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Published on: March 9, 2019
Factors Associated With Pressure Injury Development in Black or African American Critically Ill Patients: A Multisite
Jeanne Hlebichuk1,2,3,4,5, Carolyn Jacobson1,2,3,4,5, Jessie Hooks1,2,3,4,5
1Jeanne Hlebichuk, PhD, RN, NE-BC, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin.
Purpose:
The purpose of this study was to evaluate pressure injury (PI) occurrences, along with risk and protective factors for PI in critically ill Black or African American patients.
Design:
Retrospective case-control (1:4 case to control ratio) multisite study.
Subjects And Settings:
The target population was Black or African American patients receiving care in intensive care units (ICUs) at 4 medical centers in the Midwestern United States. The sample comprised 650 participants; 130 (30%) had pressure injuries (cases) and 520 (80%) were controls. Their mean age was 61 (SD 16.6) years, 53% (n = 345) were male. Data were collected from January 1, 2023, to September 30, 2023.
Methods:
Data were extracted from an electronic health record report and manual abstraction. The outcome was PIs, and exposure was ICU stay. Demographics and pertinent clinical variables were collected using a standardized form designed for purposes of the study. Pressure injury characteristics were compared between cases and controls with differences between groups analyzed with logistic regression to identify risk factors for PI.
Results:
Fourteen different skin preventive interventions were used, with a mean of 5.38 interventions (SD 2.45) per patient. Cases had M = 1.32 (SD 0.72) pressure injuries that occurred 13.7 (SD 16) days from admission. Most PIs were in the inguinal area and partial thickness (Stages 1 and 2) with (n = 31, 18%) medical device related and (n = 26, 15%) resolved at discharge. Logistic regression modeling showed that nutrition consult (β = 1.17, P < .001), number of days on a vasopressor (β = .047, P = .038), and fecal incontinence (β = 1.58, P < .001) were associated with an elevated risk of PIs. Patients with higher Glasgow Coma Scale scores (β = -.125, P = .009) and albumin (β = -.698, P = .023) had a lower likelihood of developing PIs.
Conclusion:
To the best of our knowledge, this is the first study to examine PI solely in Black or African American ICU patients. Predictors of PI development align with previous literature. Pressure injury locations were consistent with predictors in logistic regression modeling. Future work on early identifiers and prevention implementation is warranted.
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