Abstract: Risk Factors Associated with Heel Pressure Ulcers in Hospitalized Patients (44th Annual Conference (June 9-13, 2012))

Barbara Delmore, PhD, RN, CWCN, AAPWCA, NYU Langone Medical Center, Clinical Nurse Specialist, New York, NY, Sarah Lebovits, RN, MSN, ANP-BC, CWOCN, DAPWCA, NYU Langone Medical Center, Wound and Ostomy Nurse Practitioner, New York, NY, Barbara Suggs, BSN, RN, NYU Langone Medical Center, Senior Nurse Clinician; Adjunct Instructor, New York, NY, Linda Rolnitzky, MS, New York University School of Medicine, Division of Biostatistics, Research Scientist, New, NY, Philip Baldock, RN, NYU Langone Medical Center, Nursing Quality Specialist, New York, NY and Elizabeth A. Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN, The John A. Hartford Institute for Geriatric Nursing, New York University College of Nursing, Senior Advisor, New York, NY

Purpose: Heel pressure ulcers (HPUs) are steadily rising at an alarming rate. The purpose of this research is to develop and validate a method of predicting whether a patient admitted to a hospital will develop a HPU during their stay.

Methodology: This is a two-phase project using retrospective case control data with cases (patients who developed HPU) and controls (patients who did not) selected at the ratio of 1:2, respectively. Research and literature review revealed 13 factors that appear to have influence on HPU development: Diabetes, Vascular , Neuropathy, Braden Scale score < 18, >70 years, immobility, perfusion issues, obesity, cachexia, surgery >3 hours, ICU stay >3 days, ventilator >3 days, and activity status.

For Phase 1, we have collected data on 150 patients with HPUs and 300 without. Currently, we are performing univariate analyses to identify patient characteristics and hospital conditions significantly associated with HPUs. These variables will be used in multiple logistic regression modeling. We will use ROC curves to select the most adequate model to predict HPUs based on these variables.

In Phase 2, the method will be validated using additional retrospective case-control data (30 with HPU, 70 without).

Statistics: Thus far, chi-square analysis was used to study the association of each variable with HPUs.

Results: Chi-square analysis shows that Vascular disease (OR=4.421, 95% CI, 2.573-7.595, X²=.000), Diabetes (OR=2.557, 95% CI, 1.652-3.958, X²=.000), and immobility (OR=16.491, 95% CI, 8.821-30.828, X²=.000) have a strong influence on HPU development. Neuropathy, >70 years, perfusion issues, obesity, cachexia, and ICU stay were not significantly related to HPU development. Analysis continues for Braden score, activity status, ventilator days, and surgical time.

Conclusion: Targeting certain hospitalized populations who are deemed more at-risk for HPUs, will allow implementation of appropriate prevention measures.

6400 Risk Factors Associated with Heel Pressure Ulcers in Hospitalized Patients