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INTRODUCTION: Pressure ulcers (PU) have been shown to originate near the bone and progress in an outward direction, raising the question of how many patients have undetected pressure injuries (Quintavalle, 2006). Most published studies to date have looked at long-term care patients.
RESEARCH QUESTIONS: What is the prevalence of heel pressure injury detectable by high-frequency ultrasound in a population of at-risk (Braden score : 10-17) geriatric (65 years of age and older) hospitalized medical patients without visible, stageable heel pressure ulcers? Does ultrasound predict who will develop pressure ulcers? What pressure ulcer risk factors are most closely associated with occult heel pressure injury?
METHODS: Hospitalized geriatric medical patients at risk for pressure ulcers with at least one heel free of stageable pressure injury were approached to participate in the study. Information collected from those who consented included demographic data, medical history, and pressure ulcer risk assessment. Physical examination included evaluation of legs and feet, and assessment for heel pressure injury both by NPUAP staging criteria and high-frequency ultrasound. Ultrasound scans were taken of the lateral, posterior, and medial surface of each heel. Reevaluation (every other day for up to four visits) consisted of pressure ulcer risk assessment, staging of visible heel pressure ulcers and high-frequency ultrasound scanning.
RESULTS: 130 patients underwent initial assessment. Of that group, 100 patients underwent a 2nd assessment two days after the first scan, 83 patients underwent 3 consecutive assessments, and 40 patients underwent 4 consecutive assessments. High frequency ultrasound scans revealed heels with minimal fluid accumulation, some with shallow linear fluid accumulation suggestive of shear injury, fluid pockets at the calcaneal bone consistent with classic descriptions of pressure injury, and heels with diffuse fluffy infiltrates. Analysis of variables is underway in an attempt to identify patterns.
RESEARCH QUESTIONS: What is the prevalence of heel pressure injury detectable by high-frequency ultrasound in a population of at-risk (Braden score : 10-17) geriatric (65 years of age and older) hospitalized medical patients without visible, stageable heel pressure ulcers? Does ultrasound predict who will develop pressure ulcers? What pressure ulcer risk factors are most closely associated with occult heel pressure injury?
METHODS: Hospitalized geriatric medical patients at risk for pressure ulcers with at least one heel free of stageable pressure injury were approached to participate in the study. Information collected from those who consented included demographic data, medical history, and pressure ulcer risk assessment. Physical examination included evaluation of legs and feet, and assessment for heel pressure injury both by NPUAP staging criteria and high-frequency ultrasound. Ultrasound scans were taken of the lateral, posterior, and medial surface of each heel. Reevaluation (every other day for up to four visits) consisted of pressure ulcer risk assessment, staging of visible heel pressure ulcers and high-frequency ultrasound scanning.
RESULTS: 130 patients underwent initial assessment. Of that group, 100 patients underwent a 2nd assessment two days after the first scan, 83 patients underwent 3 consecutive assessments, and 40 patients underwent 4 consecutive assessments. High frequency ultrasound scans revealed heels with minimal fluid accumulation, some with shallow linear fluid accumulation suggestive of shear injury, fluid pockets at the calcaneal bone consistent with classic descriptions of pressure injury, and heels with diffuse fluffy infiltrates. Analysis of variables is underway in an attempt to identify patterns.