title: A Study of the Factors Associated with Risk for Development of Pressure Ulcers: A Longitudinal Analysis.
abstract: BACKGROUND
  Pressure ulcers (PUs) are prevalent in hospitalized patients; they may cause clinical, psychological, and economic problems in these patients. Previous studies are cross-sectional, have used pooled data, or cox-regression models to assess the risk for developing PU. However, PU risk scores change over time and models that account for time varying variables are useful for cohort analysis of data.
  
  
  OBJECTIVE
  The present longitudinal study was conducted to compare the risk of PU between surgical and nonsurgical patients, and to evaluate the factors associated with the development of these ulcers over a period of time.
  
  
  METHODS
  We evaluated 290 hospitalized patients over a 4 months period. The main outcomes for our analysis were: (1) Score on the pressure risk assessment scale; and (2) the proportion of individuals who were at severe risk for developing PUs. We used random effects models for longitudinal analysis of the data.
  
  
  RESULTS
  The mean PU score was significantly higher in the nonsurgical patients compared with surgical patients at baseline (15.23 [3.86] vs. 9.33 [4.57]; P < 0.01). About 7% of the total patients had a score of >20 at baseline and were considered as being at high-risk for PU; the proportion was significantly higher among the nonsurgical patients compared with the surgical patients (14% vs. 4%, P = 0.003). In the adjusted models, there was no difference for severe risk for PU between surgical and nonsurgical patients (odds ratios [ORs]: 0.37, 95% confidence interval [CI]: 0.01-12.80). An additional day in the ward was associated with a significantly higher likelihood of being at high-risk for PU (OR: 1.47, 95% CI: 1.16-1.86).
  
  
  CONCLUSIONS
  There were no significant differences between patients who were admitted for surgery compared with those who were not. An additional day in the ward, however, is important for developing a high-risk score for PU on the monitoring scale, and these patients require active interventions.
authors.affiliation: Department of Nursing, Dr. L H Hiranandani Hospital, Powai, Mumbai, Maharashtra, India.
authors.forename: Elizebeth
authors.initials: E
authors.lastname: Thomas
authors.affiliation: Department of Nursing, Dr. L H Hiranandani Hospital, Powai, Mumbai, Maharashtra, India.
authors.forename: Sudhaya
authors.initials: S
authors.lastname: Vinodkumar
authors.affiliation: Department of Nursing, Dr. L H Hiranandani Hospital, Powai, Mumbai, Maharashtra, India.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mathew
authors.affiliation: Consultant Epidemiologist, Dr. L H Hiranandani Hospital, Powai, Mumbai, Maharashtra, India.
authors.forename: Maninder Singh
authors.initials: MS
authors.lastname: Setia
keywords: India; longitudinal analysis; pressure ulcers; risk factors; surgical/nonsurgical