Risk Factors Associated With Pressure Ulcers in Patients With Traumatic Brain Injury Admitted to the Intensive Care Unit

Abstract

Pressure injuries (PIs) are one of the most important and frequent complications in patients admitted to the intensive care unit (ICU) or those with traumatic brain injury (TBI). The purpose of this study was to determine the incidence and risk factors of PIs in patients with TBI admitted to the ICU. In this retrospective study, the medical records of 237 patients with TBI admitted to the trauma ICU of a university hospital were examined. Demographic, trauma-related, and treatment-related characteristics of all the patients were evaluated from their records. The incidence of PIs was 13.9%, while the main risk factors were a higher injury severity score, use of mechanical ventilation, vasopressor infusion, lower Braden Scale score, fever, and period of enteral feeding. This study advances the nursing practice in the ICU by predicting the development of PIs and their characteristics in patients with TBI.

Keywords

pressure injury traumatic brain injury intensive care units risk factors

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References

Abdelmalik

P. A.

Draghic

Ling

G. S. F.

(2019). Management of moderate and severe traumatic brain injury. Transfusion, 59(S2), 1529–1538. https://doi.org/10.1111/trf.15171

Alderden

Rondinelli

Pepper

Cummins

Whitney

(2017). Risk factors for pressure injuries among critical care patients: A systematic review. International Journal of Nursing Studies, 71, 97–114. https://doi.org/10.1016/j.ijnurstu.2017.03.012

Alshahrani

Sim

Middleton

(2021). Nursing interventions for pressure injury prevention among critically ill patients: A systematic review. Journal of Clinical Nursing, 30, 2151–2168. https://doi.org/10.1111/jocn.15709

Apostolopoulou

Tselebis

Terzis

Kamarinou

Lambropoulos

Kalliakmanis

(2014). Pressure ulcer incidence and risk factors in ventilated intensive care patients. Health Science Journal, 8(3), 333. https://doi.org/10.1016/j.jcrc.2009.09.002

Becker

Tozo

T. C.

Batista

S. S.

Mattos

A. L.

Silva

M. C. B.

Rigon

Laynes

R. L.

Salomão

E. C.

Hubner

K. D. G.

Sorbara

S. G. B.

Duarte

P. A. D.

(2017). Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features: A multicenter study in southern Brazil. Intensive and Critical Care Nursing, 42, 55–61. https://doi.org/10.1016/j.iccn.2017.03.009

Bolorunduro

O. B.

Villegas

Oyetunji

T. A.

Haut

E. R.

Stevens

K. A.

Chang

D. C.

Cornwell

E. E.

3rd Efron

D. T.

Haider

A. H.

(2011). Validating the injury severity score (ISS) in different populations: ISS predicts mortality better among hispanics and females. Journal of Surgical Research, 166(1), 40–44. https://doi.org/10.1016/j.jss.2010.04.012

Brenner

E. K.

Grossner

E. C.

Johnson

B. N.

Bernier

R. A.

Soto

Hillary

F. G.

(2020). Race and ethnicity considerations in traumatic brain injury research: Incidence, reporting, and outcome. Brain Injury, 34(6), 799–808. https://doi.org/10.1080/02699052.2020.1741033

Cox

(2017). Pressure injury risk factors in adult critical care patients: A review of the literature November 16, 2017 in education. Ostomy/Wound Management, 63(11), 30–43.

Cox

Roche

(2015). Vasopressors and development of pressure ulcers in adult critical care patients. American Journal of Critical Care, 24(6), 501–510. https://doi.org/10.4037/ajcc2015123

10.

de Aguiar Júnior

Saleh

C. M.

Whitaker

I. Y.

(2016). Risk factors for complications of traumatic injuries. Journal of Trauma Nursing, 23(5), 275–283. https://doi.org/10.1097/JTN.0000000000000233

11.

de Almeida Medeiros

A. B.

da Conceição Dias Fernandes

M. I.

de Sá Tinôco

J. D.

Cossi

M. S.

de Oliveira Lopes

M. V.

de Carvalho Lira

A. L. B.

(2018). Predictors of pressure ulcer risk in adult intensive care patients: A retrospective case-control study. Intensive and Critical Care Nursing, 45, 6–10. https://doi.org/10.1016/j.iccn.2017.09.007

12.

de Souza Nogueira

de Alencar Domingues

Poggetti

R. S.

de Sousa

R. M. C.

(2014). Nursing workload in intensive care unit trauma patients: Analysis of associated factors. PLoS One, 9(11), e112125. https://doi.org/10.1371/journal.pone.0112125

13.

Dhandapani

Agarwal

Mahapatra

A. K.

(2014). Pressure ulcer in patients with severe traumatic brain injury: Significant factors and association with neurological outcome. Journal of Clinical Nursing, 23(7–8), 1114–1119. https://doi.org/10.1111/jocn.12396

14.

González-Méndez

M. I.

Lima-Serrano

Martín-Castaño

Alonso-Araujo

Lima-Rodríguez

J. S.

(2018). Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit. Journal of Clinical Nursing, 27(5–6), 1028–1037. https://doi.org/10.1111/jocn.14091

15.

Gorecki

Nixon

Madill

Firth

Brown

J. M.

(2012). What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors. Journal of Tissue Viability, 21(1), 3–12. https://doi.org/10.1016/j.jtv.2011.11.001

16.

European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance, Haesler

(Ed.). (2019). Prevention and treatment of pressure injuries/ulcers: Clinical practice guideline. The international guideline. EPUAP, NPUAP, & PPPIA. https://www.internationalguidelines.com

17.

Jackson

Durrant

Bishop

Walthall

Betteridge

Gardner

Coulton

Hutchinson

Neville

Davidson

P. M.

Usher

(2017). Pain associated with pressure injury: A qualitative study of community-based, home-dwelling individuals. Journal of Advanced Nursing, 73(12), 3061–3069. https://doi.org/10.1111/jan.13370

18.

Jonsdottir

G. M.

Lund

S. H.

Snorradottir

Karason

Olafsson

I. H.

Reynisson

Mogensen

Sigvaldason

(2017). A population-based study on epidemiology of intensive care unit treated traumatic brain injury in Iceland. Acta Anaesthesiologica Scandinavica, 61(4), 408–417. https://doi.org/10.1111/aas.12869

19.

Jung

Y. J.

Chung

Y. H.

S. J.

Lee

S. H.

Kim

Y. H.

Kim

T. H.

Keum

M. A.

Kyoung

K. H.

Kim

J. J.

Hong

S. K.

(2015). Risk factors for pressure ulcer in severe trauma patients. Journal of Acute Care Surgery, 5(1), 19–27. https://doi.org/10.17479/jacs.2015.5.1.19

20.

Kumar

R. G.

Ketchum

J. M.

Corrigan

J. D.

Hammond

F. M.

Sevigny

Dams-O’Connor

(2020). The longitudinal effects of comorbid health burden on functional outcomes for adults with moderate to severe traumatic brain injury. Journal of Head Trauma Rehabilitation, 35(4), E372–E381. https://doi.org/10.1097/HTR.0000000000000572

21.

Kwak

H. R.

Kang

(2015). Pressure ulcer prevalence and risk factors at the time of intensive care unit admission. Korean Journal of Adult Nursing, 27(3), 347–357. https://doi.org/10.7475/kjan.2015.27.3.347

22.

Lee

S. H.

(2020). The current state and prevention strategies of traumatic brain injury (TBI) in Korea. Public Health Weekly Report, 13(12), 674–691.

23.

Ngubane

(2011). Mechanical ventilation and the injured brain. Southern African Journal of Anaesthesia and Analgesia, 17(1), 76–80. https://doi.org/10.1080/22201173.2011.10872737

24.

Nguyen

K. H.

Chaboyer

Whitty

J. A.

(2015). Pressure injury in Australian public hospitals: A cost-of-illness study. Australian Health Review, 39(3), 329–336. https://doi.org/10.1071/AH14088

25.

Nonnemacher

Stausberg

Bartoszek

Lottko

Neuhaeuser

Maier

(2009). Predicting pressure ulcer risk: A multifactorial approach to assess risk factors in a large university hospital population. Journal of Clinical Nursing, 18(1), 99–107. https://doi.org/10.1111/j.1365-2702.2008.02425.x

26.

Odgaard

Aadal

Eskildsen

Poulsen

(2018). Nursing sensitive outcomes after severe traumatic brain injury: A nationwide study. Journal of Neuroscience Nursing, 50(3), 149–154. https://doi.org/10.1097/jnn.0000000000000365

27.

Osis

S. L.

Diccini

(2020). Incidence and risk factors associated with pressure injury in patients with traumatic brain injury. International Journal of Nursing Practice, 26(3), e12821. https://doi.org/10.1111/ijn.12821

28.

Saghaleini

S. H.

Dehghan

Shadvar

Sanaie

Mahmoodpoor

Ostadi

(2018). Pressure ulcer and nutrition. Indian Journal of Critical Care Medicine, 22(4), 283–289. https://doi.org/10.4103/ijccm.IJCCM_277_17

29.

Zampolini

Zaccaria

Tolli

Frustaci

Franceschini

; GISCAR Group. (2012). Rehabilitation of traumatic brain injury in Italy: A multi-centred study. Brain Injury, 26(1), 27–35. https://doi.org/10.3109/02699052.2011.635358

30.

Zarei

Madarshahian

Nikkhah

Khodakarim

(2019). Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran. Journal of Tissue Viability, 28(2), 70–74. https://doi.org/10.1016/j.jtv.2019.02.001