Identifying Risk Factors for Pressure Injury in Adult Critical Care Patients

2020 ◽  
Vol 29 (3) ◽  
pp. 204-213 ◽  
Author(s):  
Jill Cox ◽  
Marilyn Schallom ◽  
Christy Jung
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Intensive Care ◽  
Decision Tree ◽  
Scale Score ◽  
Critically Ill Patients ◽  
Braden Scale ◽  
Pressure Injury ◽  
Critical Care Patients

Background Critically ill patients have a variety of unique risk factors for pressure injury. Identification of these risk factors is essential to prevent pressure injury in this population. Objective To identify factors predicting the development of pressure injury in critical care patients using a large data set from the PhysioNet MIMIC-III (Medical Information Mart for Intensive Care) clinical database. Methods Data for 1460 patients were extracted from the database. Variables that were significant in bivariate analyses were used in a final logistic regression model. A final set of significant variables from the logistic regression was used to develop a decision tree model. Results In regression analysis, cardiovascular disease, peripheral vascular disease, pneumonia or influenza, cardiovascular surgery, hemodialysis, norepinephrine administration, hypotension, septic shock, moderate to severe malnutrition, sex, age, and Braden Scale score on admission to the intensive care unit were all predictive of pressure injury. Decision tree analysis revealed that patients who received norepinephrine, were older than 65 years, had a length of stay of 10 days or less, and had a Braden Scale score of 15 or less had a 63.6% risk of pressure injury. Conclusion Determining pressure injury risk in critically ill patients is complex and challenging. One common pathophysiological factor is impaired tissue oxygenation and perfusion, which may be nonmodifiable. Improved risk quantification is needed and may be realized in the near future by leveraging the clinical information available in the electronic medical record through the power of predictive analytics.

Risk Factors for Hospital-Acquired Pressure Injury in Adult Critical Care Patients

2022 ◽  
Vol 31 (1) ◽  
pp. 42-50
Author(s):  
Phillip Kim ◽  
Vamsi K. Aribindi ◽  
Amy M. Shui ◽  
Sharvari S. Deshpande ◽  
Sachin Rangarajan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Scale Score ◽  
Arterial Oxygen ◽  
Effective Prevention ◽  
Braden Scale ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

Background Accurately measuring the risk of pressure injury remains the most important step for effective prevention and intervention. Relative contributions of risk factors for the incidence of pressure injury in adult critical care patients are not well understood. Objective To develop and validate a model to identify risk factors associated with hospital-acquired pressure injuries among adult critical care patients. Methods This retrospective cohort study included 23 806 adult patients (28 480 encounters) with an intensive care unit stay at an academic quaternary care center. Patient encounters were randomly split (7:3) into training and validation sets. The training set was used to develop a multivariable logistic regression model using the least absolute shrinkage and selection operator method. The model’s performance was evaluated with the validation set. Results Independent risk factors identified by logistic regression were length of hospital stay, preexisting diabetes, preexisting renal failure, maximum arterial carbon dioxide pressure, minimum arterial oxygen pressure, hypotension, gastrointestinal bleeding, cellulitis, and minimum Braden Scale score of 14 or less. On validation, the model differentiated between patients with and without pressure injury, with area under the receiver operating characteristic curve of 0.85, and performed better than a model with Braden Scale score alone (P < .001). Conclusions A model that identified risk factors for hospital-acquired pressure injury among adult critical care patients was developed and validated using a large data set of clinical variables. This model may aid in selecting high-risk patients for focused interventions to prevent formation of hospital-acquired pressure injuries.

scholarly journals Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients

2017 ◽  
Vol 37 (4) ◽  
pp. e1-e11 ◽  
Author(s):  
Xiaohong Deng ◽  
Ting Yu ◽  
Ailing Hu
Keyword(s):  
Logistic Regression ◽  
Critical Care ◽  
Intensive Care ◽  
Decision Tree ◽  
Pressure Ulcers ◽  
Prediction Models ◽  
Risk Prediction Models ◽  
Braden Scale ◽  
Hospital Acquired ◽  
Critical Care Patients

BACKGROUND Assessments of risk for pressure ulcers in critical care patients may not include important predictors. OBJECTIVE To construct risk-prediction models of hospital-acquired pressure ulcers in intensive care patients and compare the models’ predictive validities with validity of the Braden Scale. METHODS Data were collected retrospectively on patients admitted to intensive care from October 2011 through October 2013. Logistic regression and decision trees were used to construct the risk-prediction models. Predictive validity was measured by using sensitivity, specificity, positive and negative predictive values, and area under the curve. RESULTS With logistic regression analysis, 6 factors were significant independent predictors. With the decision tree, 4 types of high-risk populations were identified. Predictive validity of Braden Scale scores was lower than the validities of the logistic regression and the decision tree models. CONCLUSION Risk for hospital-acquired pressure ulcers is overpredicted with the Braden Scale, with low specificity and low positive predictive value

scholarly journals Risk Factors for Hospital-Acquired Pressure Injury in Surgical Critical Care Patients

2020 ◽  
Vol 29 (6) ◽  
pp. e128-e134
Author(s):  
Jenny Alderden ◽  
Linda J. Cowan ◽  
Jonathan B. Dimas ◽  
Danli Chen ◽  
Yue Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Odds Ratio ◽  
Academic Medical Center ◽  
Skin Irritation ◽  
Surgical Critical Care ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

Background Hospital-acquired pressure injuries disproportionately affect critical care patients. Although risk factors such as moisture, illness severity, and inadequate perfusion have been recognized, nursing skin assessment data remain unexamined in relation to the risk for hospital-acquired pressure injuries. Objective To identify factors associated with hospital-acquired pressure injuries among surgical critical care patients. The specific aim was to analyze data obtained from routine nursing skin assessments alongside other potential risk factors identified in the literature. Methods This retrospective cohort study included 5101 surgical critical care patients at a level I trauma center and academic medical center. Multivariate logistic regression using the least absolute shrinkage and selection operator method identified important predictors with parsimonious representation. Use of specialty pressure redistribution beds was included in the model as a known predictive factor because specialty beds are a common preventive intervention. Results Independent risk factors identified by logistic regression were skin irritation (rash or diffuse, nonlocalized redness) (odds ratio, 1.788; 95% CI, 1.404-2.274; P < .001), minimum Braden Scale score (odds ratio, 0.858; 95% CI, 0.818-0.899; P < .001), and duration of intensive care unit stay before the hospital-acquired pressure injury developed (odds ratio, 1.003; 95% CI, 1.003-1.004; P < .001). Conclusions The strongest predictor was irritated skin, a potentially modifiable risk factor. Irritated skin should be treated and closely monitored, and the cause should be eliminated to allow the skin to heal.

Predictors of Pressure Ulcers in Adult Critical Care Patients

2011 ◽  
Vol 20 (5) ◽  
pp. 364-375 ◽  
Author(s):  
Jill Cox
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pressure Ulcers ◽  
Critical Care Patients

BackgroundPressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate. Currently, consensus is lacking on the most important risk factors for pressure ulcers in critically ill patients, and no risk assessment scale exclusively for pressure ulcers in these patients is available.ObjectiveTo determine which risk factors are most predictive of pressure ulcers in adult critical care patients. Risk factors investigated included total score on the Braden Scale, mobility, activity, sensory perception, moisture, friction/shear, nutrition, age, blood pressure, length of stay in the intensive care unit, score on the Acute Physiology and Chronic Health Evaluation II, vasopressor administration, and comorbid conditions.MethodsA retrospective, correlational design was used to examine 347 patients admitted to a medical-surgical intensive care unit from October 2008 through May 2009.ResultsAccording to direct logistic regression analyses, age, length of stay, mobility, friction/shear, norepinephrine infusion, and cardiovascular disease explained a major part of the variance in pressure ulcers.ConclusionCurrent risk assessment scales for development of pressure ulcers may not include risk factors common in critically ill adults. Development of a risk assessment model for pressure ulcers in these patients is warranted and could be the foundation for development of a risk assessment tool.

scholarly journals Surge Effects and Survival to Hospital Discharge in Critical Care Patients with COVID-19 During the Early Pandemic: A Cohort Study

2020 ◽  
Author(s):  
Christopher Dale ◽  
Rachael Starcher ◽  
Shu Ching Chang ◽  
Ari Robicsek ◽  
Guilford Parsons ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Critical Care ◽  
Cohort Study ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Hospital Discharge ◽  
Hospital Capacity ◽  
Multivariable Logistic Regression ◽  
Critical Care Patients ◽  
Over Time

Abstract BackgroundThe early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first three months of the pandemic and the presence of any surge effects on patient outcomes.MethodsRetrospective cohort study with electronic medical record data of all patients with laboratory-confirmed COVID-19 admitted to intensive care units from February 25, 2020 to May 15, 2020 admitted to intensive care units of 26 hospitals of an integrated delivery system in the Western United States. Patient demographic, comorbidity and severity of illness were measured along with exposure to pharmacologic and medical therapies and hospital outcomes over time. Multivariable logistic regression models were constructed to assess the change in survival to hospital discharge over time during the study period.ResultsOf 620 patients with COVID-19 admitted to the study ICUs (mean age 63.5 years (SD 15.7) and 69% male), 403 (65%) survived to hospital discharge and 217 (35%) died in hospital. Survival to hospital discharge increased over the study period from 60.0% in the first two weeks of patient admission to 67.6% in the last two weeks. In a multivariable logistic regression analysis, the risk-adjusted odds of survival to hospital discharge increased over time (bi-weekly change, adjusted odds ratio [aOR] 1.22, 95%CI 1.04-1.40, P = 0.02). Additionally, an a priori-defined explanatory model showed that after adjusting for both hospital occupancy and COVID positive/PUI percent hospital capacity, and the same set of covariates, the temporal trend in risk-adjusted patient survival to hospital discharge remained the same (bi-weekly change, aOR 1.18, 95% CI 1.00 to 1.38, P = 0.04) and a greater COVID positive/PUI percentage of hospital capacity remained significantly and inversely associated with survival to hospital discharge (aOR 0.95, 95% CI 0.92 to 0.98, P < 0.01).ConclusionsDuring the the early COVID-19 pandemic, risk-adjusted survival to hospital discharge increased over time for critical care patients. This may have been partially explained by surge affects, as measured by a greater COVID positive/PUI percentage of hospital capacity.

scholarly journals Surge Effects and Survival to Hospital Discharge in Critical Care Patients with COVID-19 During the Early Pandemic: A Cohort Study

2021 ◽  
Author(s):  
Christopher Dale ◽  
Rachael Starcher ◽  
Shu Ching Chang ◽  
Ari Robicsek ◽  
Guilford Parsons ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Critical Care ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Multivariable Logistic Regression Analysis ◽  
Hospital Capacity ◽  
Multivariable Logistic Regression ◽  
Critical Care Patients ◽  
Over Time

Abstract BackgroundThe early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first three months of the pandemic and the presence of any surge effects on patient outcomes.MethodsRetrospective cohort study using electronic medical record data for all patients with laboratory-confirmed COVID-19 admitted to intensive care units from February 25, 2020 to May 15, 2020 at one of 26 hospitals within an integrated delivery system in the Western United States. Patient demographics, comorbidities and severity of illness were measured along with medical therapies and hospital outcomes over time. Multivariable logistic regression models were constructed to assess temporal changes in survival to hospital discharge during the study period.ResultsOf 620 patients with COVID-19 admitted to the ICU (mean age 63.5 years (SD 15.7) and 69% male), 403 (65%) survived to hospital discharge and 217 (35%) died in the hospital. Survival to hospital discharge increased over time, from 60.0% in the first two weeks of the study period to 67.6% in the last two weeks. In a multivariable logistic regression analysis, the risk-adjusted odds of survival to hospital discharge increased over time (bi-weekly change, adjusted odds ratio [aOR] 1.22, 95%CI 1.04-1.40, P = 0.02). Additionally, an a priori-defined explanatory model showed that after adjusting for both hospital occupancy and percent hospital capacity by COVID-19 positive individuals and persons under investigation (PUI), the temporal trend in risk-adjusted patient survival to hospital discharge remained the same (bi-weekly change, aOR 1.18, 95% CI 1.00 to 1.38, P = 0.04). The presence of greater rates of COVID-19 positive/PUI as a percentage of hospital capacity was, however, significantly and inversely associated with survival to hospital discharge (aOR 0.95, 95% CI 0.92 to 0.98, P < 0.01). ConclusionsDuring the early COVID-19 pandemic, risk-adjusted survival to hospital discharge increased over time for critical care patients. An association was also seen between a greater COVID-19 positive/PUI percentage of hospital capacity and a lower survival rate to hospital discharge.

scholarly journals ESCALAS DE PREDIÇÃO DE RISCO PARA LESÃO POR PRESSÃO EM PACIENTES CRITICAMENTE ENFERMOS: REVISÃO INTEGRATIVA

2018 ◽  
Vol 9 (2) ◽  
Author(s):  
Ludmila Silva Castanheira ◽  
Andreza Werli-Alvarenga ◽  
Allana Dos Reis Correa ◽  
Daniela Mascarenhas de Paula Campos
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Risk Prediction ◽  
Pressure Ulcer ◽  
Critically Ill Patients ◽  
Skin Integrity ◽  
Pressure Injury ◽  
Terapia Intensiva

Resumo: Feridas afetam a integridade da pele, e quando não prevenidas ou tratadas podem levar a complicações decorrentes da integridade da pele prejudicada, especialmente em Unidades de Terapia Intensiva (UTIs). Atualmente, as escalas de predição de risco disponíveis para esta avaliação e validadas para o português são as de Braden, Waterlow e Norton. Objetivo: determinar qual a escala mais acurada para a avaliação de pacientes criticamente enfermos. Metodologia: Trata-se de uma revisão integrativa, cuja questão norteadora foi: qual escala para predição de risco para LP, disponível e validada para o português é mais acurada para estimar o risco de LP em pacientes criticamente enfermos internados na UTI? A busca dos estudos foi realizada na BVS, PubMed/MedLine e CINAHL. Resultados: Foram encontrados 134 artigos, elegíveis 123 e incluídos 18 na revisão. Conclusão: Os resultados apontam a necessidade da realização de estudos nesta área.Descritores: Úlcera por Pressão; Unidades de Terapia Intensiva; Cuidados Críticos; EscalasPREDICTION RISK SCALES FOR PRESSURE INJURY IN CRITICALLY ILL PATIENTS INTEGRATIVE REVIEWSummary: Wounds affect skin integrity, and when not prevented or treated can lead to complications resulting from impaired skin integrity, especially in intensive care units (ICUs). Currently, the prediction of risk scales available for this evaluation and validated for the Portuguese are Braden, Waterlow and Norton. Objective: to determine what the more accurate scale for the assessment of critically ill. Methodology: it is an integrative review, whose guiding question was: which to scale for risk prediction for LP, available and validated to Portuguese is more accurate for estimating the risk of LP in critically ill hospitalized in ICU? The search of the studies was held at the BVS, PubMed/MedLine and CINAHL. Results: found 134 items, 123 and included 18 eligible in the review. Conclusion: the results show the need of carrying out studies in this area.Descriptors: Pressure ulcer; Intensive Care Units; Critical Care; ScalesESCALAS DE PREDICCIÓN DE RIESGO PARA LESIÓN POR PRESIÓN EN PACIENTES CRÍTICAMENTE ENFERMOS: REVISIÓN INTEGRATIVAResumen: Las heridas afectan la integridad de la piel y cuando no prevenido o Tratado pueden conducir a las complicaciones resultantes de la integridad de la piel deteriorada, especialmente en unidades de cuidados intensivos (UCI). Actualmente, la predicción de las escalas de riesgo disponibles para esta evaluación y validadas para los portugueses son Braden, Waterlow y Norton. Objetivo: determinar la escala que más precisa para la evaluación de estado crítico. Metodología: ¿ es un examen integrador, cuyo rector era: que a la escala de predicción de riesgo de LP, disponible y validado al portugués es más exacta para estimar el riesgo de LP en críticamente enfermos hospitalizados en UCI? La búsqueda de los estudios se realizó en la BVS, PubMed/MedLine y CINAHL. Resultados: elegibles 18 134 artículos encontrados, 123 e incluido en la revisión. Conclusión: los resultados muestran la necesidad de llevar a cabo estudios en esta área.Descriptores: Úlcera por Presión, Unidades de Cuidados Intensivos, Cuidados Críticos, Escalas.

Pressure Injury Risk Factors in Critical Care Patients

2018 ◽  
Vol 31 (7) ◽  
pp. 328-334 ◽  
Author(s):  
Jill Cox ◽  
Sharon Roche ◽  
Virginia Murphy
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Injury Risk ◽  
Pressure Injury ◽  
Injury Risk Factors ◽  
Critical Care Patients

scholarly journals Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study (Preprint)

2021 ◽  
Author(s):  
Jenny Alderden ◽  
Linda Amoafo ◽  
Yue Zhang ◽  
Caroline Fife ◽  
David Yap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Critical Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort ◽  
Deep Tissue ◽  
Risk Profiles ◽  
Pressure Injury ◽  
Critical Care Patients

BACKGROUND Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the “outside in” as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the “inside out” due to inadequate perfusion to the deeper tissues causing tissue ischemia. OBJECTIVE The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. METHODS This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the <i>χ<sup>2</sup></i> test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. RESULTS A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device–related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, <i>χ</i><sup>2</sup><sub>1</sub>=8.43, <i>P</i>=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, <i>P</i>=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure &lt;50 mmHg (OR 0.179, 95% CI 0.072-0.416, <i>P</i>&lt;.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, <i>P</i>=.008). CONCLUSIONS Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.

scholarly journals The epidemiology of acute kidney injury in critically ill patients in the Gansu Province: The EACG study

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110180
Author(s):  
Yu Chen ◽  
Fang Feng ◽  
Xue-ni Chang ◽  
Dong Liu ◽  
Yuan Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
White Blood Cells ◽  
Kidney Injury ◽  
Gansu Province ◽  
Incidence And Mortality

To investigate the epidemiology of acute kidney injury and to clarify the risk factors associated with the prognosis of acute kidney injury in critically ill patients in the Gansu Province. This was a multicenter, retrospective study. The clinical data of all patients from January 1, 2017, to December 31, 2019, in the intensive care unit of the selected hospitals were screened. Descriptive statistical analysis was performed first, and then the patients were divided into a survival group and a nonsurvival group based on survival status at discharge. Univariate and multivariate logistic regression analyses were used to determine the risk factors for in-hospital mortality in patients with acute kidney injury. (1) Among the 8106 patients admitted, a total of 3019 patients were excluded according to the exclusion criteria. Among the included patients, 890 patients met the diagnostic criteria for AKI, with an incidence of 17.5% and mortality of 41.3%. (2) Logistic regression analysis showed that sex, age, AKI stage, infection, cardio-pulmonary resuscitation, cardiac output, mechanical ventilation, diuretics, white blood cells, platelets, blood urea nitrogen, prothrombin time, and activated partial thromboplastin time were significantly associated with the prognosis of acute kidney injury ( p < 0.05). Large-scale epidemiological data from several representative general hospitals in the Gansu Province showed that the incidence and mortality of acute kidney injury in intensive care units were still very high. Trial registration: the Chinese Clinical Trial Registry number is ChiCTR1800016945. Date of registration: 4 July 2018.

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