a deep understanding of the multifactorial risks associated with PU development.
Purpose of the Study:
- To determine the prevalence of pressure ulcers in a palliative care setting.
- To identify clinical and systemic risk factors contributing to PU development in this population.
Main Methods:
- A retrospective single-center study analyzed medical records of 339 adult palliative care patients.
- Data included demographics, comorbidities, Braden Scale, Care Dependency Scale (CDS) scores, and PU characteristics.
- Multivariable logistic regression identified independent risk and protective factors for PU development.
Main Results:
- The overall prevalence of pressure ulcers was 33.6%, with deep tissue injury being the most common type (26%).
- Independent risk factors included stroke, gastrointestinal diseases, paraplegia, confusion, hypertension, coronary artery disease, arrhythmia, and heart failure. Longer hospital stays also increased risk.
- Adherence to PU prevention protocols and complete care dependency were significant protective factors.
Conclusions:
- Pressure ulcers are highly prevalent in palliative care patients, linked to numerous comorbid conditions.
- Preventive strategies should target cardiovascular/neurological stability, cognitive function, and adherence to care protocols.
- Integrating multidisciplinary management and individualized risk assessment is crucial for reducing PU burden and improving outcomes.
Background:
Pressure ulcers (PUs) remain a prevalent and serious complication in palliative care settings, often resulting from a combination of immobility, systemic illness, and inadequate preventive strategies. Understanding the multifactorial risk landscape is essential for developing effective interventions.
Objective:
This study aimed to determine the prevalence of pressure ulcers and to identify clinical and systemic risk factors associated with PU development in a palliative care population.
Methods:
A retrospective, single-center study was conducted by reviewing medical records of 339 adult patients hospitalized for more than 24 h in the palliative care unit of Maltepe University Hospital between June 2021 and November 2023. Demographic data, comorbidities, Braden and Care Dependency Scale (CDS) scores, and PU characteristics were analyzed. Multivariable logistic regression was used to identify independent risk and protective factors.
Results:
The overall prevalence of pressure ulcers was 33.6%. A total of 385 ulcers were recorded among 114 patients, with deep tissue injury (26%) being the most common type. Significant independent risk factors included stroke (OR: 4.89), gastrointestinal diseases (OR: 8.72), paraplegia (OR: 17.65), recent confusion (OR: 148.00), hypertension (OR: 2.98), coronary artery disease (OR: 3.42), arrhythmia (OR: 3.05), and heart failure (OR: 3.88). Longer hospital stay also increased PU risk (OR: 1.04 per day). In contrast, adherence to PU prevention protocols (OR: 0.18) and complete care dependency (OR: 0.02) were significant protective factors.
Conclusion:
Pressure ulcers are alarmingly common in palliative care patients and are closely linked to multiple comorbid conditions. Targeted preventive measures focusing on cardiovascular and neurological stability, nutritional support, cognitive function, and strict adherence to care protocols are vital. Proactive, multidisciplinary management and individualized risk assessment should be integrated into routine care to reduce PU burden and improve patient outcomes.
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