ABSTRACT
AIMS: To determine the prevalence, risk, and determinants of pressure ulcer risk in a large cohort of hospitalized patients. DESIGN: A prospective cross-sectional study with data collection in January 2023. METHODS: Registered nurses collected data from 798 patients admitted to 27 health care units of an Italian hospital. The pressure ulcer risk was assessed using the Braden scale. The presence of comorbidities was collected from clinical reports. Obesity was assessed according to international indicators (Body Mass Index). The receiver operating characteristic (ROC) curve was used to estimate the sensitivity and specificity of different Braden scores for identifying participants with pressure ulcers. RESULTS: The prevalence of pressure ulcers was 9.5%, and 57.4% of the sample were at risk of developing pressure ulcers. The area under the ROC curve was 0.88. The best sensitivity and specificity were found for a Braden cutoff score of 15.5 (sensibility = 0.76; specificity = 0.85). The determinants of lower Braden scores were older age (p < 0.001), comorbidities (p < 0.001), wounds of other nature (p = 0.001), urinary incontinence (p < 0.001), fecal incontinence (p < 0.001), and urinary catheterization (p < 0.001). CONCLUSION: Several demographic factors and specific clinical indicators have been identified as determinants of the risk of developing pressure ulcers, which are easily ascertainable by healthcare providers; thus, they may routinely complement the Braden Scale in the assessment of pressure ulcer risk in order to reinforce and accelerate clinical judgment.
Subject(s)
Pressure Ulcer , Humans , Pressure Ulcer/epidemiology , Pressure Ulcer/etiology , Male , Italy/epidemiology , Female , Cross-Sectional Studies , Aged , Middle Aged , Prospective Studies , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Assessment/standards , Aged, 80 and over , Cohort Studies , Risk Factors , Prevalence , Adult , Hospitalization/statistics & numerical data , ROC CurveABSTRACT
OBJECTIVE: To date, "healed/non-healed" and clinical judgment are the only available assessment tools for digital ulcers (DU) in patients with systemic sclerosis (SSc). The aim of our study is to examine a preliminary composite DU clinical assessment score (DUCAS) for SSc for face, content, and construct validity. METHODS: Patients with SSc presenting at least 1 finger DU were enrolled and assessed with the Health Assessment Questionnaire-Disability Index, Cochin scale, visual analog scale (VAS) for DU-related pain, patient global DU status, and global assessment as patient-reported outcomes (PRO), and physician VAS for DU status (phyGDU) as an SSc-DU expert physician/nurse measure. The DUCAS included 7 DU-related variables selected by a committee of SSc DU experts and weighted on a clinical basis. Face validity was examined by consensus and partial construct validity was tested through convergent correlation with other measures of hand function, using Spearman's correlations. A range of patients with SSc was examined. A linear regression model with backward stepwise analysis was used to determine the relationship of individual variables with the primary clinical parameter, phyGDU. RESULTS: Forty-four patients with SSc (9 males, mean age 55 ± 15 yrs, mean disease duration 9.9 ± 5.8 yrs) were enrolled in the study. Overall DUCAS showed significant positive correlations with all abovementioned PRO (r > 0.4, p < 0.01). When all scores and scales were modeled, only DUCAS significantly predicted phyGDU (r = 0.59, R2 = 0.354, Akaike information criterion = 385.4). CONCLUSION: Preliminarily, we suggest that the DUCAS may be a new clinical score for SSc-related DU, having face and content validity and convergent/divergent correlations (construct validity). These early data suggest that this score deserves further evaluation.
Subject(s)
Scleroderma, Systemic/complications , Skin Ulcer/diagnosis , Adult , Aged , Disability Evaluation , Female , Health Status , Humans , Male , Middle Aged , Quality of Life , Severity of Illness Index , Skin Ulcer/etiology , Symptom AssessmentABSTRACT
Pressure ulcers are a significant problem in Public Health. A pressure ulcer is a tissutal lesion caused by different mechanisms such as local pressure, rubbing and dampness. Their frequency increases with age, in hypo-mobile patients, both in hospital and domestic environments. The preminent role of prevention in reducing the incidence and severity of pressure ulcers is supported by many studies; prevention measures are based on frequent changes in the person's posture and/or on the use of alternating pressure mattresses Study objectives : to evaluate the use of alternating pressure mattresses in such patients in terms of : 1- risk factors for ulcer development (Braden); 2- duration (days) of mattress usage; 3- description and incidence of skin lesions at the beginning of the study; 4- any possible changes (improvement/progression) in such lesions when mattress use was suspended. Appropriate data forms were filled in by nurses at the beginning and at the end of mattress usage. A total of 1,959 persons used the alternating pressure mattresses: of these, 83.62% had a Braden scale rating from 6 to 12, and 43.62% suffered from ulcers. The ulcers improved in 54.62% of the patients, progressed in 7.6%
