Escala de braden: benefícios de sua aplicação na prevenção de lesão por pressão no âmbito domiciliar / Braden scale: benefits of its use in the prevention of pressure injury in the household

Objetivo: Averiguar a eficácia da Escala de Braden como instrumento norteador na assistência para prevenção de lesão por pressão em indivíduos acamados no âmbito domiciliar. Método: Trata-se de um estudo descritivo com abordagem quantitativa com coleta de dados realizada em domicílio por meio de entrevista e inspeção da pele de 41 participantes. Resultados: A incidência de lesão por pressão foi de 7%. Constatou-se que os indivíduos acamados em domicílio com alto risco, na escala de Braden, não mostraram incidência de lesão por pressão, enquanto os que apresentaram risco moderado houve incidência. Conclusão: Apesar de ser um instrumento bastante utilizado pelos profissionais da área da saúde, o presente trabalho demonstrou que a alta sensibilidade e especificidade da Escala de Braden é questionável. Os cuidados foram essênciais para essa baixa incidência de lesão por pressão, diminuindo sua associação com a idade e tempo de acamado.

Objective: investigate the effectiveness of the Braden Scale as a guiding instrument in assisting in the prevention of pressure injury in bedridden individuals at home. Method: This is a descriptive study with a quantitative approach, with data collected at home through interviews and skin inspection of 41 participants. Results: There was an incidence of 7% of pressure injuries. It was found that individuals at high risk at home, according to the Braden scale, did not show incidence of pressure injuries, while those with moderate risk presented such incidence. Conclusion: Despite being widely used by health professionals, this study demonstrated that the high sensitivity and specificity of the Braden Scale is questionable. Care was essential for this low incidence of pressure injuries, reducing its association with age and bedridden time.

A pressure injury risk prognosis model for severe trauma patients based on Braden scale combined with microcirculation indicators / 中华急诊医学杂志

Objective:Based on Braden scale, combined with local skin temperature and local tissue oxygen saturation as microcirculation indicators, to construct a pressure injury risk prognosis model for severe trauma patients, and develop a visual nomogram.Methods:All the trauma patients in the Emergency Intensive Care Unit (EICU) of a tertiary hospital in Zhejiang Province from June 1, 2020 to August 31, 2020 were selected. The Braden scale was used to assess the risk of pressure injury in the patient and measure the patient’s sacral injury. The skin temperature and blood oxygen saturation at the pressure site were used as indicators for microcirculation evaluation. Multivariate Logistic regression was used to construct a prognostic model and visual nomogram for severe trauma patients with stress injury based on Braden score combined with microcirculation evaluation indicators, and compared with the prediction model constructed by the Braden scale alone. The discrimination degree was judged by the area under the receiver operating characteristic curve. The C index performed internal verification of the model, H-L goodness-of-fit test, and the overall discrimination index to observe and predict the effect of the model.Results:A total of 152 patients were enrolled in this study, of which 33 (21.71%) had pressure injuries. The area under the curve of the Braden scale combined with local skin temperature and local tissue oxygen saturation was 0.866, and the internal verification C index of the model was 0.847. The H-L goodness of fit test result was 8.37 ( P=0.051), indicating that the model had good discrimination and consistency. The overall discrimination index of the model was 0.144 ( P=0.023). Conclusions:The Braden scale combined with local microcirculation indicators to construct a prognostic model of stress injury in severe trauma patients has good discrimination and consistency, and the predictive power of the Braden scale is improved by 14.4%. The construction of a nomogram can provide clinical rapid convenient and reliable forecasting tool.

Análisis cuantitativo, uso de Escala Braden por enfermería en el servicio de Medicina Interna del Hospital Santo Domingo / Quantitative analysis of the use of Braden Scale by nursing in the Internal Medicine service of the Hospital Santo Domingo

Resumen El objetivo de este estudio fue evaluar, mediante un análisis cuantitativo, el uso y aplicación de la Escala de Braden por el personal de enfermería en pacientes de medicina interna del Hospital Santo Domingo, año 2018. Es un estudio cuantitativo, transversal y descriptivo; la población total fue de 1017 pacientes con una muestra de 30 (12 masculinos y 18 feminas), ingresados al área de medicina interna del Hospital General Santo Domingo, provincia Santo Domingo de los Tsáchilas, de julio a agosto del 2018. Se les realizó una revisión de su historia clínica para conocer el puntaje que determinaba el riesgo de desarrollar úlceras por presión (UPP), según la valoración que recibieron mediante la escala. Durante la aplicación de la Escala de Braden, se pronosticó riesgo bajo a 15 pacientes, riesgo medio a 10 y riesgo alto a 5, quienes presentaron alteraciones neurológicas o enfermedades crónicas como: accidente cerebrovascular, diabetes mellitus, cirrosis hepática. Se concluye que el personal de enfermería no realiza una aplicación adecuada de la Escala de Braden ni desde el ingreso del paciente ni durante su reevaluación en el servicio de medicina interna, lo que trae consigo que la atención no se realice con la calidad requerida. Factor favorable para complicaciones como las UPP.

Abstract The objective of this study was to evaluate, through a quantitative analysis, the use and application of the Braden Scale by the nursing staff in internal medicine patients of the Santo Domingo Hospital, year 2018. It is a quantitative, cross-sectional and descriptive study; The total population was 1017 patients with a sample of 30 (12 males and 18 females), admitted to the internal medicine area of the Santo Domingo General Hospital, Santo Domingo de los Tsáchilas province, from July to August 2018. They underwent a review of their medical history to know the score that determined the risk of developing pressure ulcers (UPP), according to the assessment they received using the scale. During the application of the Braden Scale, low risk was predicted for 15 patients, medium risk for 10 and high risk for 5, who presented neurological disorders or chronic diseases such as: stroke, diabetes mellitus, liver cirrhosis. It is concluded that the nursing staff does not carry out an adequate application of the Braden Scale, neither since the patient's admission nor during his reevaluation in the internal medicine service, which means that the care is not performed with the required quality. Favorable factor for complications such as UPP.

Resumo O objetivo deste estudo foi avaliar, por meio de uma análise quantitativa, o uso e a aplicação da Escala de Braden pela equipe de enfermagem em pacientes de medicina interna do Hospital Santo Domingo, ano de 2018. Trata-se de um estudo quantitativo, transversal e descritivo; A população total foi de 1017 pacientes, com uma amostra de 30 (12 homens e 18 mulheres), admitidos na área de medicina interna do Hospital Geral de Santo Domingo, província de Santo Domingo de los Tsáchilas, de julho a agosto de 2018. Eles foram submetidos a uma revisão do histórico médico para conhecer o escore que determinou o risco de desenvolver úlceras por pressão (UPP), de acordo com a avaliação que receberam usando a escala. Durante a aplicação da Escala de Braden, foram previstos baixo risco para 15 pacientes, risco médio para 10 e alto risco para 5, que apresentavam distúrbios neurológicos ou doenças crônicas como: acidente vascular cerebral, diabetes mellitus, cirrose hepática. Conclui-se que a equipe de enfermagem não realiza uma aplicação adequada da Escala de Braden, nem desde a admissão do paciente nem durante sua reavaliação no serviço de medicina interna, o que significa que o cuidado não é realizado com a qualidade exigida. Fator favorável a complicações como UPP.

Nivel de riesgo y aparición de úlceras por presión en pacientes en estado crítico / Risk level and pressure ulcer in patients in critical status / Nível de risco e aparição de úlceras por pressão em pacientes em estado crítico

La úlcera por presión es un evento constante en salud pública, un problema persistente en las unidades críticas y una preocupación de enfermería al verse involucrada en el cuidado que demanda el 50% más del tiempo utilizado. Objetivo: Describir el riesgo de aparición de las úlceras por presión en los pacientes ingresados en la unidad de cuidados críticos, con relación al tiempo de medición y estadio. Métodos: Estudio cuantitativo, observacional, descriptivo y longitudinal. Muestra: conformada por 31 pacientes. El instrumento fue aplicado en 4 momentos: Al ingreso, a las 24 y 72 h y al séptimo día de estancia. En cada medición se determinó el riesgo con la escala Braden y se valoró la piel. Resultado: El 100% de los pacientes tuvo alto riesgo al ingreso y 24 h; se redujo en un 71% a los 7 días. El 6.4% desarrolló úlcera por presión al ingreso, el 12.9% a las 24 h y el 35.5% a las 72 h. En general el 45.2% de los pacientes considerados como de alto riesgo manifestaron úlcera por presión a los 7 días de estancia hospitalaria. Se observó una correlación entre las variables nivel de riesgo y aparición de úlcera por presión a las 72 h (rs p = 0.04). Conclusión: A pesar de que se reduce el riesgo a la mitad en las primeras 72 h, aumenta la incidencia de úlcera por presión en ese mismo lapso; así, es importante que se realicen evaluaciones y revaloraciones desde el ingreso y durante los 7 primeros días de estancia hospitalaria en los pacientes críticamente enfermos utilizando un instrumento de valor predictivo.

Pressure ulcer are a constant event in public health, a persistent problem in units of critical care, and a nursing concern due to the longtime of care they need to be addressed. Objective To describe the risk of developing pressure ulcer which patients admitted into the critical care taking in consideration the time of measurement and stay. Methods This is a quantitative, observational, descriptive, and longitudinal study with a sample of 31 patients. The instrument was administered at four times: At entry, during the 24 and 72 hours, and at the seventh day of stay. In each measurement, the risk was assessed through the Braden scale. The skin status was also assessed. Result: 100% of patients were at high risk during the first 24 hours; and 71% of them were at high risk at the seventh day of admission. 6.4% developed a pressure ulcer during admission, 12.9% at 24 hours, and 35.5% at 72 hours. In general, 45.2% of the patients considered in high risk developed some pressure ulcer at the seventh day of stay. A correlation was observed among the variables risk level and pressure sores at 72 hours (rs P = .04>). Conclusion: Although the risk is reduced to the half during the first 72 hours, the incidence of pressure ulcer increases in the same period; thus, it is important to perform assessments and re-appraisements to the critically ill patients using a predictive instrument since hospital admission and during the first seven days of stay.

A úlcera por pressão é um evento constante em saúde pública, um problema persistente nas unidades críticas e uma preocupação de enfermagem ao ser envolvida no cuidado que demanda 50% mais do tempo utilizado. Objetivo: Descrever o risco de aparição das úlceras por pressão nos pacientes internados na unidade de cuidados críticos, em relação ao tempo de medição e estádio. Métodos: Estudo quantitativo, observacional, descritivo e longitudinal. Amostra conformada por 31 pacientes. O instrumento foi aplicado em quatro momentos: à entrada, às 24 e 72 horas e ao sétimo dia da permanência. Em cada medição determinou-se o risco com a escala Braden e avaliou-se a pele. Resultado: 100% dos pacientes teve alto risco à entrada e 24 horas; diminuiu em um 71% aos sete dias. 6.4% desenvolveu úlcera por pressão à entrada, 12.9% às 24 horas e 35.5% às 72 horas. Em geral 45.2% dos pacientes considerados como de alto risco manifestaram úlcera por pressão aos sete dias de permanência hospitalar. Observou-se uma correlação entre as variáveis nível de risco e aparição de úlcera por pressão às 72 horas (rs = 0.04>). Conclusão: Apesar de que se reduz o risco à metade nas primeiras 72 horas, aumenta a incidência de úlcera por pressão no mesmo período, assim, é importante que se realizem avaliações e reavaliações desde a entrada e durante os sete primeiros dias de permanência nos pacientes criticamente doentes, utilizando um instrumento de valor preditivo.

Prevalence and clinical evaluation of Pressure Ulcers using Braden scale from orthopedics wards of a tertiary care teaching hospital.

Background: The need for research into bed sores in orthopedic patients is evident from the increased number of beds they occupy and the considerable morbidity from pressure sores in orthopedic wards. Objective: To analyze and ascertain the prevalence and clinical evaluation of Pressure Ulcers from orthopedics wards of a tertiary care teaching hospital. Material and methods: The present prospective study was conducted by the Department of Orthopedics of a tertiary care teaching hospital from July 2009 to August 2014 among 228 patients seeking care for trauma to proximal femur, hip joint, pelvis and undergone elective surgery or surgery for removal of old implants. Braden scale was used for predicting pressure ulcers in the study subjects. All patients showing the potentiality of developing clinical signs of bed sores were selected and put on the study list. Patients aged ≥ 80 years, sick patients due to terminal illnesses and the worst pressure sores were excluded from the study. Results: Out of total 228 study subjects, 61 subjects developed pressure ulcers giving a prevalence of 26.75%. According to Braden Scale, 16.39% of patients were at high risk for developing the pressure ulcers. 68.85% of ulcer patients were treated for trauma mostly for fracture hips, pelvis or proximal femur or spine. Majority of patients (60.66%) developed pressure ulcers after the second week of admission. The lengths of stay of patients with bed sores exceed the stay of non sores patients on orthopedic wards by several times. Sacrum was the most commonly affected part of body. Conclusion: The findings of the current study highlight the multi-factorial etiology of pressure ulcers and they are preventable. Its prevention would require multidimensional approach including the collaboration of all the nursing and surgical staff. Frequent patient turning, close monitoring and frequent skin checks would delay the onset of pressure ulcers.

Evaluation of the Braden Scale Implementation by nurses: A Case Study in a Specialized Hospital in the Dhaka City.

Objective: The aim of this routine to research (R to R) developmental study was to implement the Braden Scale (BS) to identify risks of pressure ulcer (PU) development among hospitalized patients with spinal cord injury admitted in National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Bangladesh. Methods: Roger’s Diffusion of Innovation Theory and PU related literature were used to guide the development of the implementation. The subjects were 10 nurses and 13 doctors who were working at the NITOR. Different strategies were provided for the implementation of the BS including workshops to provide knowledge, persuasion, and decision making to implement the BS for the nurse participants. The outcomes of this study were to determine: (a) nurses’ adoption in terms of the rate of using the BS and the accuracy of using the BS to identify PU risks, (b) nurses’ satisfaction to use the BS, and (c) doctors’ satisfaction on the implication of the BS to identify the risks of PUs in hospitalized adult patients with paraplegia. Data were analyzed by descriptive statistics and percentage of agreement. Results: Weekly proportions of nurses’ adoption in terms of the rate of using the BS ranged from 96% to 100%. The accuracy of using the BS yielded percentage of agreement between 70.6% to 100% for each item of the BS. Nurses’ and doctors’ satisfactions were at very high levels. Mean score of nurses’ satisfaction was 98.5% (SD=1.23) and mean score of doctors’ satisfaction was 89.79% (SD=4.17). Conclusion: Nurses are capable to assess PU risks of paraplegic patients independently by using the BS and may be incorporated to identify PU risks in addition to their work protocol. After identifying the PU risks, effective nursing care should be implemented to the patients in order to prevent the PU formation.

Valoración del riesgo de ulcera por presión según la escala de Braden en el paciente neurológico / Assessing the risk of pressure ulcers according Braden scale in neurological patients

Objetivo: determinar el riesgo de úlceras por presión en el paciente neurológico postrado, mediante la aplicación de la escala Braden en el Servicio de Neurología 13 A del Hospital Nacional Edgardo Rebagliati Martins. Material y métodos: el diseño fue de tipo descriptivo de corte transversal y se realizó durante los meses de octubre a diciembre de 2012, la población estuvo conformada por 120 pacientes postrados al mes y la muestra se obtuvo con la fórmula para estimar proporción poblacional finita, obteniéndose 75 pacientes postrados a través del muestreo aleatorio simple, quienes cumplieron con los criterios de inclusión y exclusión. Para la recolección de datos se utilizó una ficha conjuntamente con la escala de Braden, los datos recolectados fueron procesados y tabulados en una base de datos para el respectivo análisis. Resultados: el estudio mostró que el mayor porcentaje de pacientes evaluados presentaron riesgo moderado con 49%, riesgo bajo con 31% y alto riesgo con 20%. Conclusiones: la escala Braden, dada su sensibilidad y especificidad, permitió reconocer el nivel de riesgo a úlcera por presión en los pacientes neurológicos.

Objetive: Of this study was to predict the pressure ulcers risk in bedridden neurological patients by using the Braden scale in the Neurology 13 A Edgrdo Rebagliati Martins Public Hospital. Material and methods: The desing was descriptive cross-sectional and was executed durig the months of October to December in 2012, the population consisted by 120 bedridden neurological patients per monthand the samples was obtained with the formula for estimating finite population proportion obtaining 75 bedridden patients throughsimple random sampling, who meet the criteria for inclusion and exclusion. The data was collected by using data collection sheet jointly with the Braden scale, the data collected were processed and tabulated in a database for examination. Results: The study showed that the highest percentage of patients evaluated presented with 49% moderate risk, low risk with 31% and 20% high risk. Conclusions: The Braden scale given its sensitivity and specificity allowed us to recognize the level of pressure ulcer risk in neurological patients.

Avaliação do custo do tratamento de úlceras por pressão em pacientes hospitalizados usando curativos industrializados / Evaluation of the cost of treating pressure ulcers in hospitalized patients using industrialized dressings

Este trabalho avaliou o uso de curativos industrializados: poliuretano, hidrogel, carvão ativo e também hidrogel com alginato, no tratamento de úlcera por pressão na Clínica Neurocirúrgica do Hospital da Restauração. O objetivo foi identificar o fator crítico que aumenta a demanda e custos com curativos industrializados. A avaliação, realizada na Clínica Neurocirúrgica, identificou os indivíduos que apresentaram risco de desenvolver úlcera por pressão. 62 pacientes foram avaliados e a prevalência foi de 22,6 por cento, segundo escore obtido na escala de Braden. A avaliação comparativa entre indivíduos que receberam medidas preventivas e entre os que não receberam mostrou que o custo médio diário de hospitalização para o primeiro grupo foi 45 por cento maior que para o segundo grupo. O teste de Wilcoxon-Mann-Withiney comparou a população de risco com a população de baixo risco, mostrando que a análise dos escores da Escala de Braden entre os grupos apresenta diferenças estatisticamente significativas quando estas duas populações são comparadas, intervalo de confiança de 95 por cento. Úlcera por pressão é um indicador de qualidade dos serviços de saúde. Pode-se reduzir custo e oferecer serviços públicos de maior qualidade se forem implantados treinamentos com a equipe de enfermagem, usando um protocolo de medidas preventivas baseado em um teste de avaliação de risco como a escala de Braden.

This work evaluated wound dresses used in the Neurosurgery Department of Restauração Hospital: polyurethane, hydrogel and activated carbon wound dresses and hydrogel with alginate used for pressure ulcer care. This work aimed to identify a critical factor that increases demand and cost of wound dresses. The evaluation conducted at the Neurosurgery Department identified individuals at risk of pressure ulcer development. Sixty-two patients were evaluated and the prevalence of pressure ulcer was 22.6 percent according to the Braden scale. Comparative evaluation between patients that didn't receive preventive measures and others that received, showed that the average daily cost of hospitalization for the first group was 45 percent higher than the mean for the second group. The Wilcoxon-Mann-Withiney test compared the population at risk to develop pressure ulcer and population at low risk showing that the evaluation of Braden Scale scores between the groups presents statistically significant differences and confidence limits of 95 percent. Pressure ulcer is a key quality indicator in health services.It is possible to reduce costs and offer higher quality public health services by implementing a training program of nursing staff using a preventive measure protocol based on a test to evaluate risk as Braden Scale.

A enfermagem e a utilização da escala de Braden em úlcera por pressão / Nursing and use of the Braden scale for pressure ulcers / La enfermería y la utilización de la escala de Braden en úlcera por presíón

O estudo objetivou caracterizar o perfil sociodemográfico de pacientes com úlceras por pressão e analisá-las quanto a sua localização, aos diagnósticos médicos e ao potencial de risco, conforme a escala de Braden. Foi realizada pesquisa descritiva-exploratória, com 14 pacientes de três setores do Hospital Universitário Lauro Wanderley, em João Pessoa. Os dados foram obtidos mediante observação dos pacientes e registro em ficha de avaliação com o referido parâmetro, em junho e julho de 2008. Os resultados predominantes foram: sexo feminino (71%); faixa etária acima de 59 anos (42,8%); localização das úlceras na região sacral (50%); doenças crônicas degenerativas (40%); alto risco (57,1%). A escala de Braden é de grande valia na assistência de enfermagem, pois permite intervir de forma eficiente e eficaz com vistas à involução e prevenção das novas úlceras por pressão.

This study aimed to characterize the socio-demographic profile of patients with pressure ulcers, and to analyse them in terms of location, medical diagnosis and potential risk on the Braden Scale. An exploratory, descriptive study was made of 14 patients from three sectors of the Lauro Wanderley University Hospital in João Pessoa. In June and July, 2008, data were obtained by observation and recorded on an evaluation form using the Braden Scale. The results were: female (71%); age over 59 years (42.8%); ulcers located in the sacral region (50%); chronic degenerative diseases (40%); and high-risk (57.1%). The Braden Scale is of great value in nursing care because it permits efficient and effective curative and preventive intervention against pressure ulcers.

El estudio objetivó caracterizar el perfil sociodemográfico de pacientes con úlceras por presión y analizarlas cuanto a su sitio, a los diagnósticos médicos y al potencial de riesgo, conforme la escala de Braden. Fue cumplida investigación descriptiva-exploratoria, con pacientes de tres sectores del Hospital Universitario Lauro Wanderley, en João Pessoa, PB, Brasil. Los datos fueron obtenidos por medio de observación de los pacientes y registro en ficha de evaluación con el referido parámetro, en junio y julio de 2008. Los resultados predominantes fueron: sexo feminino (71%); franja etaria mayor que 59 años (42,8%); localización de las úlceras en la región sacra (50%); enfermedades crónicas degenerativas (40%); alto riesgo (57,1%). La escala de Braden es de grande valía en la asistencia de enfermería, pues permite intervenir de manera eficiente y eficaz mirando a la involución y prevención de nuevas úlceras por presión.

Cuidados a la piel del niño y factores de riesgo para desarrollar úlceras por presión / Skin care and child risk factors for developing pressure ulcers

Los niños en estado crítico representan el 16.9 a 26%de hospitalización en el d. f.; y se encuentran en riesgo de sufrir trastornos en la piel y de desarrollar úlceras por presión (upp). En México sólo existe un estudio de investigación sobre upp en pediatría, hecho que no descarta la presencia de estas lesiones en la población nacional. Éste trabajo es el resultado de una investigación realizada en un hospital de tercer nivel del sector salud del Distrito Federal, objetivos: analizar la asociación que existe entre los cuidados de enfermería que se proporcionan a la piel del niño críticamente enfermo y el desarrollo de upp, así como identificar la relación existente entre los factores de riesgo y la aparición de las mismas. Metodología: Se realizó un estudio correlacional y longitudinal, en niños de 6 a 12 años internados en áreas críticas de un hospital de tercer nivel del sector salud del d. f., el instrumento utilizado fue la Escala de Braden y la Cédula de valoración y seguimiento de upp. En cuanto a las enfermeras encargadas del cuidado de los niños, se aplicó la Guía de observación para identificar los cuidados de enfermería brindados a la piel. Resultados: Se observó a un total de 77 enfermeras; distribuidas en tres turnos, los cuidados que brindaron a la piel del niño, alcanzaron un nivel de cuidado adecuado del 19.5 %. En cuanto a la población infantil se observó a 35 niños (71.4% del sexo masculino). El nivel de riesgo de upp en los niños fue alto (68.6%, Escala de Braden); 82.9% presentó alguna upp, 58.6% Con lesiones estadio I, y los sitios de aparición en la región occipital, talones, omóplatos, glúteos y sacro. La prueba de Spearman reveló una relación lineal estadísticamente significativa, débil e inversamente proporcional entre el nivel del cuidado a la piel del niño y el desarrollo upp (rs= -.310, p=.006), lo mismo se encontró al relacionar el índice de riesgo de upp y el desarrollo de estas lesiones (rs= .384, p=.001). Discusión: La relación existente entre los factores de riesgo y el desarrollo de las upp, así como la asociación que hay entre el nivel de calidad de cuidado y la presencia de estas lesiones en niños en estado crítico, favorece la incidencia de upp en un hospital de tercer nivel del d.f., la cual resulta alarmante al compararla con los resultados obtenidos en otras investigaciones. Conclusiones: Es necesario considerar que para asegurar la prevención de las upp se requiere de la participación de diferentes áreas y niveles jerárquicos, por lo que no es responsabilidad única de la enfermera la calidad del cuidado que proporcione, ya que para eso se requiere disponibilidad y accesibilidad de los recursos humanos y materiales, continuidad en el cuidado, competencia técnica y satisfacción del usuario.

Comprising 16.9%-26% of Mexico City Federal District's total hospi-talizations, children in critical status are at risk of developing pressure ulcers (pu). Despite the few related studies conducted in Mexico, a prevalence of this kind of lesions among Mexican children does exist. Conducted in a Federal District health sector third level hospital, the principal objective of this study was to analyze the association and risk factors between Nursing care and the development of pres-sure ulcers in a sample of critically ill Mexican children. Methodology: basic-cor-relational study on 6-12 year old children in critical care units of a Federal District health sector third level hospital; the Braden Scale, the Mexican pu Assessment and Follow-Up Card, and a Nursing Care Observation Guide were used. Results: 77 nurses distributed in 3 shifts, and 35 children (25 male) were observed. The pu risk among children was found to be 68.6% (Braden Scale); 29 children (≈82.9%) developed at least one pressure ulcer; 58.6% of them were grade 1 (or stage 1), and they were mainly located at the occipital, heels, shoulder-blades, and sacrum regions. The Spearman tests revealed an inverse statistically significant linear rela-tion between the skin care and the development of pu (rs1 = -.310, p = .006), while a positive relation between pu risk and its prevalence (rs2 = .384, p = .001). Discus-sion: Considering these results, the pu risk factors - Nursing care - pu development prevalence relation turned out to be critical. Conclusions: In order to prevent pus, it is necessary to provide care with quality, but also to have adequate hospital and staff resources and supports.

Prevention of Pressure Ulcer using the Pressure Ulcer Risk Assessment Based on Braden Scale

PURPOSE: Active prevention is an essential component in reducing the development of pressure sores. For the high-risk patient group, following the certified pressure sore screening scale as well as educating the patient and the nurses who care for them can lead to optimal management of these patients. Applying a risk assessment scale along with a prevention strategy can reduce medical costs and length of stays at the hospital. The purpose of this study is to evaluate the efficacy of a new pressure sore risk assessment scale based on the universally recommended Braden scale and our prevention program. METHODS: From June to August, 2003, our pressure ulcer risk assessment scale was applied to a total of 1882 patients admitted to the experimental group (intensive care unit, neurosurgery, general surgery, and oncology units). It was based on Braden scale. We analysed sensitivity, specificity, positive and negative predictive value and ROC curve to evaluate its efficacy. Pressure ulcer prevention program was composed of patient's education using protocol and specific nursing care. The incidence of pressure ulcers was also measured during the 3 months period, and those were compared to the control group of 1789 patients from March to May, 2002. RESULTS: 118(6.27%) of the experimental group were high-risk with an incidence of pressure ulcers measuring 4 (0.21%). Sensitivity, specificity, positive and negative predictive value of our scale were 100%, 94%, 4%, 100%, respectively, and AUC(area under the curve) was 0.992. In the control group, the incidence of pressure ulcers was 11(0.61%). Statistical analyses using chi- squared tests with a significance level of 5%, the results were such that chi-square=3.6482(p=0.0561). The results proved to be statistically significant in borderline. CONCLUSION: The results from this study proved that pressure sore risk assessment scale based on Braden scale has an excellent efficacy, and shows that our pressure ulcer prevention program is partially effective in reducing pressure ulcer incidence.

The Relationship of Risk Assessment Using Braden Scale and Development of Pressure Sore in Neurologic Intensive Care Unit / 성인간호학회지

PURPOSE: The purpose of this study was to evaluate the applicability of braden scale to assess pressure ulcer risk patients and to identify additional risk factors of pressure sores in an neurologic intensive care unit. METHOD: The subjects of this study were 66 patients in neurologic intensive care units. Data was prospectively collected from Sep. to Dec., 2002. Data were analyzed by mean, percentage, t-test, chi-square, discriminant analysis using Spss pc+. RESULT: The results of this study were as follows: 1) There was a significant difference between scoring of braden scale and pressure ulcer development. The subscales that predicted pressure ulcer development using braden scale only were sensory perception, moisture, mobility, friction and shear. By using these subscales, sensitivity was 86.7%, and specificity was 61.1%, and total hit ratio was 72.7%. 2) Additional pressure ulcer risk factors which showed significance for discriminating two group were protein, albumin, gender, level of consciousness, pattern of bowel elimination. By using the combination of these additional risk factors in addition to the braden scale, total hit ratio increased to 84.8%. CONCLUSION: This data suggest that albumin, protein, gender, level of consciousness, pattern of bowel elimination in addition to the braden scale should be included in the pressure sore assessment tool.

Úlcera de pressão em pacientes de Unidade de Terapia Intensiva: incidência, avaliação de risco e medidas de prevenção / Pressure ulcers in Intensive Care Unit adult patients: incidence, risk assessment and preventive measures

A úlcera de pressão ainda representa um problema no cenário da saúde. Este estudo teve como objetivos: a) determinar a incidência, estágio e localização de úlceras de pressão nos pacientes de uma UTI geral, b) caracterizar os pacientes quanto aos dados demográficos e fatores de risco para úlcera de pressão, c) verificar o comportamento da escala de Braden e d) correlacionar o tipo do colchão e o número de mudanças de decúbito com o nível de percepção sensorial e mobilidade do paciente. A população foi constituída de 113 pacientes, acompanhados diariamente durante sua internação na UTI. A coleta de dados foi feita em um período de três meses e utilizou como instrumentos a escala de Braden e outras fichas elaboradas pela autora da pesquisa. Os resultados permitiram verificar que: a) a incidência de pacientes com úlcera de pressão foi 10,62%, sendo 57,14 % em estágio II e 42,86% em estágio I, localizando-se sobretudo no cotovelo (35,72%), sacro (21,43%) e cóccix (14,29%); b) os grupos de pacientes com e sem úlcera de pressão não apresentaram diferenças quanto aos dados demográficos e fatores de risco estudados: idade, sexo, raça, doenças preexistentes, diagnóstico médico, cirurgia, peso corporal, índice de massa corporal, pressão arterial diastólica, temperatura, hemoglobina; c) a escala Braden apresentou melhor desempenho no ponto de corte 16 (67% sensibilidade, 40% especifidade, 12% e 91% valores de predição positivo e negativo) correlacionando com o tempo de seguimento do paciente; d) houve correlação estatisticamente significativa entre a mudança de decúbito e o tipo de colchão utilizado com o grau de mobilidade e percepção sensorial do paciente. Concluiu-se que a incidência de pressão foi mais baixa que em outras populações de terapia intensiva e que medidas de prevenção foram mais implementadas em pacientes com percepção sensorial e mobilidade afetada. Recomenda-se que novos estudos sejam conduzidos nessa ) área e que a escala de Braden continue sendo testada em língua portuguesa.

Pressure ulcer still features a problem in healthcare. The objectives of this research were: a) determine the incidence, stages and sites of pressure ulcers in adult patients in a general Intensive Care Unit, b) characterize these patients according to demographic and risk factors for pressure ulcers, c) verify Braden Scale variations and, d) make correlacion between type of mattress and frequency of position changes versus patient's sensory percepcion level and mobility. The subjects were 113 patients followed up daily during their stay in this ICU. Data were collected during three months. The author utilized Braden Scale and other tools during this period. The results were: a) the incidence of patients with pressure ulcers was 10,62% constituted of 57,14% in stage II and 42,86% in stage I, located mainly in elbow (35,72%), sacrum (21,43%) and coccyx (14,29%), b) the patients groups with and without pressure ulcers didn't have differences concerning the studied demographic and risk factors: age, gender, race, pre existing diseases, medical diagnosis, surgery, weight, Body Mass Index, diastolic arterial pressure, body temperature and hemoglobin, c) the Braden Scale score that showed the best performance was 16, considered as cutoff point (sensitivity 67%, specificity 40%, positive and negative predictive values 12% and 91%) and correlation with time of patient's follow up was made, d) there was significant statistical correlation between position changes and type of mattress versus level of mobility and patient sensory perception. The conclusion was that the incidence of pressure ulcers in the ICU studied was lower than other ICUs and that preventive interventions were more implemented in patients with sensory perception and mobility impairment. The author recommends that more studies should be made in this area as well as more tests in Portuguese with the Braden Scale performance.

Estudo sobre a prevalência e a incidência de úlceras de pressão em um hospital universitário / Study on the prevalence and incidence of pressure ulcers in a university hospital

As úlceras de pressão (UP) representam um grave problema para os pacientes hospitalizados, especialmente em termos de sofrimento pessoal e econômico, e um desafio não só para os enfermeiros, mas para toda a equipe interdisciplinar. Os objetivos deste estudo foram identificar e analisar os índices de prevalência e incidência de UP, nas unidades de Clínica Médica, Cirúrgica, UTI e semi Intensiva do Hospital Universitário da USP, bem como, estabelecer as possíveis associações com as características sócio demográficas e clínicas da clientela. Após aprovação do Comitê de Ética e Pesquisa do HU, procedeu-se à coleta de dados em duas etapas: enquanto os dados da prevalência foram levantados num único dia da semana, os relacionados à incidência, durante três meses consecutivos. para tanto, o exame físico de todos os pacientes internados e de todos os pacientes em risco para o desenvolvimento de UP, era realizado, respectivamente para os estudos da prevalência e incidência. A avaliação de risco para o desenvolvimento de UP foi feita através da Escala de Braden, tendo como nota de corte o escore inferior ou igual a 16. No estudo da prevalência, dos 102 pacientes avaliados, 19 desenvolveram UP, acarretando índice de 18,63%. Dentre os pacientes que apresentavam UP, houve predomínio do sexo feminino (52,63%), da raça branca (89,47%), de pacientes não fumantes (68,42%), com tempo de internação superior a 10 dias, principalmente por doenças do sistema cardiovascular ou respiratório (por doenças de base ou associadas), além de lesões no estágio I (51,85%) e não gerião sacra (22,22%). A idade média de 71,53 (DP=15,75) anos e o tempo médio de internação (12,31) dos pacientes com UP mostraram-se significativamente superiores àqueles exibidos pelos pacientes sem UP (p<0,001 e p=0,044, respectivamente). No estudo da incidência, dos 211 pacientes de risco acompanhados, 84 desenvolveram um total de 134 UP, acarretando índice ) de 39,81%. Os pacientes com UP caracterizaram-se por predomínio do sexo masculino (52,28%), da raça branca (80,95%) e de naõ fumantes (73,81), e as úlceras predominaram no estágio II (52,98%) e também em região sacra (33,58%), não sendo observadas UP nos estágios III ou IV. A idade média desses pacientes foi de 70,31 anod (DP=16,44), e houve diferença estatisticamente significante entre as idades dos pacientes com e sem UP, mostrando-se novamente superiores para os pacientes com UP. Além disso, a idade apresentou ainda, correlações estatisticamente significativas, positiva com a incidência e negativa com a umidade, ambas de fraca intensidade, sugerindo que as maiores incidências ocorreram entre os pacientes idosos e que estes tendem a apresentar maiores escores na sub escala umidade da escala de Braden. Embora a maioria dos pacientes com UP (50 ou 59,52%) tenha apresentado escore menor ou igual a 16, ou seja, risco para desenvolvimento de UP, os índices de prevalência e incidência encontrados neste estudo, quando comparados aos estudos internacionais, mostraram-se elevados. Os resultados indicam não somente a urgente necessidade da implantação de um programa de prevenção e tratamento de UP na instituição, como contribuem, metodologicamente, para que outros serviços possam estabelecer tal tipo de investigação, para a ampliação do conhecimento acerca desse problema no país.

Pressure Ulcer (PU) represents a great problem for hospitalized patients, especially concerning economic and personal suffering, and this is a challenge not only for registered nurses (RN) but also for interdisciplinary staff. The goals for this study are to identify and to analyze the PU prevalence and incidence in the clinical, surgical, intensive care unit and semi-intensive units at the University Hospital of São Paulo University, as well as establish possible association with social demographic and clinical characteristics of the patients. After approval of the Ethical and Research Commitee of the University Hospital, the collection of data took place in two stages. While the prevalent information was surveyed in only day, the incidence took three months to accomplish. A physical examination was performed on all the interned patients and all the others that had a risk of developing the PU to study the predominance of the occurrence. An evolution of the chance of developing PU was assessed using the Braden Scale with a cutoff score of less than or equal to 16. In this study of prevalence, from the 102 patients, 19 developed PU, an index of 18.63%. Among those patients that developed PU, 52.63% were female, 89.47% white race, 68,42% non-smoker patients, with more than 10 days of internment period mainly with cardiac or respiratory diseases (or associated illnesses), beside the lesions at stage I (51.85%) and on the sacral region (22.22%). The average age was 71.53 years old (DP=15.75) and the average time of internment was 12.32 days for the patients with PU, and it was significantly greater than those patients without the PU (p<0,001 and p=0,044 respectively). In the incidence study of 211 patients with risks to develop PU, 84 developed it, with a total of 134 PU, an index of 39.81%. Those with PU were predominant male (52.38%), of white race (80.95%), and non-smokers (52.98%). The ulcers were predominant at stage II, and also on the sacral region (33.58%), not having been found PU at stages III and IV. The average age of these patients was 70.31 years old (DP=16.44). The results showed significant statistical difference between the ages of patients with and without PU, again superior for those patients with PU. Besides, the age presented positive correlation statistically significant and negative with moisture, both with low intensity, suggesting that there are more incidences occurring with elderly patients who tend to present bigger score in the Moisture Subscale of the Braden Scale. Although, the majority of the patients with PU (50 or 59.52%) presented a score of 16 or less, it means, risk to develop PU, the prevalence and incidence indexes found in these studies were high when compared with the international studies. The results indicate, not only, an urgent need of implantation of a preventive program and treatment of PU in the institution, but also contribute, methodologically, that other services be established, like type of investigation, to amplify the knowledge of this problem in the country.