Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission

Hye Ran Kwak; Jiyeon Kang

doi:10.7469/kjan.2015.27.3.347

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Kwak and Kang: Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission

Original Article

Korean J Adult Nurs 2015;27(3):347-357.

Published online: NaN June 2015

DOI: https://doi.org/10.7469/kjan.2015.27.3.347

Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission

Hye Ran Kwak¹, Jiyeon Kang²

^¹Dong-A University Medical Center, CCU, Busan

^²Department of Nursing, Dong-A University, Busan, Korea

Corresponding author: Kang, Jiyeon Department of Nursing, Dong-A University, 1 Dongdaesin-dong 3-ga, Seo-gu, Busan 602-714, Korea. Tel: +82-51-240-2871, Fax: +82-51-240-2920, E-mail: jykang@dau.ac.kr

Received 14 April 20153 June 2015 Accepted 8 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to assess the prevalence rate of, and the risk factors for pressure ulcers in critical patients at the time of intensive care unit (ICU) admission.

Methods

We reviewed the electronic medical records of 2,107 patients who were admitted to the intensive care units in D university hospital between January 1 and December 31, 2012. The collected date were analyzed by x²-test, t-test, and multi-variate logistic regression with forward stepwise selection using the SPSS program version 21.

Results

The prevalence rate of pressure ulcers at the ICU admission was 23.7%. Risk factors significantly affecting pressure ulcers carrying were the age of 80 years or older (OR=3.70, 95% CI: 1.80~7.60), body weight less than 50 kg (OR=2.82, 95% CI: 1.74~4.56), sedated consciousness (OR=6.10, 95% CI: 3.57~10.40), use of ventilator (OR=1.60, 95% CI: 1.02~2.49), use of vasopressors (OR=1.53, 95% CI: 1.09~2.14), ICU admission via operation room (OR=0.49, 95% CI: 0.29~0.85), and hospital admission from nursing homes (OR=13.65, 95% CI: 3.02~61.72).

Conclusion

The findings of this study suggested that the prevention efforts for pressure ulcers should be given in prior to ICU admission. Further research is necessary for developing nursing interventions for preventing pressure ulcers in the pre-ICU stage.

Keywords: Pressure ulcer, Prevalence, Risk factors, Intensive care units, Patient admission

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Table 1.

Prevalence of Pressure Ulcers at the ICU Admission

Types of ICU	Admitted patients	Pressure ulcers carrying patients	Prevalence (%)
Types of ICU	n (%)	n (%)	Prevalence (%)
Mixed	637 (31.2)	215 (43.0)	33.8
Neurological	569 (27.0)	116 (23.2)	20.4
Cardiac	901 (47.8)	169 (33.8)	18.8
Total	2,107 (100.0)	500 (100.0)	23.7

ICU=intensive care unit.

Table 2.

The Demographic and Disease-related Characteristics of the Subjects (N=1,024)

Variables	Categories	PU group (n=408)	Non-PU group (n=616)	x² or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	240 (58.8)	359 (58.3)	0.03	.863
Gender	Female	168 (41.2)	257 (41.7)	0.03	.863
Age (year)	＜40	23 (5.6)	53 (8.6)	25.62	＜.001
	40~60	90 (22.1)	191 (31.0)	4.81	＜.001
	60~80	222 (54.4)	316 (51.3)
	≥80	73 (17.9)	56 (9.1)
		66.14±14.51	61.64±14.78
Body weight (kg)	＜50	89 (21.8)	61 (9.9)	33.95	＜.001
	50~60	110 (27.0)	157 (25.5)
	60~70	128 (31.4)	216 (35.1)
	≥70	81 (19.9)	182 (29.5)
		58.78±11.62	63.29±10.91	6.32	＜.001
Main disease	Respiratory	46 (11.3)	40 (6.5)	24.37	.004
	Circulatory	131 (32.1)	229 (37.2)
	Liver	4 (1.0)	9 (1.5)
	Kidney	38 (9.3)	34 (5.5)
	Neurological	101 (24.8)	171 (27.8)
	Sepsis	13 (3.2)	17 (2.8)
	Gastrointestinal	15 (3.7)	24 (3.9)
	Cancer	22 (5.4)	57 (9.3)
	Metabolic	10 (2.5)	8 (1.3)
	Others	28 (6.9)	27 (4.4)
ICU types	Mixed	161 (39.5)	155 (25.2)	23.87	＜.001
	Neurological	105 (25.7)	207 (33.6)
	Cardiac	142 (34.8)	254 (41.2)
KHNA severity	IV (62~92)	0 (0.0)	1 (0.2)	37.90	＜.001
	V (93~141)	260 (63.7)	497 (80.7)
	VI (≥142)	148 (36.3)	118 (19.2)

PU=pressure ulcers; ICU=intensive care unit; KHNA=Korean hospital nurses association.

Table 3.

Comparison of Personal Risk Factors between PU Group and Non-PU Group (N=1,024)

Variables	Categories	PU group (n=408)	Non-PU group (n=616)	x² or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Consciousness	Alert	57 (14.0)	223 (36.2)	106.28	＜.001
	Drowsy	121 (29.7)	222 (36.0)
	Stupor	74 (18.1)	76 (12.3)
	Semicoma	20 (4.9)	17 (2.8)
	Coma	17 (4.2)	10 (1.6)
	Sedation	119 (29.2)	68 (11.0)
Hypertension	Yes	251 (61.5)	360 (58.4)	0.97	.326
Hypertension	No	157 (38.5)	256 (41.6)	0.97	.326
Diabetes	Yes	301 (73.8)	472 (76.6)	1.08	.299
Diabetes	No	107 (26.2)	144 (23.4)	1.08	.299
Other comorbidities	Yes	321 (78.7)	426 (69.2)	11.27	.001
Other comorbidities	No	87 (21.3)	190 (30.8)	11.27	.001
Albumin (g/dL)	＜2.9	98 (24.0)	61 (9.9)	77.06	＜.001
	2.9~3.3	170 (41.7)	180 (29.2)
	≥3.4	140 (34.3)	375 (60.9)
CRP (mg/dL)	≤0.5	63 (15.8)	144 (23.6)	9.23	.002
CRP (mg/dL)	＞0.5	337 (84.3)	465 (76.4)	9.23	.002
Hb (mg/dL)	＜Standard^†	270 (66.2)	314 (51.0)	23.15	＜.001
Hb (mg/dL)	≥Standard^†	138 (33.8)	302 (49.0)	23.15	＜.001
Body temperature (℃)	＜36	99 (24.3)	178 (28.9)	10.41	.015
	36.1~37.0	218 (53.4)	347 (56.3)
	37.1~38.0	67 (16.4)	64 (10.4)
	≥38.1	24 (5.9)	27 (4.4)
Braden scale score		11.27±2.39	13.28±2.70	12.52	＜.001

PU=Pressure ulcers; CRP=C-reactive protein; Hb=Hemoglobin;

^† Male=13 mg/dL, Female=11 mg/dL.

Table 4.

Comparison of Institutional Risk Factors between PU Group and Non-PU Group (N=1,024)

Variables	Categories	PU group (n=408)	Non-PU group (n=616)	x² or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Ventilator	Yes	240 (58.8)	275 (44.6)	19.74	＜.001
Ventilator	No	168 (41.2)	341 (55.4)	19.74	＜.001
CRRT	Yes	0 (0.0)	1 (0.2)	0.66	.416
CRRT	No	408 (100.0)	615 (99.8)	0.66	.416
Hypothermia therapy	Yes	5 (1.2)	7 (1.1)	0.02	.897
Hypothermia therapy	No	403 (98.8)	609 (98.9)	0.02	.897
Restraints	Yes	41 (10.0)	38 (6.2)	5.19	.023
Restraints	No	367 (90.0)	578 (93.8)	5.19	.023
Vasopressors	Yes	198 (48.5)	189 (30.7)	33.25	＜.001
Vasopressors	No	210 (51.5)	427 (69.3)	33.25	＜.001
Sedatives	Yes	199 (48.8)	253 (41.1)	5.91	.015
Sedatives	No	209 (51.2)	363 (58.9)	5.91	.015
ICU admission route	ED	197 (48.6)	292 (48.2)	6.45	.040
	OR	132 (32.6)	232 (38.3)
	GW	76 (18.8)	82 (13.5)
Hours of hospital stay prior to ICU admission	≤6	126 (32.1)	325 (53.9)	65.66	＜.001
	7~12	79 (20.2)	117 (19.4)
	13~24	53 (13.5)	49 (8.1)
	25~48	48 (12.2)	48 (8.0)
	≥49	86 (21.9)	64 (10.6)
		55.98±149.25	38.90±136.62	1.88	.061
Surgery	Yes	146 (35.8)	236 (38.3)	0.67	.413
Surgery	No	262 (64.2)	380 (61.7)	0.67	.413
Hospital admission route	Local hospital	195 (49.4)	275 (45.8)	35.28	＜.001
	Nursing home	26 (6.6)	3 (0.5)
	Home	174 (44.1)	322 (53.7)

CRRT=continuous renal replacement therapy; ED=emergency department; GW=general ward; ICU=intensive care units; OR=operating room; PU=pressure ulcers.

Table 5.

Multi-variate Analysis of Risk factors for Carrying Pressure Sores at the ICU Admission (N=1,024)

Variables	Categories	Standardized		Odds ratio		p	x² (p)
Variables	Categories	B	SE	Exp (B)	95% CI	p	x² (p)
Age (year)	＜40	ref.				.002	202.93
	40~60	0.53	.33	1.70	0.89~3.23	.106	(＜.001)
	60~80	0.73	.31	2.07	1.12~3.83	.020
	≥80	1.31	.37	3.70	1.80~7.60	＜.001
Body weight (kg)	＜50	1.04	.25	2.82	1.74~4.56	＜.001
	50~60	0.39	.21	1.47	0.98~2.21	.065
	60~70	0.31	.20	1.36	0.92~2.00	.119
	≥70	ref.				＜.001
Consciousness	Alert	ref.				＜.001
	Drowsy	0.77	.22	2.16	1.41~3.29	＜.001
	Stupor	1.25	.25	3.50	2.14~5.71	＜.001
	Semicoma	1.17	.40	3.22	1.47~7.08	.004
	Coma	1.52	.47	4.57	1.82~11.48	.001
	Sedation	1.81	.27	6.10	3.57~10.40	＜.001
Ventilator		0.47	.23	1.60	1.02~2.49	.040
Vasopressors		0.42	.17	1.53	1.09~2.14	.015
ICU admission route	ED	0.06	.22	1.06	0.69~1.65	.790
	OR	-0.71	.28	0.49	0.29~0.85	.010
	GW	ref.				.003
Hospital admission route	Local hospital	l 0.10	.16	1.11	0.81~1.51	.514
	Nursing home	e 2.61	.77	13.65	3.02~61.72	.001
	Home	ref.				.003

PU=pressure ulcers; ICU=intensive care units; ED=emergency department; OR=operating room; GW=general ward.

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