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Pressure Ulcers and Risk Assessment in Severe Burns

Lewis, Giavonni M. MD; Pham, Tam N. MD; Robinson, Ellen; Otto, Andrew MD; Honari, Shari RN; Heimbach, David M. MD; Klein, Matthew B. MD; Gibran, Nicole S. MD

doi: 10.1097/BCR.0b013e31825d5538
Original Articles

Risk and incidence of pressure ulcers (PUs) in the burn population remain poorly understood. The purpose of this study was to determine the timing and incidence of PUs at our regional burn center and to identify early risk factors for PU development in burn patients. A retrospective review of 40 charts was performed from among the 1489 patients admitted to our regional burn center between January 2008 and December 2009. Twenty patients acquired PUs during their admission and were identified on the basis of International Classification of Diseases, ninth revision, designation, hospital stay >7 days, and thermal injury (excluding toxic epidermal necrolysis and purpura fulminans). The remaining 20 patients were matched controls based on ±5 years in age and ±8% TBSA. Patient, injury, and outcome characteristics were compared among patient groups using χ2 for categorical variables and Mann-Whitney for continuous variables. The incidence of PU was 1.3% of all admissions. PU most commonly occurred at the sacrum/coccyx (eight), lower extremity (seven), and occiput (six). A majority of PU presented at stage 2 (33%), stage 3 (26%), and unstageable (30%). Thirteen were splint or device related and reportable. Ninety percent of patients with PUs presented with a Braden score of 16 or less (P = .03), although 60% of controls also had admission Braden scores less than 16. On an average, PUs were acquired within 17 days of admission. Data suggest burn patients are particularly at risk of developing PU based on admission Braden scores. However, low Braden scores do not necessarily correlate with eventual development of PU. Therefore, early and aggressive PU prevention and risk assessment tools must be used to diagnose PUs at an early and reversible stage.

From the Department of Surgery, University of Washington, Seattle.

Presented at the meeting of 43rd Annual ABA Conference, Chicago, Illinois, March 30, 2012.

Address correspondence to Giavonni M. Lewis, MD, Harborview Medical Center, 325 Ninth St Avenue, Seattle, Washington 98104.

© 2012 The American Burn Association