ABSTRACT
OBJECTIVE: Contribution to validation of the Braden scale in patients admitted to the ICU, based on an analysis of its reliability and predictive validity. DESIGN: An analytical, observational, longitudinal prospective study was carried out. SETTING: Intensive Care Unit, Hospital Virgen del Rocío, Seville (Spain). PATIENTS: Patients aged 18years or older and admitted for over 24hours to the ICU were included. Patients with pressure ulcers upon admission were excluded. A total of 335 patients were enrolled in two study periods of one month each. INTERVENTIONS: None. VARIABLES OF INTEREST: The presence of gradei-iv pressure ulcers was regarded as the main or dependent variable. Three categories were considered (demographic, clinical and prognostic) for the remaining variables. RESULTS: The incidence of patients who developed pressure ulcers was 8.1%. The proportion of gradei andii pressure ulcer was 40.6% and 59.4% respectively, highlighting the sacrum as the most frequently affected location. Cronbach's alpha coefficient in the assessments considered indicated good to moderate reliability. In the three evaluations made, a cutoff point of 12 was presented as optimal in the assessment of the first and second days of admission. In relation to the assessment of the day with minimum score, the optimal cutoff point was 10. CONCLUSIONS: The Braden scale shows insufficient predictive validity and poor precision for cutoff points of both 18 and 16, which are those accepted in the different clinical scenarios.
Subject(s)
Critical Care , Pressure Ulcer/epidemiology , Severity of Illness Index , Adult , Aged , Area Under Curve , Female , Humans , Incidence , Intensive Care Units , Length of Stay , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , ROC CurveABSTRACT
INTRODUCTION: Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients. METHODOLOGY: The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors. A qualitative systematic review of primary studies has been performed and a search was conducted of the PubMed, The Cochrane Library, Scopus and Web of Science databases. Methodological limitations in observational studies have been considered. RESULTS: From 200 references, 17 fulfilled the eligibility criteria. These studies included 19,363 patients admitted to intensive care units. Six studies were classified as high quality and 11 were classified as moderate quality. Risk factors that emerged as predictive of pressure ulcers development more frequently included age, length of ICU stay, diabetes, time of MAP <60-70mmHg, mechanical ventilation, length of mechanical ventilation, intermittent haemodialysis or continuous veno-venous haemofiltration therapy, vasopressor support, sedation and turning. CONCLUSIONS: There is no single factors which can explain the occurrence of pressure ulcers. Rather, it is an interplay of factors that increase the probability of its development.
Subject(s)
Pressure Ulcer/etiology , Critical Illness , Humans , Intensive Care Units , Pressure Ulcer/epidemiology , Risk FactorsABSTRACT
Introducción Las úlceras porpresión representan un significativo problema para pacientes, profesionales y sistemas sanitarios. Presentan una incidencia y una prevalencia importantes a nivel mundial. Su carácter iatrogénico plantea que su aparición es evitable y su incidencia es un indicador de calidad científico-técnica tanto en el ámbito de la atención primaria como en el de la especializada. El objetivo de esta revisión ha sido identificar los factores de riesgo relacionados con la aparición de úlceras por presión en pacientes críticos. Metodología Se siguieron las recomendaciones de la declaración PRISMA adaptadas a la identificación de estudios sobre factores de riesgo. Se ha realizado una revisión sistemática cualitativa de estudios primarios a través de una búsqueda en Pubmed, The Cochrane Library, Scopus y Web of Science. Se consideraron las limitaciones metodológicas en estudios observacionales. Resultados De 200 referencias bibliográficas, 17 cumplieron nuestros criterios de selección. Estos estudios incluyeron 19.363 pacientes ingresados en unidades de cuidados intensivos. Seis se clasificaron como de calidad fuerte y 11 de calidad moderada. Los factores de riesgo que aparecieron más frecuentemente asociados al desarrollo de úlceras por presión incluyeron: edad, tiempo de estancia en UCI, diabetes, tiempo de PAM <60-70mmHg, ventilación mecánica, duración de la ventilación mecánica, terapia de hemofiltración venovenosa continua o diálisis intermitente, tratamiento con drogas vasoactivas, con sedantes y cambios posturales. Conclusiones No aparecen factores de riesgo que por sí mismos puedan predecir la aparición de la úlcera por presión. Más bien se trata de una interrelación de factores que incrementan la probabilidad de su desarrollo.
