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Factors Associated with Pressure Ulcers in Adults in Acute Care Hospitals

Fisher, Andrea R. MSN, MSc, RN; Wells, George PhD; Harrison, Margaret B. PhD, RN

Advances in Skin & Wound Care:
Original Investigation
Abstract

OBJECTIVES: To identify and describe the relationship of factors associated with pressure ulcers in adults in acute care hospitals.

DESIGN: Cross-sectional prevalence studies

SETTING: University teaching hospital

PATIENTS: Prevalence studies conducted from 1993 to 1995 with a total of 1992 subjects served as the derivation sample and a 1996 prevalence study with 581 subjects served as the validation sample.

MAIN OUTCOME MEASURES: Pressure ulcers and the Braden risk assessment subscale scores.

DATA ANALYSIS: Logistic regression analysis was used to derive a model that fit the data and performed well at identifying factors associated with pressure ulcers. Performance of the model, in terms of calibration, was statistically evaluated using the Hosmer-Lemeshow goodness-of-fit test. The effectiveness of the model, in terms of discrimination, was assessed by considering the cut-off values using 2 by 2 classification tables to measure the overall percentage of subjects correctly classified in the validation sample.

MAIN RESULTS: Factors associated with pressure ulcers in adults in acute care hospitals were identified as age, male gender, sensory perception, moisture, mobility, nutrition, and friction/shear. Three interactions were also found to be associated with pressure ulcers; 2 interactions (age and sensory perception and moisture and sensory perception) were negatively associated and 1 interaction (nutrition and gender/male) was positively associated with pressure ulcers. The Hosmer-Lemeshow goodness-of-fit test for the derivation sample (.76) and the validation sample (.79) indicated that the model was well calibrated and a good fit. The overall percentage of subjects correctly classified using the validation sample was 88%, indicating that the model performed well.

CONCLUSIONS: This study enhances the knowledge of the relationship of factors associated with pressure ulcers in adults in acute care populations and enhances the use and relative importance of particular Braden Scale sub-scales.

In Brief

In this important study, the authors highlight the need for early, intensive preventive measures for older patients and for patients with deficits related to sensory perception, moisture, friction and shearing forces, and nutrition.

Author Information

Andrea R. Fisher, MSN, MSc, RN, Advanced Practice Nurse, Stroke, The Ottawa Hospital, Ottawa, Ontario, Canada. George Wells, PhD, is Chairman and Professor, Department of Epidemiology and Community Medicine; Professor, Faculty of Medicine, University of Ottawa; and Senior Investigator, Clinical Epidemiology Program, Ottawa Health Research Institute, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada. Margaret B. Harrison, PhD, RN, is Associate Professor, Queen’s University School of Nursing, Kingston, Ontario, Canada, and Senior Scientist, Ottawa Health Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada. Submitted June 1, 2001; accepted in revised form November 12, 2002.

© 2004 Lippincott Williams & Wilkins, Inc.