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, whichever 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 ≤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 ≤13 and/or a low body mass index at admission.