Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study
Sonia Labeau, Elsa Afonso, Julie Benbenishty, Bronagh Blackwood, Carole Boulanger, Stephen J. Brett, Silvia Calvino-Gunther, Wendy Chaboyer, Fiona Coyer, Mieke Deschepper, Guy François, Patrick M. Honoré, Radmilo Janković, Ashish K. Khanna, Mireia Llauradó‐Serra, Frances Lin, Louise Rose, Francesca Rubulotta, Leif Saager, Ged Williams, Stijn Blot, on behalf of the DecubICUs Study Team, the European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators, Dritan Muzha, Antoni Margarit Ribas, Fernando Lipovesty, Cecilia Loudet, Fiona Coyer, Philipp Eller, Nafseen Mostafa, Patrick M. Honoré, Vanesa Mercado Telleria, Jasmina Smajić, Paula Cristina Nogueira, Khalid Mahmood Khan Nafees, Romuald Hentchoya, Louise Rose, Javiera Soledad, Frances Lin, Yenny Cardenas, A. Reyes, Alan Šustić, Meropi Mpouzika, Tamas Vymazal, Hanne Irene Jensen, Hernán Aguirre-Bermeo, Liivi Maddison, M. Valta, Silvia Calvino-Gunther, Frank Bloos, Faustina Excel Adipa, Vasilios Koulouras, Judy Enamorado Enamorado, Zsuzsann Ágoston, Hrönn Birgisdóttir, Amit Gupta, Mohan Gurjar, Bram Kilapong, Seyed Mohammad Reza Hashemian, Ignacio Martín‐Loeches, Julie Benbenishty, Andrea Cortegiani, Kelly Fletcher, Yoshiro Hayashi, Wangari Waweru-Siika, Khalid Abidi, Sang‐Min Lee, B. Hadri, Mihails Dolgusevs, Fayez Abillama, Tomas Jovaiša, Cyril A Thix, Muhammed Elhadi, Basri Mat Nor, Shanti Ratnam, Mohd Zulfakar Mazlan, Sundaresan Maiyalagan, Luis Alejandro Sánchez‐Hurtado, Adrian Belii, Mendsaikhan Naranpurev, Prabha Gautam, Dylan De lange, Rachael Parke, Rose Ilesanmi, Mirjana Shosholcheva, Antonija Petosic, Ranveig Lind, Madiha Hashmi Ffarcsi, Javier Bogarin, Aaron Mark Hernandez, Malgorzata Mikaszewska-Sokolewicz, B. A. M. Sousa, Dana Tomescu, Dorel Săndesc, Théogène Twagirumugabe, V. G. Gusarov, Maie Salem Ebaid, Radmilo Janković, Gari Slobodianiuk, Andrea Martonova
Abstract
PURPOSE: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. METHODS: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. RESULTS: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9-27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6-16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2-1.8), stage II (OR 1.6; 95% CI 1.4-1.9), and stage III or worse (OR 2.8; 95% CI 2.3-3.3). CONCLUSION: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.