Risk for undernutrition and development of pressure injury in hospitalised patients in Brazil: Multicentre prospective cohort study

Abstract

Although pressure injury (PI) is preventable, the number of patients developing this type of injury is still high. In this prospective cohort study, we aimed to assess whether high risk for undernutrition was a risk factor for PI in 1937 patients aged ≥18 at six hospitals in Sao Paulo, Brazil. Patients' risk for undernutrition was assessed using three unique screening tools. Risk for PI was assessed using the Braden Scale. Data were analysed using Poisson regression with robust variance (95% CI, P ≤ .05). While 57.1% of patients were at risk for undernutrition in the Nutritional Risk Screening (NRS 2002), only 36.8% and 2.6% were at risk in the Braden Scale Nutrition Subscale (BSNS) and Subjective Global Assessment of Nutritional Status (SGANS), respectively. The cumulative incidence rate was 5.9%. Of those who developed PI, 91.2%, 56.2%, and 18.4% were at risk for undernutrition in the NRS 2002, BSNS, and SGANS scales, respectively. We found a significantly higher risk for PI in patients who were at risk for undernutrition compared with those who were not at risk, supporting previous evidence about the role of undernutrition as a key risk factor for PI in hospitalised patients.

Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis

“…Screening of titles and abstracts was done with 11,517 entries where 123 studies were deemed appropriate for full-text analysis. In the end, 67 studies were included in narrative synthesis, with 32 prospective cohort studies [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], 26 retrospective record reviews [ 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ,…”

“…Forty-five studies analysed pressure injury development as a dichotomous outcome [ 18 , 20 , 21 , 23 , 24 , 26 , 27 , 29 , 30 , 32 , 33 , 35 , 36 , 39 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 53 , 54 , 55 , 56 , 57 , 58 , 60 , 61 , 62 , 63 , 65 , 66 , 68 , 71 , 72 , 74 , 75 , 77 , 79 , 82 , 83 ], 20 studies reported time to the development of pressure injuries [ 19 , 22 , 25 , 28 , 31 , 34 , 37 , 38 , 40 ,…”

“…The focus of “outcome measurement” was the assessment of pressure injuries by skilled or trained health worker, e.g., nurses, doctors etc., and the definition of pressure injuries by certain and clearly defined standards. Many studies failed to report an adequate staging or assessment of pressure injury by trained health workers, specific pressure injury definition, or both, which resulted in 40% of studies having moderate [ 18 , 19 , 24 , 25 , 29 , 31 , 32 , 33 , 39 , 42 , 45 , 47 , 51 , 53 , 55 , 57 , 58 , 59 , 62 , 63 , 69 , 72 , 73 , 74 , 76 , 78 , 82 ] and 19% having high risk of bias in this domain [ 18 , 22 , 34 , 36 , 41 , 43 , 52 , 56 , 60 , 64 , 71 , 75 , 79 ].…”

“…Variables related to body size e.g., body mass index (BMI), weight and height were entered in 17 studies [ 18 , 19 , 24 , 26 , 30 , 34 , 43 , 49 , 50 , 53 , 56 , 61 , 62 , 64 , 77 , 83 , 84 ]. Out of 23 entered variables, eight emerged as significant predictors of pressure injury development.…”

“…Researchers of 41 studies analysed age as an independent predictor in their multivariate analysis [ 19 , 21 , 22 , 23 , 24 , 27 , 28 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 43 , 44 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 61 , 62 , 63 , 67 , 72 , 75 , 77 , 82 , 83 , 84 ]. In over half of them (60%) increasing age resulted in a higher risk of pressure injury development.…”