Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Sonia O Labeau, Elsa Afonso, Julie Benbenishty, Bronagh Blackwood, Carole Boulanger, Stephen J Brett, Silvia Calvino-Gunther, Wendy Chaboyer, Fiona Coyer, Mieke Deschepper, Guy François, Patrick M Honore, Radmilo Jankovic, Ashish K Khanna, Mireia Llaurado-Serra, Frances Lin, Louise Rose, Francesca Rubulotta, Leif Saager, Ged Williams, Stijn I Blot, DecubICUs Study Team, European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators

Abstract

Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients.

Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis.

Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9-27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6-16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2-1.8), stage II (OR 1.6; 95% CI 1.4-1.9), and stage III or worse (OR 2.8; 95% CI 2.3-3.3).

Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.

Keywords: Decubitus epidemiology; ICU; Morbidity; Mortality; Outcome; Pressure injury; Pressure ulcer; Risk factors.

Conflict of interest statement

Received honoraria or grants outside the submitted work: Ashish K. Khanna (Medtronic, Philips North America, Edwards Lifesciences, Zoll Medical, La Jolla pharmaceuticals, and Retia Medical). Stijn I. Blot (Pfizer, 3M). Leif Saager (Medtronic, Merck, The 37 Company, Ferrer Deutschland). For the other authors, there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Anatomical locations of pressure injuries (most affected body sites). Left: Numbers (percentages) of overall pressure injuries − total number of pressure injuries = 6764. Right: Numbers (percentages) of intensive care unit-acquired pressure injuries − total number of pressure injuries = 3997
Fig. 2
Fig. 2
Kaplan–Meier estimates of overall survival according to pressure injury status on the study day among adult intensive care unit patients. Green line indicates patients without pressure injuries; yellow line indicates patients whose worst pressure injury is of stage I; orange line indicates patients whose worst pressure injury is stage II; red line indicates patients whose worst pressure injury is stage III or worse (i.e. stage IV or Unstageable or Suspected Deep Tissue Injury). Tick marks indicate censored data (hospital discharge before 12 weeks). Log-rank test: p < 0.001

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