Patients with Existing Pressure Ulcers Admitted to Acute Care

Abstract

Purpose: This study describes the characteristics of patients with pressure ulcers present on admission to the hospital and predictors of pressure ulcer presence and severity. Design: Prospective cohort study. Setting and subjects: Adults (n = 267) admitted to a Pacific Basin military hospital who were expected to stay more than 24 hours. Instruments: Braden scale, portable vital sign machine, and pulse oximeter. Methods: Pressure ulcer risk was evaluated and skin inspection was performed. Demographic, physiologic, and laboratory data were obtained. Medical history and patient acuity were recorded. Results: Thirty-four of 267 subjects (12.8%) had a pressure ulcer. Most were male and white. Their mean age was 65.7 years; mean albumin level, 2.9 g/dL; mean hematocrit level, 31.9 vol%; mean oxygen saturation, 95.3 mm Hg; and mean hemoglobin level, 10.7 g/dL. The mean Braden scale score for subjects without ulcers on admission was 19.7, and it was 15.9 for those with ulcers (P < .05). Analysis of variance showed that subjects with pressure ulcers had a significantly lower albumin level, total lymphocyte count, hematocrit level, and hemoglobin level. These subjects were significantly older and had a longer hospital length of stay. Regression showed that albumin level, oxygen saturation, and length of stay (P < .01) accounted for 11.3% of the variance of pressure ulcer presence and that albumin level and length of stay (P < .001) accounted for 11.2% of the variance in ulcer severity. Conclusions: Poorer nutritional status and decreased oxygen perfusion were predictors of pressure ulcers on admission. Nutrition and length of stay were predictors of ulcer severity. Further research is warranted.