Factors associated with the incidence of pressure wounds in critical patients: a cohort study

Teixeira, Andreza de Oliveira; Brinati, Lídia Miranda; Toledo, Luana Vieira; Silva Neto, José Faustino da; Teixeira, Daniela Lucas de Paula; Januário, Carla de Fátima; Silva Neto, Letícia Marques da; Salgado, Patrícia de Oliveira

doi:10.1590/0034-7167-2021-0267

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (6) • 2022 • https://doi.org/10.1590/0034-7167-2021-0267 copy

Factors associated with the incidence of pressure wounds in critical patients: a cohort study

Factores relacionados a la incidencia de úlcera por presión en pacientes críticos: estudio de cohorte

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to identify the incidence of pressure wound in critical patients and its associated factors.

Methods:

retrospective cohort study, based on the analysis of 369 critical patients’ records. Descriptive and inferential statistics were used, as well as logistic regression.

Results:

the incidence of pressure wounds was 11.4%. Patients who had been hospitalized for four days or more (OR 2.99; CI95% 1.15-7.78), used nasoenteric tubes (OR: 3.81; CI95%: 1.4010.38), vesical drainage catheters (OR: 4.78; CI95%: 1.31-17.38) and tracheostomy (OR: 3.64; CI95%: 1.48-8.97) had a higher chance of developing pressure wounds. The mean score of the Braden scale among participants who developed (14.2 points) pressure wounds was statistically different (p<0.001) than that of those who did not (12.3 points).

Conclusions:

the incidence of pressure wounds was associated with a higher time in the unit, the use of nasoenteric tubes, vesical drainage catheters, and tracheostomies were associated with a higher time of hospitalization in the unit.

Descriptors:
Nursing; Pressure Ulcer; Risk Factors; Intensive Care Units; Critical Care

Patient Characteristics	With PW (n = 42)		Without PW (n = 327)		OR	CI95%	p value
Patient Characteristics	n	%	n	%	OR	CI95%	p value
Sex
Female	19	45.2	148	45.3	1
Male	23	54.8	179	54.7	1.001	0.52-1.91	0.998
Age
≤ 72 years	15	35.7	174	53.2	1
> 72 years	27	64.2	153	46.7	2.047	1.05-3.99	0.035^*
Time in the ICU
≤ 4 days	08	19.0	209	63.9	1
> 4 days	34	81.0	118	36.1	7.53	3.37-16.80	< 0.001^*
SAPS III score
≤ 53 points	06	14.2	179	54.7	1
> 53 points	36	85.7	148	45.2	7.26	2.98-17.69	< 0.001^*
Clinical outcome of the hospitalization
Discharged from the ICU	21	50.0	210	64.2	1
Death	17	40.4	74	22.6	2.30	1.15-4.59	0.019^*
Transfer	04	09.5	43	13.1	0.93	0.30-2.85	0.899

Variables	With PW (n = 42)		Without PW (n = 327)		OR	CI95%	p value
Variables	n	%	N	%	OR	CI95%	p value
Nasoenteric catheter
Absent	06	14.3	223	68.2	1	5.26-31.49	< 0.001^*
Present	36	85.7	104	31.8	12.86	5.26-31.49	< 0.001^*
Triple lumen catheter
Absent	31	73.8	302	92.4	1	1.93-9.54	< 0.001^*
Present	11	26.2	25	7.6	4.29	1.93-9.54	< 0.001^*
Central venous catheter
Absent	23	54.8	237	72.5	1	1.13-4.18	0.020^*
Present	19	45.2	90	27.5	2.17	1.13-4.18	0.020^*
Peripheral venous catheter
Absent	05	11.9	33	10.1	1	0.30-2.26	0.716
Present	37	88.1	294	89.9	0.83	0.30-2.26	0.716
Vesical drainage catheter
Absent	03	7.1	158	48.3	1	3.68-40.12	< 0.001^*
Present	39	92.9	169	51.7	12.15	3.68-40.12	< 0.001^*
Invasive arterial pressure
Absent	35	83.3	306	93.6	1	1.16-7.34	0.023^*
Present	07	16.7	21	6.4	2.91	1.16-7.34	0.023^*
Tracheostomy
Absent	25	59.5	308	94.2	1	5.10-23.83	< 0.001^*
Present	17	40.5	19	5.8	11.02	5.10-23.83	< 0.001^*
Orotracheal tube
Absent	12	28.6	233	71.2	1	3.04-12.62	< 0.001^*
Present	30	71.4	94	28.8	6.20	3.04-12.62	< 0.001^*

Variables	With PW (n = 42) n	Without PW (n = 327) %	OR	CI95%	p value
Time in the ICU (n)
≤ 4 days	08	209	1	1.15-7.78	0.025^*
> 4 days	34	118	2.99	1.15-7.78	0.025^*
Nasoenteric catheter (n)
Absent	06	223	1	1.40-10.38	0.009^*
Present	36	104	3.81	1.40-10.38	0.009^*
Vesical drainage catheter (n)
Absent	03	158	1	1.31-17.38	0.018^*
Present	39	169	4.78	1.31-17.38	0.018^*
Tracheostomy (n)
Absent	25	308	1	1.48-8.97	0.005^*
Present	17	19	3.64	1.48-8.97	0.005^*

Braden scale	With PW (n = 42)		Without PW (n = 327)		OR	CI95%	p value
Braden scale	n	%	N	%	OR	CI95%	p value
Low risk (more than 16 points)	03	7.1	86	26.3	0.22	0.06-0.72	0.012*
Moderate risk (12 to 16 points)	19	45.2	169	51.7	0.72	0.40-1.47	0.433
High risk (11 or less points)	20	47.6	72	22.0	3.22	1.66-6.23	0.001*

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[1] Corresponding author: Luana Vieira Toledo E-mail: luana.toledo@ufv.br