Which factors predict incident pressure ulcers in hospitalized patients? A prospective cohort study.

Abstract

The prevention of pressure ulcers (PU) is an important public health issue owing to their substantial clinical and economic burden. To investigate predictors of incident PU in hospitalized patients and the performance of the Braden Scale in intensive care units (ICU) and normal care units (NCU). We conducted a prospective cohort study including all inpatients treated at the University Hospital Carl Gustav Carus Dresden, Germany, between 2007 and 2011. Documentation comprised patient characteristics, Braden Scale and clinical signs of PU. The primary outcome was incident PU during inpatient treatment. Predictors of PU were explored by using univariate and multivariate logistic regression models. To evaluate the performance of the Braden Scale a receiver operating characteristics (ROC) curve analysis was applied. The overall incidence of PU during inpatient treatment was 0·78%. A higher rate of PU was observed at ICU vs. NCU (4·77% vs. 0·59%). Multivariate analysis identified age [odds ratio (OR) 1·04, 95% confidence interval (CI) 1·035-1·041 per year], female sex (OR 1·11, 95% CI 1·01-1·22), length of stay (OR 17·79, 95% CI 15·46-20·48 for 30 or more days vs. < 10 days) and admission from care facility compared with admission from home (OR 3·14, 95% CI 2·63-3·75) as significant predictors of incident PU. The area under the ROC curve was 84·89% at NCU and 69·0% at ICU. The identified predictors for incident PU may inform targeted, evidence-driven preventive measures to decrease the burden of PU.