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Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients

A Systematic Review and Meta-Analysis

Chaboyer, Wendy P., PhD, FACCCN, FAAN1; Thalib, Lukman, PhD2; Harbeck, Emma L., PhD3; Coyer, Fiona M., PhD4,5; Blot, Stijn, PhD6,7; Bull, Claudia F., BNutr(Hon)3; Nogueira, Paula C., PhD8; Lin, Frances F., PhD1

doi: 10.1097/CCM.0000000000003366
Online Review Article

Objectives: To systematically assess the incidence and prevalence of pressure injuries in adult ICU patients and the most frequently occurring pressure injury sites.

Data Sources: MEDLINE, Embase, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature.

Study Selection: Observational studies reporting incidence rates, cumulative incidence, and prevalence of pressure injuries.

Data Extraction: Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Meta-analyses of pooled weighted estimates were calculated using random effect models with 95% CIs reported due to high heterogeneity. Sensitivity analyses included studies that used skin inspection to identify a pressure injury, studies at low risk of bias, studies that excluded stage 1 and each stage of pressure injury.

Data Synthesis: Twenty-two studies, 10 reporting cumulative incidence of pressure injury irrespective of stage, one reporting incidence rate (198/1,000 hospital-days), and 12 reporting prevalence were included. The 95% CI of cumulative incidence and prevalence were 10.0–25.9% and 16.9–23.8%. In studies that used skin inspection to identify pressure injuries, the 95% CI of cumulative incidence was 9.4–27.5%; all prevalence studies used skin inspection therefore the results were unchanged. In studies assessed as low risk of bias, the 95% CI of cumulative incidence and prevalence were 6.6–36.8% and 12.2–24.5%. Excluding stage 1, the 95% CI of cumulative incidence and prevalence were 0.0–23.8% and 12.4–15.5%. Five studies totalling 406 patients reported usable data on location; 95% CI of frequencies of PIs were as follows: sacrum 26.9–48.0%, buttocks 4.1–46.4%, heel 18.5–38.9%, hips 10.9–15.7%, ears 4.3–19.7%, and shoulders 0.0–40.2%.

Conclusions: Although well-designed studies are needed to ensure the scope of the problem of pressure injuries is better understood, it is clear prevention strategies are also required.

1School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, QLD, Australia.

2Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar.

3Menzies Health Institute Queensland, Griffith University, QLD, Australia.

4Intensive Care Services, Royal Brisbane and Women’s Hospital and School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.

5Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, United Kingdom.

6Department of Internal Medicine, Ghent University, Ghent, Belgium.

7Burns, Trauma and Critical Care Research Centre, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.

8Department of Medical-Surgical Nursing, School of Nursing, University of Saõ Paulo, Saõ Paulo, Brazil.

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Dr. Coyer’s institution received funding from 3M and Molnlycke. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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