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Title: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study
Authors: Labeau, Sonia O. 
Afonso, Elsa 
Benbenishty, Julie Sarah 
Blackwood, Bronagh 
Boulanger, Carole 
Brett, Stephen J. 
Calvino-Gunther, Silvia 
Chaboyer, Wendy 
Coyer, Fiona 
Deschepper, Mieke 
François, Guy 
Honore, Patrick M. 
Jankovic, Radmilo 
Khanna, Ashish K. 
Llaurado-Serra, Mireia 
Lin, Frances 
Rose, Louise 
Rubulotta, Francesca 
Saager, Leif 
Williams, Ged F. 
Blot, Stijn I. 
Muzha, Dritan 
Margarit Ribas, Antoni 
Lipovesty, Fernando 
Loudet, Cecilia 
Coyer, Fiona 
Eller, Philipp 
Mostafa, Nafseen 
Honoré, Patrick M. 
Telleria, Vanesa Mercado 
Smajic, Jasmina 
Nogueira, Paula Cristina 
Khalid Mahmood Khan, Nafees 
Hentchoya, Romuald 
Rose, Louise 
Soledad, Javiera 
Lin, Frances 
Cardenas, Yenny 
Reyes, Amylkar Garay 
Sustic, Alan 
Mpouzika, Meropi 
Major Field of Science: Medical and Health Sciences
Field Category: Health Sciences
Keywords: Decubitus epidemiology;ICU;Morbidity;Mortality;Outcome;Pressure injury;Pressure ulcer;Risk factors
Issue Date: Feb-2021
Source: Intensive Care Medicine, 2021, vol. 47, pp. 160–169
Volume: 47
Start page: 160
End page: 169
Journal: Intensive Care Medicine 
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.
ISSN: 1432-1238
DOI: 10.1007/s00134-020-06234-9
Rights: This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Type: Article
Affiliation : Cyprus University of Technology 
HOGENT University of Applied Sciences and Arts 
Ghent University 
Cambridge University Hospitals NHS Trust 
Hadassah Hebrew University Medical Center 
Queen’s University Belfast 
Royal Devon and Exeter NHS Foundation Trust 
Imperial College London 
University Hospital of Grenoble-Alpes 
Griffith University 
University of the Sunshine Coast 
Queensland University of Technology and Intensive Care Services 
University of Huddersfield 
Ghent University Hospital 
European Society of Intensive Care Medicine 
CHU Brugmann University Hospital 
University of Niš 
Wake Forest School of Medicine 
Universitat Internacional de Catalunya 
Outcomes Research Consortium 
King’s College London 
Sunnybrook Research Institute 
University of Toronto 
Michael Garron Hospital 
Universitaetsmedizin Goettingen 
University of Michigan 
Al Mafraq Hospital 
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