title: Insult after injury: pressure ulcers in trauma patients.
abstract: METHODS
  Nonexperimental-Descriptive.
  
  
  METHODS
  The inclusion criteria were trauma patients, ages 15 and older, who were hospitalized for > 2 days, and who did not have preexisting skin breakdown. A total of 148 consecutive trauma patients admitted to the study institution meeting the inclusion criteria were prospectively enrolled.
  
  
  METHODS
  Patients were assessed every 3 days for skin breakdown. Information on the patient's bed type, therapies, medical devices, and nutrition was collected. The Braden Scale for predicting pressure ulcer risk was completed at each assessment.
  
  
  RESULTS
  Of the 148 patients enrolled, 30 developed at least one area of skin breakdown for a prevalence of 20.3% in patients hospitalized more than 2 days. The most common cause of breakdown was positional pressure (47.4%). Cervical collars were the second leading cause at 23.7%, followed by tracheostomy/endotracheal tubes at 10.5%. The mobility subscale of the Braden Pressure Ulcer Risk Assessment tool was significantly predictive of skin breakdown (p < .001).
  
  
  CONCLUSIONS
  Skin breakdown is a significant problem in trauma patients who are hospitalized for more than 2 days. Aggressive protocols on positioning, cervical collar use, and airway adjuncts, as well as additional active nursing interventions for immobile patients, may be ways to decrease the skin breakdown prevalence in this population.
authors.affiliation: Inova Fairfax Hospital, Falls Church, Virginia, USA.
authors.forename: D
authors.initials: D
authors.lastname: Watts
authors.forename: E
authors.initials: E
authors.lastname: Abrahams
authors.forename: C
authors.initials: C
authors.lastname: MacMillan
authors.forename: J
authors.initials: J
authors.lastname: Sanat
authors.forename: R
authors.initials: R
authors.lastname: Silver
authors.forename: S
authors.initials: S
authors.lastname: VanGorder
authors.forename: M
authors.initials: M
authors.lastname: Waller
authors.forename: D
authors.initials: D
authors.lastname: York
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D009730:Nursing Assessment / Q000379:methods; D016530:Orthopedic Nursing; D003668:Pressure Ulcer / Q000145:classification / Q000209:etiology* / Q000451:nursing / Q000503:physiopathology; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index