Incidence of Hospital Acquired Pressure Ulcers and the Association with Nutritional Status

Accurate patient screening for pressure ulcers (PU) is difficult in the clinical setting, with nutritional status evaluation especially problematic. Our purpose in this retrospective study was to determine the extent to which Braden nutrition scores and other nutrition screening parameters (body mass index (BMI), poor intake, weight loss) predict PU development with emphasis on heel and sacral PU.

Records of 230 hospitalized patients that developed PU were compared to a matched control group (n = 230) without PU. Logistic regression was used to predict PU development at admission, 1-week, and 2-weeks of hospitalization.

Of nutrition screening factors, only BMI predicted risk for PU, specifically sacral PU.  Patients with sacral PU had a BMI of 24.0 + 6.1 kg/m² versus 29.6 + 8.9 kg/m² in controls.  A 12% increase in sacral PU risk occurred for every 5 kg/m²decrease in BMI.

Braden score at admission was 16.7 for the group who developed any PU compared to 18.1 for controls (p = 0.0001).  The odds ratio was 0.91 (9% risk increase for every 5-point drop in Braden score).  Likewise the Braden score predicted sacral PU with an 11% increase in risk for every 5-point decrease.  The odds of a heel PU increased by 19% for every 5-point decrease in the Braden score.  However, the nutrition subscale did not predict risk for any type of PU. Removal of the nutrition subscale from the overall Braden score did not diminish the Braden’s ability to predict risk of developing a PU.

These results suggest the Braden score is a valid predictor of PU development, but the nutrition subscale does not enhance the predictive power. It remains to be determined whether nutrition factors are not predictive of PU or whether accurate nutrition data is too difficult to collect in the clinical setting.