Differential Diagnosis in Pressure Ulcers and Medical Devices

Background: Pressure ulcers (PU) are considered to an adverse event and constitute a constant challenge for all health professionals and institutions. Aim: Study the prevalence and incidence of PU in a intensive care unit (ICU) and the difficulties of classification and characterization of the lesions in critical ill patients. .Materials and methods: Retrospective cohort analysis of electronic health record database from adult patients admitted to a ICU during 2012/1013. Barriers/difficulty's to classification of PUs 'were also studied in the nursing staff. Results: Epidemiologic sample study included 600 participants, and differential diagnoses study 27 nurses. The episodes in the study period (n = 600), 98 'were identified with at least one PU present during hospitalization period, corresponding to a prevalence rate of 16.3%. The remaining 502 had no PU recording at entry or during hospitalization, 98 patients who were identified with PU, 40.8% presented it upon admission, and 59.2% developed ulceration in the service after 24 hours of admission (n = 58), which resulted in an incidence rate of 11.4%. The categorization of the PU ulcers identified in the present study, the most prevalent was category II (36,1%), followed by IV (35,4%), then I (13.1%) and III (10.8%). Regarding barriers of the differential diagnosis, 77.7% reported difficulty in evaluating PU in patients with peripheral arterial disease; 92.5% referred difficulty in evaluating Category I in dark skin; 81.5% referred subjectivity in the characterization in the mucosa; 40.7% reported difficulty PU associated to medical devices; 96.3% considered essential training as a way to reduce subjectivity. Conclusion: Extra attention needs to be taken to prevent PU in ICU. The incidence of PU is higher if associated with a medical device, Staff must adopt multiple strategies to prevent it. More education and sharing experiences is needed to reduce the subjectivity of differential diagnosis in PU.