Identification of Risk Factors for the Development of Pressure Ulcers Despite Standard Screening Methodology and Prophylaxis in Trauma Patients.
OBJECTIVE
To present information about a study of risk factors for development of pressure ulcers (PrUs) in trauma patients.


BACKGROUND
This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
After participating in this educational activity, the participant should be better able to:1. Describe the previous PrU research, scope of the problem, and methodology of the study.2. Explain the results of the study identifying PrU risk factors for trauma patients.



OBJECTIVE
Pressure ulceration prevention has been emphasized  over the past several years in inpatient hospital settings with  subsequent decreases in the development of pressure ulcers (PrUs).  However, there remains a subset of trauma and burn patients  that develop PrUs despite standard screening methodology and  prophylaxis. This study determines the conditions that predict  development of pressure ulcers (PrUs) despite conventional  prophylaxis and screening.


METHODS
Demographic and PrU data were collected over a  5-year period from June 2008 to May 2013. Patients diagnosed  with PrUs upon arrival in the trauma bay were excluded from  analysis. An ordinal logistic regression of PrU stage was used to  estimate odds ratios (ORs) and associated 95% confidence intervals  (CIs) for the association between characteristics of interest and  odds of a PrU. A backward selection process was used to select the  most parsimonious model.


RESULTS
During the study period, 14,616 trauma patients were  admitted and had available data. A total of 124 patients (0.85%) that met inclusion criteria went on to develop PrUs during their hospital course. Factors associated with the development of PrUs included spine Abbreviated Injury Scale (AIS) >3 (OR, 5.72; CI, 3.63-9.01), mechanical ventilation (OR, 1.95; CI, 1.23-3.10) and age 40 to 64 (OR, 2.09; CI, 1.24-3.52) and age ≥ 65 (OR, 4.48; CI, 2.52-7.95). Interestingly, head injury AIS >3 was protective from the development of PrUs (OR, 0.56; CI, 0.32-0.96). Hypotension and shock defined as systolic BP <90 mm Hg and base deficit less than -6 were not associated with the development of PrUs. In addition, body mass index was not associated with PrU development.


CONCLUSIONS
Spinal injuries, older than age 40, and mechanical  ventilation predict the development of PrUs for a subset of  patients, despite conventional prophylaxis and screening. Advanced  prevention methods, such as low-air-loss mattresses for these patient  subgroups should be considered immediately upon identification  of these risk factors during the hospital course.
Lauren A. Raff, MD • Chief Resident • Department of Surgery • University of Alabama at BirminghamHolly Waller, MPH, RN • Director • Trauma and Burn Services • University of Alabama at BirminghamRussell L. Griffin, PhD • Assistant Professor of Epidemiology • University of Alabama at Birmingham Center for Injury SciencesJeffrey D. Kerby, MD, PhD • Director • Division of Acute Care Surgery Care • University of Alabama at Birmingham Patrick L. Bosarge, MD • Assistant Professor • Department of Surgery • Director • Trauma Critical Care Fellowship.
Lauren A
LA
Raff
Holly
H
Waller
Russell L
RL
Griffin
Jeffrey D
JD
Kerby
Patrick L
PL
Bosarge
D000407:Alabama; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards; D008991:Monitoring, Physiologic / Q000379:methods*; D015999:Multivariate Analysis; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy