Beyond Conventional Risk Scales: Temporal Patterns and Multidimensional Predictors of Early Deep Tissue...

Area of Science:

• Critical Care Medicine
• Nursing Research
• Patient Safety

Background:

• Deep tissue pressure injury (DTPI) is a severe complication in critically ill patients.
• Established risk factors include immobility and malnutrition.
• Hemodynamic instability, edema, and sedation may also contribute to DTPI onset.

Purpose of the Study:

• To investigate temporal patterns of early versus late DTPI in ICU patients.
• To identify clinical predictors of DTPI, focusing on nutritional risk, edema, and sedation.
• To evaluate the utility of routine clinical parameters and risk scales in predicting DTPI.

Main Methods:

• Retrospective cohort study of 211 adult ICU patients.
• DTPIs classified as early (≤9 days) or late (>9 days) based on onset.
• Analysis included bivariate comparisons, logistic regression, and ROC curve analysis of demographic, clinical, and treatment variables.

Main Results:

• Over half of patients (51.7%) developed early-onset DTPI.
• Late DTPI was linked to longer hospital and ICU stays, more edema, and higher sedative use.
• Independent predictors of early DTPI included shorter ICU stay, lower nutritional risk score (NRS-2002), edema, and sedation.

Conclusions:

• Conventional risk scales like the Braden score have limited predictive power for early DTPI.
• Nutritional risk, edema, and sedation are significant independent predictors of early DTPI.
• Integrating multidimensional clinical parameters into risk assessment is crucial for effective DTPI prevention in ICUs.