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March 15, 1995

Pressure Ulcer Risk Factors Among Hospitalized Patients With Activity Limitation

Author Affiliations

From the Center for Aging (Drs Allman, Goode, and Bartolucci), the Division of Gerontology and Geriatric Medicine, Department of Medicine (Drs Allman and Goode, and Ms Patrick), and the Department of Biostatistics (Dr Bartolucci and Ms Burst), University of Alabama at Birmingham; and the Department of Veterans Affairs Medical Center, Birmingham, Ala (Drs Allman and Goode). Ms Patrick is now affiliated with the Baptist Medical System, Birmingham, Ala.

JAMA. 1995;273(11):865-870. doi:10.1001/jama.1995.03520350047027

Objective.  —To identify specific demographic, medical, functional status, and nutritional characteristics that predict the development of stage 2 or greater pressure ulcers among patients whose activity is limited to bed or chair.

Design.  —Prospective inception cohort study.

Setting.  —Tertiary care, urban, university teaching hospital.

Patients.  —A total of 286 patients fulfilling the following criteria: admitted to the hospital within the previous 3 days, age 55 years or more, expected to be confined to bed or chair for at least 5 days or had a hip fracture, and without a stage 2 or greater pressure ulcer.

Main Outcome Measure.  —Time to in-hospital development of a stage 2 or greater pressure ulcer.

Results.  —Total cumulative incidence of pressure ulcers was 12.9% (n=37) after a median time of 9 days from admission to final skin examination. Age of 75 years or more, dry skin, nonblanchable erythema (a stage 1 pressure ulcer), previous pressure ulcer history, immobility, fecal incontinence, depleted triceps skinfold, lymphopenia (lymphocyte count <1.50×109/L), and decreased body weight (<58 kg) were significantly associated with pressure ulcer development by univariate Kaplan-Meier survival analyses (P<.05 by log-rank test). Risk ratios (and 95% confidence intervals) for predictors (P≤.05) of pressure ulcer development after multivariable Cox regression analysis included the following: nonblanchable erythema, 7.52 (1.00 to 59.12); lymphopenia, 4.86(1.70 to 13.89); immobility, 2.36 (1.14 to 4.85); dry skin, 2.31 (1.02 to 5.21); and decreased body weight, 2.18 (1.05 to 4.52). The 3-week cumulative incidence of pressure ulcers with none, one, two, or three or more of these characteristics was 0%, 11.4%, 39.6%, and 67.9%, respectively (P<.001 by log-rank test).

Conclusions.  —These results suggest that nonblanchable erythema, lymphopenia, immobility, dry skin, and decreased body weight are independent and significant risk factors for pressure ulcers in hospitalized patients whose activity is limited to bed or chair.(JAMA. 1995;273:865-870)