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Background: Critically ill patients are at increased risk for developing pressure ulcers (PU). While the Braden Score helps predict risk of PU, focused identification of risk is needed. In 2007, over 12,000 adult ICU patients had at-risk scores (≤18) sometime during their stay, while over 400 developed PU during hospitalization.
We believe that equivalent Braden scores may not indicate identical risk. The Braden Score has 6 sub-scores: sensory perception, skin moisture, mobility, nutrition, activity, and friction. Total score ranges from 6-23 with lower scores representing higher risk. We hope to focus our preventative assessments and interventions using sub-scores.
Methods: Braden scores and skin assessments of adults admitted into intensive or progressive care units (ICU/PCU) in 2007 were analyzed from our electronic medical record. Only patients with at least one hospital-based Braden Score of ≤18 (N=12,961) were included. 428 patients with pre-existing PU were excluded.
Time to development of a PU was analyzed with survival analysis including Kaplan-Meier survival curves and proportional hazards regression models. Braden subscales were assessed for likelihood of developing PUs using a log rank test. Initial Braden assessment during hospitalization was the focus of analysis.
Results: Not all Braden subscales were equally predictive of PU development. Patients with high friction, high moisture, or low mobility at admission were over 16 times, 8 times, and 4 times, respectively, more likely to develop pressure ulcers than patients with subscale scores closer to normal. Patients with decreased sensory perception were also at slightly increased risk.
We believe that equivalent Braden scores may not indicate identical risk. The Braden Score has 6 sub-scores: sensory perception, skin moisture, mobility, nutrition, activity, and friction. Total score ranges from 6-23 with lower scores representing higher risk. We hope to focus our preventative assessments and interventions using sub-scores.
Methods: Braden scores and skin assessments of adults admitted into intensive or progressive care units (ICU/PCU) in 2007 were analyzed from our electronic medical record. Only patients with at least one hospital-based Braden Score of ≤18 (N=12,961) were included. 428 patients with pre-existing PU were excluded.
Time to development of a PU was analyzed with survival analysis including Kaplan-Meier survival curves and proportional hazards regression models. Braden subscales were assessed for likelihood of developing PUs using a log rank test. Initial Braden assessment during hospitalization was the focus of analysis.
Results: Not all Braden subscales were equally predictive of PU development. Patients with high friction, high moisture, or low mobility at admission were over 16 times, 8 times, and 4 times, respectively, more likely to develop pressure ulcers than patients with subscale scores closer to normal. Patients with decreased sensory perception were also at slightly increased risk.
Conclusions:
Aligning preventative interventions and product selection with the appropriate Braden subscale scores, rather than just the total score, may improve resource utilization, nursing efficiency, and patient outcomes. Further study is warranted. Prevention of nosocomial PUs in the critically ill is crucial to improve quality and reduce resource use.