Body mass index and pressure ulcers: improved predictability of pressure ulcers in intensive care patients.

BACKGROUND: Obesity contributes to immobility and subsequent pressure on skin surfaces. Knowledge of the relationship between obesity and development of pressure ulcers in intensive care patients will provide better understanding of which patients are at high risk for pressure ulcers and allow more efficient prevention. OBJECTIVES: To examine the incidence of pressure ulcers in patients who differ in body mass index and to determine whether inclusion of body mass index enhanced use of the Braden scale in the prediction of pressure ulcers. METHODS: In this retrospective cohort study, data were collected from the medical records of 4 groups of patients with different body mass index values: underweight, normal weight, obese, and extremely obese. Data included patients' demographics, body weight, score on the Braden scale, and occurrence of pressure ulcers. RESULTS: The incidence of pressure ulcers in the underweight, normal weight, obese, and extremely obese groups was 8.6%, 5.5%, 2.8%, and 9.9%, respectively. When both the score on the Braden scale and the body mass index were predictive of pressure ulcers, extremely obese patients were about 2 times more likely to experience an ulcer than were normal weight patients. In the final model, the area under the curve was 0.71. The baseline area under the curve for the Braden scale was 0.68. CONCLUSIONS: Body mass index and incidence of pressure ulcers were related in intensive care patients. Addition of body mass index did not appreciably improve the accuracy of the Braden scale for predicting pressure ulcers.

Predictive validity of the Braden scale for patients in intensive care units.

BACKGROUND: Patients in intensive care units are at higher risk for development of pressure ulcers than other patients. In order to prevent pressure ulcers from developing in intensive care patients, risk for development of pressure ulcers must be assessed accurately. OBJECTIVES: To evaluate the predictive validity of the Braden scale for assessing risk for development of pressure ulcers in intensive care patients by using 4 years of data from electronic health records. Methods Data from the electronic health records of patients admitted to intensive care units between January 1, 2007, and December 31, 2010, were extracted from the data warehouse of an academic medical center. Predictive validity was measured by using sensitivity, specificity, positive predictive value, and negative predictive value. The receiver operating characteristic curve was generated, and the area under the curve was reported. RESULTS: A total of 7790 intensive care patients were included in the analysis. A cutoff score of 16 on the Braden scale had a sensitivity of 0.954, specificity of 0.207, positive predictive value of 0.114, and negative predictive value of 0.977. The area under the curve was 0.672 (95% CI, 0.663-0.683). The optimal cutoff for intensive care patients, determined from the receiver operating characteristic curve, was 13. CONCLUSIONS: The Braden scale shows insufficient predictive validity and poor accuracy in discriminating intensive care patients at risk of pressure ulcers developing. The Braden scale may not sufficiently reflect characteristics of intensive care patients. Further research is needed to determine which possibly predictive factors are specific to intensive care units in order to increase the usefulness of the Braden scale for predicting pressure ulcers in intensive care patients.

Dietetic technicians report low to moderate levels of burnout.

This study identified and described the status of burnout experienced by dietetic technicians (DTRs) in various settings. A questionnaire was sent to a random sample of 300 members from the American Dietetic Association's (ADA's) Dietetic Technician in Practice practice group. The Maslach Burnout Inventory-Human Services Survey was used to measure burnout. On the emotional exhaustion subscale, the respondents reported a mean score of 20.6 (high level of burnout >27), 5.3 on the depersonalization subscale (high level of burnout >14), and 38.6 on the personal accomplishment subscale (high level of burnout <30). These results suggest that the DTRs as a group perceive themselves to be moderately emotionally exhausted, to have a low level of depersonalization, and to have a high level of personal accomplishment. Further analysis also suggests that DTRs in nontraditional settings experience more personal accomplishment than those in traditional healthcare and foodservice settings.