The clinical relevance of the Waterlow pressure sore risk scale in the ICU.

OBJECTIVE: To evaluate whether the Waterlow pressure sore risk (PSR) scale has prognostic significance for intensive care patients. DESIGN: A prospective study. SETTING: The surgical intensive care unit (ICU) of the University Hospital Rotterdam. PATIENTS: Data were evaluated from 594 patients who had been admitted to the ICU during the year 1994. METHODS AND RESULTS: Each patient was assessed daily with respect to their Waterlow PSR score and the development of pressure sores in the sacral region. Actuarial statistical methods were used to analyse the predictive value of the risk score. When a patient had a Waterlow PSR score > 25 on admission, the risk of developing a pressure sore was significantly increased compared to patients with a PSR score < 25. After admission, the daily Waterlow PSR scores obtained were significantly associated with the risk of developing a pressure sore. For each additional point this risk increased by 23% (95% confidence interval 17 to 28%). CONCLUSIONS: The Waterlow PSR scale provides the medical and nursing staff at an early stage with reliable information about the risk patients have in developing a pressure sore.

Pressure sores in an intensive care unit and related variables: a descriptive study.

The development of pressure sores is associated with negative patient outcome. Patients in an intensive care unit (ICU) are particularly prone to developing pressure sores, caused by severe illness and being immobile for long periods. A method to prevent the development of pressure sores is to use the Waterlow pressure sore risk calculator as a warning device, followed by appropriate action. A prevalence study on pressure sores was conducted in the ICU, where the following variables were noted for each patient admitted: pressure sore stage on sacrum or buttocks, the Waterlow pressure sore risk score, and the number and kind of preventive measures taken by the nursing staff. The results show that the prevalence of pressure sores varies greatly over the study period, that a relationship exists between the pressure sore stage and the risk of developing a pressure sore and that nurses are more motivated to take pressure sore precautions based on the visible damage due to pressure than by the warning provided by the presence of specific risk factors. It is concluded that point prevalence measurement does not give reliable information about the pressure sore problem in general in an ICU and that daily measurement of the risk of developing pressure sores with the Waterlow pressure sore risk calculator helps nurses to indicate specific risk factors and assists them with decisions on the frequency and method of pressure sore precautions to be taken.