Predictors of Pressure Injuries in a Critical Care Unit in Lebanon: Prevalence, Characteristics, and Associated Factors

Abstract

PURPOSE: The purpose of this study was to identify factors associated with pressure injury in a medical-surgical intensive care unit (MSICU). DESIGN: Retrospective review of medical records. SUBJECTS AND SETTING: We reviewed the medical records of 145 patients who developed a new pressure injury in the MSICU of a 420-bed university medical center in Lebanon. METHODS: Medical records of all patients cared for in the MSICU from December 2014 to June 2017 were reviewed by a research assistant using a standardized form. We extracted potential risk factors for pressure injury including sex, age, weight upon admission, weight at discharge, length of MSICU stay, episodes of hypotension, administration of inotropes/vasopressors, admitting diagnosis, comorbid conditions, and cumulative scores on the Braden Scale for Pressure Sore Risk. The outcome variable was development of any new pressure injury during their stay in our intensive care unit. RESULTS: Forty-nine patents (33.7%) developed a new pressure injury. Bivariate analysis found statistically significant associations between pressure injury occurrences and administration of vasopressors (odds ratio [OR] = 0.42; 95% confidence interval = 0.29-0.87; P =.02), the administration of dopamine (OR = 0.20; 95% confidence interval = 0.04-0.94; P =.04), and hospital-acquired pressure injury. Among the continuous variables, analysis revealed significant relationships between weight at discharge (t = 2.31, P =.02), MSICU length of stay (t = 5.30; P =.000), cumulative Braden Scale score (t = 3.06; P =.002), hypotension (t =-2.74; P =.007), and development a new pressure injury. Multivariate analysis indicated that length of stay (β=-.110; P =.002), administration of vasopressors (β=-.266; P =.029), and total hours of hypotension (β=-.53; P =.041) were significant predictors of pressure injury. CONCLUSIONS: Vasopressor use, hypotension, and length of stay were associated with an increased likelihood of pressure injury in adults managed in an MSICU. None of these factors is specifically evaluated during completion of the Braden Scale for Pressure Sore Risk. Based on these findings we recommend development of a pressure injury scale specific to critically ill adults. Copyright © 2018 by the Wound, Ostomy and Continence Nurses Society.