Risk Factors for Pressure Ulcer in Severe Trauma Patients

Abstract

This study identifies risks for pressure ulcer in patients admitted to surgical intensive care units because of severe traumatic injuries with injury severity scores of 15 or higher. Methods: Data was collected from records of patients admitted from January 1, 2011, to December 31, 2013. The analysis addressed general characteristics, trauma-related characteristics, and treatment-related characteristics of pressure ulcers. Descriptive statistics include the raw numbers, percentages, and the standard deviations. Hypothesis tests including t-tests, chi-square tests, and multi-regression analyses were performed using SPSS ver.dow 12.0. Results: Two hundred and fifty-nine patients were admitted to surgical intensive care units with severe trauma injuries. Of those, 44 patients (17.0%) had a pressure ulcer. The mean pressure ulcer duration was 8.4 days. The most common pressure ulcer was the second phase ulcer at 51.9%. Risk factors were found to be age (p＜0.001), shock (p＜0.021), and the fixture device (p＜0.020). Conclusion: Early nursing interventions are necessary to prevent a pressure ulcer in patients with severe trauma injuries admitted to surgical intensive care units.

Risk Factors Associated With Pressure Ulcers in Patients With Traumatic Brain Injury Admitted to the Intensive Care Unit

“…Patients with an ISS of 25 points or higher had a lower risk of PI development than patients with an ISS of 15 points or lower. In a previous study (Jung et al, 2015) on patients with severe trauma, the ISS score of the PI group was higher than that of the non-PI group, which is different from the results of this study. A Brazilian study evaluated the ISS and identified significant differences in the ISS values between groups with high and medium/low nursing activity scores; patients who required a high nursing workload presented with a greater severity of trauma (de Souza Nogueira et al, 2014); therefore, it is possible that nurses provide more aggressive nursing care to severe patients, which may influence the incidence of PIs.…”

“…The risk factors of PIs in patients with TBI admitted to the ICU were the use of mechanical ventilation, period of enteral feeding (more than 7 days), period of fever (more than 7 days), vasopressor infusion, lower BSS, and ISS (25 points or more). In this study, the use of mechanical ventilation resulted in 11.54-fold greater risk of PI development, which was higher than that reported in patients admitted to the ICU (6.08-fold) (González-Méndez et al, 2018) or with severe trauma (4.54-fold) (Jung et al, 2015). The lives of patients with severe TBI are sustained by specialized treatments (Ngubane, 2011), including mechanical ventilation, due to impaired consciousness and motor deficits (Dhandapani et al, 2014).…”

Characteristics and Risk Factors for Pressure Ulcers in Severe Trauma Patients Admitted to the Trauma Intensive Care Unit

“…Of the 315 patients with severe trauma, 42 patients developed pressure ulcers, corresponding to 13.3% of patients. The reported incidence of pressure ulcers in South Korea is from 9% to 17% [12,24], and internationally it has been reported as 28.3% [13]. These results are affected by differences in patients' general characteristics, trauma type, and treatment characteristics as well as by social and cultural differences.…”

“…Trauma-related characteristics were collected through the information entered into the Korean Trauma Data Base. Based on the items collected from a previous study, this information was organized into five items: mechanism of injury, trauma type, parts of damage, ISS, and admission route [12].…”

“…In a TICU, patients are intubated and receive mechanical ventilation, and undergo assessment according to the site of injury [9,10]. The initial stage of treatment focuses on short-term issues such as treatment for shock through damage control surgery and mass blood transfusions, medication, and changes in consciousness [11,12]. While in the long-term stage of treatment, the focus is on managing sensory integration problems and skin integrity using various therapeutic devices, rehabilitation, and return to daily activities [11,12].…”