Value of pressure injury assessment scales for patients in the intensive care unit: Systematic review and diagnostic test accuracy meta-analysis

Zhang, Yi; Zhuang, Yiyu; Shen, Jiantong; Chen, Xianggping; Wen, Qiuyue; Jiang, Qi; Lao, Yuewen

doi:10.1016/j.iccn.2020.103009

Cited by 31 publications

(48 citation statements)

References 38 publications

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“…Altogether, these findings are really important, helping nurses and physicians to better identify patients who require additional care. For instance, the widely used Braden scale to assess the risk for pressure ulcers (which takes into account sensory perception, skin moisture, activity, mobility, nutrition, friction and shear) has poor predictive value for patients in ICU ( Cox, 2012 , Deschepper et al, 2021 , Zhang et al, 2021 ). For this reason, in addition to standard tools, BMI should be considered when evaluating the risk for pressure ulcers development.…”

Section: Discussionmentioning

confidence: 99%

Complications of prone positioning in patients with COVID-19: A cross-sectional study

Binda¹,

Galazzi²,

Marelli³

et al. 2021

Intensive and Critical Care Nursing

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Objective To determine the prevalence of complications in patients with COVID-19 undergone prone positioning, focusing on the development of prone-related pressure ulcers. Methods Cross-sectional study conducted in the hub COVID-19 center in Milan (Italy), between March and June 2020. All patients with COVID-19 admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning were included. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. Results A total of 219 proning cycles were performed on 63 patients, aged 57.6 (10.8) and predominantly obese males (66.7%). The main complications recorded were: prone-related pressure ulcers (30.2%), bleeding (25.4%) and medical device displacement (12.7%), even if none unplanned extubation was recorded. Bleeding of upper airways represented the most common site (17.5%). Only 15 prone positioning cycles (6.8%) were interrupted, requiring staff to roll the patient back in the supine position. The likelihood of pressure ulcers development was independently associated with the duration of prone positioning, once adjusting for age, hypoxemic level, and nutritional status (OR 1.9, 95%CI 1.04 to 3.6). Conclusion The use of prone positioning in patients with COVID-19 was a safe and feasible treatment, also in obese patients, who might deserve more surveillance and active prevention by intensive care unit staff.

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Section: Discussionmentioning

confidence: 99%

Complications of prone positioning in patients with COVID-19: A cross-sectional study

Binda¹,

Galazzi²,

Marelli³

et al. 2021

Intensive and Critical Care Nursing

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“…In this study, we found that Braden score was not associated with the occurrence of PIs in ICU adult patients. A recent meta‐analysis also showed that the Braden Scale only had a moderate predictive value with good sensitivity and low specificity for determination of risk of PIs in adult ICU patients 28,29 . Even though Braden Scale covers seven domains to determine the skin condition, it does not include other specific risk factors of PIs in ICU patients such as age, sedation, vasoactive agents, and mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi‐centre prospective point prevalence study

Lin

et al. 2021

International Wound Journal

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Despite increasing preventive efforts, pressure injury still occurs in intensive care patients. This study was aimed to describe pressure injury prevalence, risk factors, and prevention practices in adult intensive care patients. This was a multi‐centre, one‐day, prospective point prevalence study in which a total of 198 intensive care units from 21 provinces in China participated. Overall and ICU‐acquired prevalence in intensive care patients were 12.26% and 4.31%, respectively. Consistent with earlier reports, almost half of the ICU‐acquired pressure injuries were at stage I, one‐fourth were at stage 2, and the most common body sites for pressure injuries were sacral and heel region. Risk factors identified were consistent with prior studies. Repositioning was the most commonly used pressure injury prevention strategy, followed by alternating pressure mattresses/overlays, floating heels, and air‐filled mattresses/overlays. These reflect a good level of adherence to recommended international pressure injury prevention clinical practice guidelines. The results provide a baseline reference for overall and ICU‐acquired prevalence among adult intensive care patients in China. Future research on what contributed to the lower pressure injury incidence in China needs to be conducted to inform healthcare organisations on their future preventive strategies for pressure injury prevention.

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“…In addition, despite widespread use, there is a lack of verification of tools used for PI risk assessment in the ICU setting. 31 Future research must incorporate robust design to revise and refine existing mucosal PI classification options. Using instruments in real time also accommodates the assessment of content and construct validity.…”

Section: Discussionmentioning

confidence: 99%

Inter-rater reliability of descriptors for the classification of mucosal pressure injury: A prospective cross-sectional study

Fitzgerald¹,

McTier²,

Whitehead³

et al. 2023

Australian Critical Care

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Background: Mucosal pressure injuries (PIs) are usually caused by pressure from essential medical devices. There is no universally accepted criterion for assessment, monitoring, or reporting mucosal PI. Reliable descriptors are vital to benchmark the frequency and severity of this hospital-acquired complication.Objectives: The objective of this study was to determine whether modified Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) descriptors improved the reliability of mucosal PI assessment. Secondary aims were to explore nurses' knowledge of and attitudes toward mucosal PI. Methods: A prospective cross-sectional survey was distributed to nurses from two tertiary affiliated intensive care units via REDCap ® to capture demographic data, knowledge, attitudes, and inter-rater reliability (IRR) measures. Nurses were randomised at a 1:1 ratio to original or modified ROMPIS descriptors and classified 12 images of mucosal PI. IRR was assessed using percentage agreement, Fleiss' kappa, and intraclass correlation coefficients. Results: The survey response rate was 20.9% (n ¼ 98/468), with 73.5% (n ¼ 72/98) completing IRR measures. Agreement was higher with modified (75%) than original ROMPIS descriptors (69.4%). IRR was fair for the original (k ¼ 0.30, 95% confidence interval [CI] [0.28, 0.33], z 26.5, p < 0.001) and modified ROMPIS (k ¼ 0.29, 95% CI [0.26, 0.31], z 25.0, p < 0.001). Intraclass correlation coefficient findings indicated ratings were inconsistent for the original (0.33, 95% CI [0.18, 0.59], F 18.8 (11 df), p < 0.001) and modified ROMPIS (0.31, 95% CI [0.17, 0.57], F 17.6 (11 df), p < 0.001). PI-specific education and risk factor recognition were common. Conclusion: Modified descriptors had marginally better agreement. Participants understand management and prevention but need to strengthen their perceived capacity for mucosal PI risk assessment. This work provides a foundation for future benchmarking and a platform from which further research to refine and test descriptors specific to mucosal PI can be generated.

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Value of pressure injury assessment scales for patients in the intensive care unit: Systematic review and diagnostic test accuracy meta-analysis

Cited by 31 publications

References 38 publications

Complications of prone positioning in patients with COVID-19: A cross-sectional study

Complications of prone positioning in patients with COVID-19: A cross-sectional study

Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi‐centre prospective point prevalence study

Inter-rater reliability of descriptors for the classification of mucosal pressure injury: A prospective cross-sectional study

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