Pressure Injuries and the Waterlow Subscales in the Intensive Care Unit: A Multicentre Study

IF 3.2 3区医学 Q1 NURSING Journal of Clinical Nursing Pub Date : 2024-11-08 DOI:10.1111/jocn.17526

Hongxia Tao, Hongyan Zhang, Xinmian Kang, Yahan Wang, Yuxia Ma, Juhong Pei, Lin Han

{"title":"Pressure Injuries and the Waterlow Subscales in the Intensive Care Unit: A Multicentre Study","authors":"Hongxia Tao, Hongyan Zhang, Xinmian Kang, Yahan Wang, Yuxia Ma, Juhong Pei, Lin Han","doi":"10.1111/jocn.17526","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Pressure injuries (PIs) impose a significant burden on patients in the intensive care unit (ICU) and the healthcare system. Assessing the risk of developing PIs is crucial for prevention. However, it is unclear whether all subscales of the Waterlow scale can be used to assess PIs risk in ICU.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To assess whether all subscales of the Waterlow scale can predict PIs risk in ICU.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Multicentre prospective study.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A total of 18,503 patients from ICUs in 40 tertiary-level hospitals in Gansu province of China were enrolled from April 2021 to August 2023. The incidence and characteristics of PIs were recorded. Univariate Cox regression analyses were performed for each subscale as a predictor of PIs development, followed by multivariate Cox regression with covariates for each subscale separately.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Out of 17,720 patients included, the incidence of PIs was 1.1%. Multivariate analysis revealed skin type (HR: 1.468, 95% CI: 1.229, 1.758), sex (HR: 0.655, 95% CI: 0.472, 0.908), advanced age (HR: 1.263, 95% CI: 1.106, 1.442), continence (HR: 1.245, 95% CI: 1.052, 1.473), tissue malnutrition (HR: 1.070, 95% CI: 1.007, 1.136) and neurological deficit (HR: 1.153, 95% CI: 1.062, 1.251) were independently predictive of PIs development for all participants. Skin type (HR: 2.326, 95% CI: 1.153, 3.010) (HR: 2.217, 95% CI: 1.804, 2.573) independently predicted PIs occurrence for high-risk and very high-risk group, respectively, while sex (HR: 0.634, 95% CI: 0.431, 0.931) and age (HR: 1.269, 95% CI: 1.083, 1.487) predicted PIs development for very high-risk group.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>This study found that not all subscales of the Waterlow scale are associated with the PIs development in patients in ICU, highlighting the importance of the skin type subscale in predicting PI risk across all patient groups.</p>\n </section>\n \n <section>\n \n <h3> Implications for Clinical Practice</h3>\n \n <p>Nurses need to focus on patient's skin and related (moisture, pain and pressure) conditions and take measures to promote skin health and avoid the occurrence of PI.</p>\n </section>\n \n <section>\n \n <h3> Patient or Public Contribution</h3>\n \n <p>None.</p>\n </section>\n </div>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":"33 12","pages":"4809-4818"},"PeriodicalIF":3.2000,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Nursing","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jocn.17526","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Pressure injuries (PIs) impose a significant burden on patients in the intensive care unit (ICU) and the healthcare system. Assessing the risk of developing PIs is crucial for prevention. However, it is unclear whether all subscales of the Waterlow scale can be used to assess PIs risk in ICU.

Objectives

To assess whether all subscales of the Waterlow scale can predict PIs risk in ICU.

Design

Multicentre prospective study.

Methods

A total of 18,503 patients from ICUs in 40 tertiary-level hospitals in Gansu province of China were enrolled from April 2021 to August 2023. The incidence and characteristics of PIs were recorded. Univariate Cox regression analyses were performed for each subscale as a predictor of PIs development, followed by multivariate Cox regression with covariates for each subscale separately.

Results

Out of 17,720 patients included, the incidence of PIs was 1.1%. Multivariate analysis revealed skin type (HR: 1.468, 95% CI: 1.229, 1.758), sex (HR: 0.655, 95% CI: 0.472, 0.908), advanced age (HR: 1.263, 95% CI: 1.106, 1.442), continence (HR: 1.245, 95% CI: 1.052, 1.473), tissue malnutrition (HR: 1.070, 95% CI: 1.007, 1.136) and neurological deficit (HR: 1.153, 95% CI: 1.062, 1.251) were independently predictive of PIs development for all participants. Skin type (HR: 2.326, 95% CI: 1.153, 3.010) (HR: 2.217, 95% CI: 1.804, 2.573) independently predicted PIs occurrence for high-risk and very high-risk group, respectively, while sex (HR: 0.634, 95% CI: 0.431, 0.931) and age (HR: 1.269, 95% CI: 1.083, 1.487) predicted PIs development for very high-risk group.

Conclusions

This study found that not all subscales of the Waterlow scale are associated with the PIs development in patients in ICU, highlighting the importance of the skin type subscale in predicting PI risk across all patient groups.

Implications for Clinical Practice

Nurses need to focus on patient's skin and related (moisture, pain and pressure) conditions and take measures to promote skin health and avoid the occurrence of PI.

Patient or Public Contribution

None.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

重症监护病房中的压伤和沃特洛分量表：一项多中心研究。

背景：压迫性损伤（PIs）给重症监护病房（ICU）的患者和医疗系统带来了沉重的负担。评估发生压伤的风险对于预防压伤至关重要。然而，目前尚不清楚 Waterlow 量表的所有分量表是否都能用于评估重症监护室的压伤风险：评估 Waterlow 量表的所有分量表是否都能预测 ICU 中的 PIs 风险：多中心前瞻性研究：方法：2021年4月至2023年8月，甘肃省40家三级甲等医院ICU的18503名患者入组。记录了 PI 的发生率和特征。对预测 PIs 发生的各分量表进行单变量 Cox 回归分析，然后对各分量表分别进行带协变量的多变量 Cox 回归分析：在纳入的 17720 名患者中，PIs 的发生率为 1.1%。多变量分析显示皮肤类型（HR：1.468，95% CI：1.229，1.758）、性别（HR：0.655，95% CI：0.472，0.908）、高龄（HR：1.263，95% CI：1.106，1.442）、尿失禁（HR：1.245，95% CI：1.在所有参与者中，组织营养不良（HR：1.070，95% CI：1.007，1.136）和神经功能缺损（HR：1.153，95% CI：1.062，1.251）可独立预测 PIs 的发生。皮肤类型（HR：2.326，95% CI：1.153，3.010）（HR：2.217，95% CI：1.804，2.573）分别独立预测高危组和极高危组 PIs 的发生，而性别（HR：0.634，95% CI：0.431，0.931）和年龄（HR：1.269，95% CI：1.083，1.487）预测极高危组 PIs 的发生：本研究发现，并非 Waterlow 量表的所有分量表都与 ICU 患者的 PIs 发展相关，这突出了皮肤类型分量表在预测所有患者组 PI 风险方面的重要性：对临床实践的启示：护士需要关注患者的皮肤及相关情况（湿度、疼痛和压力），并采取措施促进皮肤健康，避免PI的发生：患者或公众贡献：无。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Journal of Clinical Nursing 医学-护理

CiteScore

6.40

自引率

2.40%

发文量

审稿时长

2 months

期刊介绍： The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice. JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice. We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.