Incidence of pressure ulcers in a neurologic intensive care unit

Objectives: To determine the risk factors for pressure ulceration in an intensive care setting, to evaluate the Braden scale as a predictor of pressure ulcer risk in critically ill patients, and to determine whether pressure ulcers are likely to occur early in the hospital stay. Design: Cohort study of patients with no preexisting ulcers with a 3-month enrollment period. Setting: The neurologic intensive care unit and the neurologic intermediate unit at a primary care/referral hospital with a level I trauma center. Patients: A total of 186 patients entered the study. Intervention: Within 12 hrs of admittance, initial assessment, photographs, and Braden score were completed. Patients were re-examined every 4 days or at discharge from the unit, which-ever came first. Main Outcome Measures: Determining risk factors for pressure ulcers, performing detailed statistical analyses, and testing the usefulness of the Braden score as a predictor of pressure ulcer risk. Results: Twenty-three of 186 patients developed at least one pressure ulcer (incidence = 12.4%) after an average stay of 6.4 days. The Braden scale, which measures six characteristics of skin condition and patient status, proved to be a primary predictor of ulcer development. No ulcers developed in the 69 patients whose Braden score was 16 or higher, The likelihood of developing a pressure sore was predicted mathematically from the Braden score. However, being underweight was a significant and distinct factor in pressure ulcer development. Conclusions: Pressure ulcers may develop within the first week of hospitalization in the intensive care unit. Patients at risk have Braden scores of less than or equal to 16 and are more likely to be underweight. These results suggest that aggressive preventive care should be focused on those patients with Braden scores of less than or equal to 13 and/or a low body mass index at admission.