ABSTRACT

Objective:

Pressure ulcers (PU) are common in patients admitted to palliative care clinics (PCC). Pregressive nutritional deficiency, incontinence, and limitation of movement increase the risk of new PU formation. Purpose: To examine the risk of PU in patients hospitalized in PCC andthe rate of wounds on admission.

Materials and Methods:

We retrospectively analyzed patients hospitalized between 2017 and 2019 in a PCC integrated into a tertiary health institution. Patients with demographic and clinical data, data on the region, number, and stage of PU, and Norton and Braden pressure risk scores were enrolled. Patients with scores 11 on the Norton scale and 18 on the Braden scale were considered to be at higher risk for PU.

Results:

The final analysis included 566 patients [mean age: 68 years, male: 328 (58%)]. On admission, PU was recorded in 181 patients (32%) (sacrum: 80%). According to the Norton scale, 269 (47.5%) of all cases were under the risk of PU and 48.7% (n=131) of them already had PU. According to the Braden scale, 475 (83.9%) patients were at risk of PU, and 37.5% (n=178) of them already had PU. Among subjects with a low Norton score (n=297), 16% (n=50) already had PUs. Among subjects with PUs, the Norton score was not high 27.6%. Only 3.3% (n=3) of 91 patients whose Braden score was not low already had a PU. The sensitivity and specificity of the Norton score in the prediction of PU were 48.9% and 83.2%, respectively. The sensitivity and specificity of the Braden score in the prediction of PU were 66.9% and 99.0%, respectively.

Conclusion:

Physical PU examination on admission to PCC and during follow-up can identify a significant number of cases. The utility of Norton and Braden scores to estimate the occurrence of PUs may be limited in the palliative care setting or patients.

Keywords: Palliative care, pressure ulcer, Norton scale, Braden scale

References

National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler, editor. Cambridge Media: Osborne Park, Western Australia; 2014.

Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System. J Wound Ostomy Continence Nurs 2016;43:585-97.

Scott JR, Gibran NS, Engrav LH, Mack CD, Rivara FP. Incidence and characteristics of hospitalized patients with pressure ulcers: State of Washington, 1987 to 2000. Plast Reconstr Surg 2006;117:630-4.

Braden B, Bergstrom N. A conceptual schema for the study of the etiology of pressure sores. Rehabil Nurs 1987;12:8-12.

Herrman EC, Knapp CF, Donofrio JC, Salcido R. Skin perfusion responses to surface pressure-induced ischemia: implication for the developing pressure ulcer. J Rehabil Res Dev 1999;36:109-20.

Ayello EA, Baranoski S, Lyder CH, et al. Pressure Ulcers. Wound care essentials: Practice principles. Lippincott Williams and Wilkins; 2012;324-59.

Defloor T. The risk of pressure sores: a conceptual scheme. J Clin Nurs 1999;8:206-16.

Cooper KL. Evidence-based prevention of pressure ulcers in the intensive care unit. Crit Care Nurse 2013;33:57-66.

González-Méndez MI, Lima-Serrano M, Martín-Castaño C, Alonso-Araujo I, Lima-Rodríguez JS. Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit. J Clin Nurs 2018;27:1028-37.

House KW, Johnson TM. Prevention of Pressure Ulcers. In: Thomas D, Compton G. editors. Pressure Ulcers in the Aging Population. Aging Medicine. Humana Press: Totowa, NJ; 2014.

Langemo DK, Black J; National Pressure Ulcer Advisory Panel. Pressure ulcers in individuals receiving palliative care: a National Pressure Ulcer Advisory Panel white paper. Adv Skin Wound Care 2010;23:59-72.

Doğu Ö, Önen S. Basınç ülseri takip ve tedavisinde kullanılan ölçekler. Yoğun Bakım Hemşireliği Dergisi 2020;24:199-208.

Soyer Ö. Yoğun bakım hastalarında Jackson/Cubbin Basınç Alanı Risk Hesaplama Aracının duyarlılık, özgüllük, tahmin etme değerinin incelenmesi. İzmir: Dokuz Eylül Üniversitesi; 2014.

Oğuz S, Olgun N. Braden Ölçeği ile hastaların risklerinin belirlenmesi ve planlı hemşirelik bakımının bası yaralarının önlenmesindeki etkinliğinin saptanması. Hemşirelik Forum 1998;1:131-5.

García-Fernández FP, Pancorbo-Hidalgo PL, Agreda JJS. Risk assessment scales for pressure ulcer in intensive care units: A systematic review with metaanalysis. European Wound Management Association Journal. Gerokomos 2013;24:82-9.

Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res 1987;36:205-10.

Kottner J, Dassen T. Pressure ulcer risk assessment in critical care: interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units. Int J Nurs Stud 2010;47:671-7.

Stoelting J, McKenna L, Taggart E, Mottar R, Jeffers BR, Wendler MC. Prevention of nosocomial pressure ulcers: a process improvement project. J Wound Ostomy Continence Nurs 2007;34:382-8.

Jun Seongsook RN, Jeong Ihnsook RN, Lee Younghee RN. Validity of pressure ulcer risk assessment scales; Cubbin and Jackson, Braden, and Douglas scale. Int J Nurs Stud 2004;41:199-204.

Beğer T. Yoğun bakımda dekübit ülserleri: Risk faktörleri ve önlenmesi. Yoğun Bakım Dergisi 2004;4:244-53.

Yepes D, Molina F, León W, Pérez E. Incidence and risk factors associated with the presence of pressure ulcers in critically ill patients. Med Intensiva 2009;33:276-81.

Sharp CA, White RJ. Pressure ulcer risk assessment: do we need a golden hour? J Wound Care 2015;24:237.

Coyer F, Miles S, Gosley S, Fulbrook P, Sketcher-Baker K, Cook JL, et al. Pressure injury prevalence in intensive care versus non-intensive care patients: A state-wide comparison. Aust Crit Care 2017;30:244-50.

Turgut N, Ak A, Yakar N, Yakar N, Yılmaz B, Cora B, et al. Yoğun bakım hastalarında basınç ülseri sıklığı, önlenmesi ve tedavis J Turk Soc Intens Care 2017;15:72-6.

Chen HL, Cao YJ, Wang J, Huai BS. Calibration power of the Braden scale in predicting pressure ulcer development. J Wound Care 2016;25:655-9.

Ranzani OT, Simpson ES, Japiassú AM, Noritomi DT; Amil Critical Care Group. The Challenge of Predicting Pressure Ulcers in Critically Ill Patients. A Multicenter Cohort Study. Ann Am Thorac Soc 2016;13:1775-83.

O’Tuathail C, Taqi R. Evaluation of three commonly used pressure ulcer risk assessment scales. Br J Nurs 2011;20:S27-8.

Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Lopez-Medina IM, Alvarez-Nieto C. Risk assessment scales for pressure ulcer prevention: a systematic review. J Adv Nurs 2006;54:94-110.

Kwong E, Pang S, Wong T, Ho J, Shao-ling X, Li-jun T. Predicting pressure ulcer risk with the modified Braden, Braden, and Norton scales in acute care hospitals in Mainland China. Appl Nurs Res 2005;18:122-8.

Bergquist S. The quality of pressure ulcer prediction and prevention in home health care. Appl Nurs Res 2005;18:148-54.

Pressure Ulcers on Admission to Palliative Care Unit and Scores on Norton and Braden Scales

ABSTRACT

References