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Eur J Intern Med. 2009 Jul;20(4):394-7. doi: 10.1016/j.ejim.2008.11.001. Epub 2008 Dec 6.

Risk assessment study of the pressure ulcers in intensive care unit patients.

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Department of Internal Medicine, Gulhane Military Medical Academy, HaydarpaƟa Training Hospital, Istanbul, Turkey.


In this research, we studied the incidence of pressure ulcer and risk factors and screening of the patients for pressure ulcers at intensive care unit on the first day of admission in 142 patients. All patients were evaluated according to National Pressure Ulcer Advisory Panel during the ICU period strictly. Pressure ulcer risk evaluation was performed according to Norton Scale. Nutritional state was evaluated according to nutritional risk screening 2002. Age, hospitalization period, mean arterial pressure, pressure ulcer degree, hemoglobin and albumin levels, body mass index, APACHE-II scores and comorbidities were evaluated. In the following parameters, first value represents PU (+) cases, and second value represents PU (-) cases. On the admittance: 14 (9.8%) patients had PU (prevalence). NRS-2002: 5.4+/-1.9 and 4.3+/-2.1 (p<0.05), Norton score: 8.4+/-4.7 and 13.9+/-4.6 (p<0.05), albumin 2.7+/-0.7 g/dl and 3.2+/-0.8 g/dl (p<0.05). MAP and hemoglobin levels were not different (p>0.05). Mean pressure ulcer degree was 2.15. On the discharge: first values represent new developed PU (+) patients and second values represent PU (-) cases. 25 (17.6%) patients had PU. Incidence was 7.8%. NRS-2002: 6.4 and 3.6 (p<0.05), Norton score: 7.1 and 14.4 (p<0.05), albumin 2.2 g/dl and 3.0 g/dl (p<0.05). MAP 55.15+/-24.10 mm Hg and 79.76+/-18.12 mm Hg (p<0.05), APACHE-II score 22.3+/-4.2 and 18.2+/-6.2 (p<0.05). Hospitalization period: 18.3+/-10.3 days and 6.6+/-4.3 days (p<0.05) respectively. BMI and hemoglobin levels were not different (p>0.05). Two or more co morbidity, neurophyschiatric disorders, infections and medications were more prevalent in PU (+) group (p<0.05). Results of this study show us the PU incidence of ICU patients may be low if we perform PU screening all patients at the admission and put into practice NPUAP strictly. Age, low Norton score, hospitalization period, high APACHE-II score, hypotension, malnutrition and hypoalbuminemia were significant in patients with PU; however, BMI and hemoglobin were not significant. The studies focusing on the relation between the effect of optimization of these parameters from the first day of admittance and pressure ulcer are required.

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