Predictors of Pressure Ulcer Development in Adult Critical Care Patients

Predictors of Pressure Ulcer Development in Adult Critical Care patients

Background: Pressure ulcer development in critical care patients has been described as one of the most under-rated conditions that plague this population. A multiplicity of risk factors have been identified, however there is lack of consensus regarding the risk factors that pose the greatest threat. Lack of a critical care pressure ulcer risk assessment tool has also been cited as an impediment to accurate risk determination in this population.

Purpose: To determine which risk factors best predict pressure ulcer development in adult critical care patients. Risk factors under investigation included total Braden scale score, Braden subscales (mobility, activity, sensory perception, moisture, nutrition, friction/shear), age, blood pressure, length of ICU admission, APACHE II, vasopressor administration and comorbid conditions.

Methods: A retrospective, correlational design was used to examine 347 patients admitted to a medical/surgical ICU from October 2008- May 2009.

Statistics: Descriptive statistics described the study sample. Pearson Product Moment Correlation was used for correlational analyses and direct logistic regression was used to create a model that best predicted pressure ulcer development. T-test and chi-square were used to compare study variables between patients with and without pressure ulcers.

Results: The risk factors age, ICU length of stay, mobility and cardiovascular disease explained a significant portion of the variance in pressure ulcer development. A second logistic regression analysis excluding 20 patients who developed Stage I ulcers, found ICU length of stay, cardiovascular disease, friction/shear and norepinephrine infusion explained a significant portion of the variance in pressure ulcer development.

Conclusions: Current pressure ulcer risk assessment scales may not capture risk factors that confront critically ill adults. Development of an ICU pressure ulcer risk assessment model is warranted and would serve as the foundation for development of a critical care pressure ulcer risk assessment tool.