Comparing the Braden and Jackson/Cubbin Pressure Injury Risk Scales in Trauma-Surgery ICU Patients

2020 ◽  
Vol 40 (6) ◽  
pp. 52-61
Author(s):  
Jacob Higgins ◽  
Sherri Casey ◽  
Erin Taylor ◽  
Riley Wilson ◽  
Paula Halcomb
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Predictive Value ◽  
Injury Risk ◽  
Area Under The Curve ◽  
Surgical Patients ◽  
Braden Scale ◽  
Surgical Critical Care ◽  
Pressure Injury ◽  
Critical Care Patients

Background The occurrence of pressure injury in the critical care environment has multiple risk factors. Prevention requires reliable assessment tools to help predict injury risk. The Braden scale, a commonly used risk assessment tool, has been shown to have poor predictive properties in critical care patients. The Jackson/Cubbin scale was developed specifically for pressure injury risk stratification in critically ill patients and has demonstrated acceptable predictive properties in the general critical care population but has not been examined in critically ill trauma-surgical patients. Objective To compare the predictive properties of the Braden and Jackson/Cubbin scales in a trauma-surgical critical care population. Methods A retrospective medical records review was performed to evaluate the clinical characteristics of 366 trauma-surgical critical care patients. Additionally, the negative predictive value, positive predictive value, sensitivity, specificity, and receiver operating characteristic curve with area under the curve of the Braden and Jackson/Cubbin scales were determined. Results The sample consisted of primarily middle-aged (mean [SD], 56 [19] years) men (64%) admitted after trauma (71%). The participants who developed pressure injuries were older, more often required vasopressors and mechanical ventilation, and were less mobile. Predictive properties for the Braden and Jackson/Cubbin scales, respectively, were as follows: negative predictive value, 78% versus 87%; positive predictive value, 53% versus 66%; sensitivity, 17% versus 54%; specificity, 95% versus 92%; and area under the curve, 0.710 versus 0.793. Conclusion The Jackson/Cubbin scale demonstrated superior predictive properties and discrimination compared with the Braden scale for pressure injury risk prediction in critically ill trauma-surgical patients.

scholarly journals Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted With Community-Acquired Pressure Injury

2020 ◽  
Vol 47 (5) ◽  
pp. 470-476
Author(s):  
Jenny Alderden ◽  
Mollie Cummins ◽  
Sunniva Zaratkiewicz ◽  
Yunchuan ‘Lucy’ Zhao ◽  
Kathryn Drake ◽  
...  
Keyword(s):  
Critical Care ◽  
Surgical Critical Care ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

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.

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

Glucocorticoid Rescue for Late-Phase Acute Respiratory Distress Syndrome in Trauma/Surgical Critical Care Patients

2006 ◽  
Vol 72 (7) ◽  
pp. 644-648
Author(s):  
Curt S. Koontz ◽  
K. Kye Higdon ◽  
Troy L. Ploger ◽  
Benjamin W. Dart ◽  
Charles M. Richart ◽  
...  
Keyword(s):  
Critical Care ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Distress Syndrome ◽  
High Dose ◽  
Surgical Critical Care ◽  
Before And After ◽  
Critical Care Patients

High-dose glucocorticoid therapy (GCT) for the late fibroproliferative phase of acute respiratory distress syndrome (ARDS) is controversial and has shown mixed results in medical patients. No studies have evaluated GCT in trauma/surgical critical care patients. The purpose of this study is to review the outcomes of trauma/surgical critical care patients with refractory ARDS treated with GCT. From January 2001 through September 2005, a pharmacy log was used to identify critically ill trauma/surgical patients in refractory ARDS (7 males and 2 females) who received GCT in an attempt to salvage them. GCT consisted of 200 mg intravenous methylprednisolone bolus for one dose and then 3 mg/kg per day divided every 6 hours for 6 weeks or until weaned off the ventilator. All patients as well as the survivors were analyzed. Outcome data was analyzed with SPSS (Chicago, IL) and the paired sample test. A P value ≤0.05 was considered significant. Data is presented as mean ± standard deviation. The Institutional Review Board approved this retrospective chart review. Seven patients (6 males and 1 female; age, 31 ± 16 years) survived (78%), weaned off of the ventilator, and were discharged from the hospital. The 2 deaths were secondary to refractory respiratory failure as well as cardiac arrest (n = 1) and anoxic brain injury from septic hypotension (n = 1). In survivors (n = 7), hospital length of stay (LOS) and intensive care unit LOS was 71 ± 30 days and 53 ± 16 days, respectively. Duration of GCT administration was 17 ± 6.4 days (range, 11–30 days). Ventilator time before GCT, during GCT, and after GCT was 22 ± 8.4, 15 ± 7.5, and 1.6 ± 6.0 days, respectively. During GCT, 8 patients developed pneumonia, 5 had urinary tract infection, and 3 had bacteremia. All infections were effectively treated with broad-spectrum antibiotics, except in one patient who died of sepsis. PaO2/FIO2 ratio just before and after GCT was 100 ± 36 and 247 ± 56, respectively (n = 7; P < 0.001). Sequential organ failure assessment score just before and after GCT was 9.1 ± 2.3 and 5.0 ± 1.6, respectively (n = 7; P < 0.001). GCT rescue may have a role in salvaging critically ill trauma/surgical critical care patients in late-stage ARDS. More patients, however, need to be studied.

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 &lt; .001), minimum Braden Scale score (odds ratio, 0.858; 95% CI, 0.818-0.899; P &lt; .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 &lt; .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.

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 &lt; .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.

Efficacy of Epidural Analgesia for Pain Management of Critically Ill Patients and the Implications for Nursing Care

1991 ◽  
Vol 2 (4) ◽  
pp. 729-740 ◽  
Author(s):  
Jeanne F. Slack ◽  
Margaret Faut-Callahan
Keyword(s):  
Critical Care ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Critically Ill ◽  
Nursing Care ◽  
Critically Ill Patients ◽  
Continuous Epidural Analgesia ◽  
Analgesic Agents ◽  
Care Problems ◽  
Critical Care Patients

Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient’s recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care

Subsequent Pressure Injury Development in Mechanically Ventilated Critical Care Patients with Hospital-Acquired Pressure Injury

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jenny Alderden ◽  
Allen Cadavero ◽  
Yunchuan “Lucy” Zhao ◽  
Desiree Dougherty ◽  
Se-Hee Jung ◽  
...  
Keyword(s):  
Critical Care ◽  
Mechanically Ventilated ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

Tracheostomy

2019 ◽  
pp. 850-854
Author(s):  
Saba Ghorab ◽  
David G. Lott
Keyword(s):  
United States ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Critical Care Patients

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.

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