title: cEEG electrode-related pressure ulcers in acutely hospitalized patients.
abstract: BACKGROUND
  Pressure ulcers resulting from continuous EEG (cEEG) monitoring in hospitalized patients have gained attention as a preventable medical complication. We measured their incidence and risk factors.
  
  
  METHODS
  We performed an observational investigation of cEEG-electrode-related pressure ulcers (EERPU) among acutely ill patients over a 22-month period. Variables analyzed included age, sex, monitoring duration, hospital location, application methods, vasopressor usage, nutritional status, skin allergies, fever, and presence/severity of EERPU. We examined risk for pressure ulcers vs monitoring duration using Kaplan-Meyer survival analysis, and performed multivariate risk assessment using Cox proportional hazard model.
  
  
  RESULTS
  Among 1,519 patients, EERPU occurred in 118 (7.8%). Most (n = 109, 92.3%) consisted of hyperemia only without skin breakdown. A major predictor was monitoring duration, with 3-, 5-, and 10-day risks of 16%, 32%, and 60%, respectively. Risk factors included older age (mean age 60.65 vs 50.3,p< 0.01), care in an intensive care unit (9.37% vs 5.32%,p< 0.01), lack of a head wrap (8.31% vs 27.3%,p= 0.02), use of vasopressors (16.7% vs 9.64%,p< 0.01), enteral feeding (11.7% vs 5.45%,p= 0.04), and fever (18.4% vs 9.3%,p< 0.01). Elderly patients (71-80 years) were at higher risk (hazard ratio 6.84 [1.95-24],p< 0.01), even after accounting for monitoring time and other pertinent variables in multivariate analysis.
  
  
  CONCLUSIONS
  EERPU are uncommon and generally mild.Elderly patients and those with more severe illness have higher risk of developing EERPU, and the risk increases as a function of monitoring duration.
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: Lidia M V R
authors.initials: LM
authors.lastname: Moura
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: Thiago S
authors.initials: TS
authors.lastname: Carneiro
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: David
authors.initials: D
authors.lastname: Kwasnik
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: Valdery F
authors.initials: VF
authors.lastname: Moura
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Blodgett
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: Mary
authors.initials: M
authors.lastname: McKenna Guanci
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Hoch
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cole
authors.affiliation: Massachusetts General Hospital (LMVRM, TSC, DK, VFM, JC, MKG, DBH, JH, AJC, MBW), Boston; Physicians Ancillary Services, LLC (CSB), Rocky Hill, CT; and Labouré College (CSB), Milton, MA.
authors.forename: M Brandon
authors.initials: MB
authors.lastname: Westover