Factors contributing to epidemic development of decubitus ulcers (DU) in a surgical intensive care unit Academic Article uri icon

Overview

MeSH Major

  • Biomedical Research
  • General Surgery

abstract

  • INTRODUCTION: The incidence of DU has increased over 1000% in our SICU since 1993, with a current incidence of 9%. Sixty percent of all patients who stay in the ICU>7 days develop a stage II or greater DU. This prospective study was performed to determine the variables which contributed to this increase. METHODS: All patients admitted from 1/1/98 to 7/31/98 were followed prospectively for DU. Only stage II DU or worse were included. A cohort (comprising 97% of DU patents) represented all patients with an ICU length of stay (ULOS) > 7 days. Patients with ULOS > 7 days but without DU were the comparator group. Age, ULOS, APACHE III (AIII), multiple organ dysfunction score (MODS), need for IV sedation or preesors, type and start date of nutrition (TPN, enteral feeding, oral), number of days bedridden, hospital ulcer risk score (URS), days to DU (Days), and mortality (M) were recorded. Statistics: ANOVA, MANOVA, and chi square,*p<0.05. RESULTS: incidence of DU was 9%. Days to DU was 9.2 days. M in DU patients was similar (50% vs. 27%, p=0.41) There were no differences for IV sedation, pressors, type of nutrition, or URS days 1-7. BY ANOVA: DU (n=33) Non-DU (n=22) p Age*73.4 ± 2.4 56.3 ± 6.6 .0026 AIII 86.8 ± 3.0 74.5 ± 6.2 .0872 MODS 10.2 ± 0.9 6.6 ± 1.4 .1516 ULOS*24.3 ± 4.0 12.1 ± 1.4 .0288*Days to Nutrition 1.9 ± 0.3 3.5 ± 0.9 .0003*URS day 1 8.8 ± 0.3 8.8 ± 0.3 .8662 URS day 8*9.5 ± 0.3 7.9 ± 0.8 .0022*Days Bedridden 17.0 ± 2.5 9.7 ± 1.2 .0328*By MANOVA only age (p=.0164) and days in bed (p=.0178) predicted the development of DU. CONCLUSION: Elderly, bedridden patients are at highest risk for DU, regardless of severity of illness. That patients do not differentiate early, based on severity of illness or URS, complicates design of a prevention protocol. The difference in URS on day 8, but not day 1, indicates that URS should be followed serially. A persistent, high URS may dictate an early mobilization strategy.

publication date

  • December 1999

Research

keywords

  • Academic Article

Additional Document Info

start page

  • A64

volume

  • 27

number

  • 1 SUPPL.