Frequency of Pressure Ulcers and Related Risk Factors in Patients Transferred From the Intensive Care Unit to the Internal Diseases Clinic

Abstract

Purpose: Determination of pressure ulcer frequency and pressure ulcer-related clinical features in patients transferred from intensive care units (ICU) to internal medicine clinics. Material and Methods: A prospective, observational study included 100 consecutive patients aged 18 years and older. Nutritional risk score (NRS-2002) and BRADEN scale at admission to the intensive care unit were calculated. During the transfer to the internal medicine clinic, the frequency, localization and stage of pressure ulcers were determined. Patients with and without pressure ulcers were compared according to clinical and laboratory characteristics. Results: Of the 100 patients included in the study, 52 (52%) were women. The mean age was 69.8±16.5 years. The frequency of pressure ulcer was 50%, the most common location and stage was sacrum (88%), and stage 2 (58%). The mean age (74±13, 66±18 respectively, p=0.022) and length of stay in ICU (p<0.001) were higher in patients with pressure ulcer. Those with cerebrovascular disease and dementia (p=0.016 and p<0.001 respectively), using invasive mechanical ventilation, positive inotropic agents and antibiotics (p<0.001, p=0.005, and p=0.008, respectively), with pressure ulcer before ICU (p<0.001), high risk of malnutrition and pressure ulcer (p<0.001) were more common in patients with pressure ulcer. It was seen that 1 day increase in ICU length of stay increased the risk of pressure ulcer 1.42 times. Conclusion: This study revealed that half of the patients transferred from the ICU to the internal medicine clinics had pressure ulcer, and the risk of developing pressure ulcers increases as the length of stay in the ICU is prolonged.

Keywords

• NRS-2002 Score
• Braden Scale
• Immobilization

Yoğun Bakım Ünitesinden İç Hastalıkları Kliniğine Devir Olan Hastalardaki Basınç Ülseri Sıklığı ve İlişkili Risk Faktörleri

Abstract

Amaç: Bu çalışmanın amacı yoğun bakım ünitelerinden (YBÜ) iç hastalıkları kliniklerine devir olan hastalardaki basınç ülseri sıklığının belirlenmesi ve basınç ülseri ile ilişkili klinik özelliklerin araştırılmasıdır. Araçlar ve Yöntem: Prospektif, gözlemsel çalışmaya iç hastalıkları kliniklerine YBÜ’den devir olan 18 yaş ve üzeri 100 hasta ardışık olarak alındı. Olguların YBÜ’ye yatış esnasındaki nutrisyonel risk skoru (NRS-2002) ve BRADEN ölçeği ile iç hastalıkları kliniklerine devir esnasındaki basınç ülseri sıklığı, lokalizasyonu ve evresi belirlendi. Basınç ülseri olan ve olmayan hastalar klinik ve laboratuvar özelliklerine göre karşılaştırıldı. Bulgular: Çalışmaya alınan 100 hastanın 52’si (%52) kadındı. Ortalama yaş 69.8±16.5 yıl bulundu. İç hastalıkları kliniğine devir esnasında basınç ülseri sıklığı %50, en sık basınç ülseri lokalizasyonu sakrum (%88), en sık basınç ülseri evresi evre 2 (%58) idi. Basınç ülseri olanlarda olmayanlara göre; yaş ortalaması (sırasıyla 74±13, 66±18; p=0.022), YBÜ yatış süresi (p<0.001), serebrovasküler hastalık ve demansı olan (sırasıyla p=0.016 ve p<0.001), invasif mekanik ventilasyon, pozitif inotrop ajan ve antibiyotik kullanılan (sırasıyla p<0.001, p=0.005 ve p=0.008), YBÜ yatışı öncesi basınç ülseri olan (p<0.001), malnütrisyon risk skoru ve BRADEN ölçeği ile belirlenen basınç ülseri riski artmış bulunan (p<0.001) hasta sıklığı yüksekti. Lojistik regresyon analizinde YBÜ yatış süresindeki 1 günlük artışın basınç ülseri riskini 1.42 kat artırdığı görüldü. Sonuç: Bu çalışma YBÜ’den iç hastalıkları kliniklerine devir olan her iki hastadan birinde basınç ülserinin mevcut olduğunu ve YBÜ yatış süresi uzadıkça basınç ülseri gelişme riskinin arttığını ortaya koymuştur.

Keywords

• NRS-2002 skoru
• Braden Ölçeği
• Hareketsizlik

References

1. 1. Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System. J Wound Ostomy Continence Nurs. 2016; 43(6):585-597.
2. 2. Vangilder C, Macfarlane GD, Meyer S. Results of nine international pressure ulcer prevalence surveys: 1989 to 2005. Ostomy Wound Manage. 2008;54 (2):40-54.
3. 3. Amlung SR, Miller WL, Bosley LM. The 1999 National Pressure Ulcer Prevalence Survey: a benchmarking approach. Adv Skin Wound Care. 2001;14(6):297-301.
4. 4. Padula WV, Delarmente BA. The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019;16(3):634-640.
5. 5. Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for predicting pressure sore risk. Nurs Res. 1987;36(4):205-210.
6. 6. Laporte L, Hermetet C, Jouan Y, et al. Ten-year trends in intensive care admissions for respiratory infections in the elderly. Ann Intensive Care. 2018;8(1):84.
7. 7. Dealey C. A joint collaboration: international pressure ulcer guidelines. J Wound Care. 2009;18(9):368-372.
8. 8. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-336.

9. 9. Labeau SO AE, Benbenishty J, Blackwood B, et al. DecubICUs Study Team; European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Med. 2021;47(2):160-169.
10. 10. Sayar S, Turgut S, Doğan H, et al. Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow scale and factors influencing the development of pressure ulcers. J Clin Nurs. 2009;18(5):765-774.
11. 11. Tosun ZK. Yoğun Bakım Ünitelerindeki Yaşlı Hastalarda Bası Yarası Prevalansı ve Etkileyen Faktörler. YBHD. 2015;19 (2):43-53.
12. 12. Terekeci H KY, Top C, Onem Y, Celik S, Oktenli C. Risk assessment study of the pressure ulcers in intensive care unit patients. Eur J Intern Med. 2009;20(4):394-397.
13. 13. Kwak HR, Kang J. Pressure ulcer prevalence and risk factors at the time of intensive care unit admission. Korean J Adult Nurs. 2015;27:347-357.
14. 14. McGee WT, Nathanson BH, Lederman E, Higgins TL. Decubitus ulcers are associated with prolonged length of stay in critically ill patients. Crit Care. 2013;17: 1-200.
15. 15. Chou R, Dana T, Bougatsos C, et al. Pressure ulcer risk assessment and prevention: a systematic comparative effectiveness review. Ann Intern Med. 2013;159(1):28-38.
16. 16. Serrano ML, Mendez MG, Cebollero FC, Rodriguez JL. Risk factors for pressure ulcer development in Intensive Care Units: A systematic review.Medicina Intensiva. 2017;41(6):339-346.
17. 17. Alhaug J, Gay CL, Henriksen C, Lerdal A. Pressure ulcer is associated with malnutrition as assessed by Nutritional Risk Screening (NRS 2002) in a mixed hospital population. Food Nutr Res. 2017;61(1):1324230.
18. 18. Takeda T, Koyama T, Izawa Y, Makita T, Nakamura N. Effects of malnutrition on development of experimental pressure sores. J Dermatol. 1992;19(10):602-609.
19. 19. Bergstrom N, Braden B, Kemp M, Champagne M, Ruby E. Predicting pressure ulcer risk: a multisite study of the predictive validity of the Braden Scale. Nurs Res. 1998;47(5):261-269.
20. 20. Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence in intensive care patients: a cross-sectional study. J Eval Clin Pract. 2008;14(4):563-568.
21. 21. González-Méndez MI, Lima-Serrano M, Martín-Castaño C, Alonso-Araujo I, Lima-Rodríguez JS. Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit. J Clin Nurs. 2018;27(5-6):1028-1037.
22. 22. Graves N, Birrell F, Whitby M. Effect of pressure ulcers on length of hospital stay. Infect Control Hosp Epidemiol. 2005;26(3):293-297.
23. 23. Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015;162(5):370-379.
24. 24. Livesley NJ, Chow AW. Infected pressure ulcers in elderly individuals. Clin Infect Dis. 2002;35(11):1390-1396.
25. 25. Redelings MD, Lee NE, Sorvillo F. Pressure ulcers: more lethal than we thought? Adv Skin Wound Care. 2005;18(7):367-372.