Risk factors for pressure injuries: evaluation using five prediction scales in adult patients in the intensive care unit

• Grant number: 24/04394-8
• Support Opportunities: Scholarships in Brazil - Master
• Start date: April 01, 2025
• End date: February 28, 2026
• Field of knowledge: Health Sciences - Nursing
• Principal Investigator: Luciana Patrícia Fernandes Abbade
• Grantee: Larissa Cassiano Bernardo
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

Introduction: Pressure injuries (PI) are skin damage caused by prolonged pressure, moisture, and hemodynamic conditions, making their prevention essential for health. To this end, risk assessment scales are used, which, although demonstrating good predictive values, lack evidence on which scales are most suitable for Intensive Care Unit (ICU) patients. Among the scales adapted for use in Brazil, critical points can be identified as risk factors. Therefore, evaluating the items in these five scales helps determine the most relevant risk factors and develop a new risk scale proposal in the future. Objective: To assess risk factors for PI in adult ICU patients based on variables present in the Braden Scale (BS), EVARUCI, Revised Cubbin and Jackson Scale, Sunderland Scale, and CALCULATE. Method: This is a prospective cohort observational study of psychometric analysis on the five PI risk assessment scales conducted in the Specialized Intensive Care Unit of the Hospital das Clínicas of the Botucatu Medical School-UNESP. The scales will be applied to patients over 18 years old, with a minimum of 24 hours of hospitalization and no previous PI upon admission. The scales will be applied daily until ICU discharge, death, or 21 consecutive days of data collection. Descriptive statistics will be performed for categorical variables (frequency and percentages) and quantitative variables (mean, standard deviation, median, minimum, and maximum). Data normality will be verified by the Shapiro-Wilk test. A multivariate analysis with Poisson regression (log-linear model) will be used to assess risk factors for PI development. Variable selection for the final model will follow a hierarchical structure of five blocks, with items having p<0.25 retained for subsequent analysis. The final model will assess collinearity among covariates using the Durbin-Watson test. Effects will be calculated as relative risk with a 95% confidence interval. The analysis will be performed using IBM SPSS 20, with significance considered at p < 0.05. Research approved by the local Research Ethics Committee. Expected Results: The main risk factors associated with PI development are anticipated to be identified through the analysis of variables in the five PI risk prediction scales. These results are essential for deepening the understanding of the conditions that favor the occurrence of PI in the clinical context of an Intensive Care Unit. By identifying these factors, we aim to contribute to improving prevention and management strategies for these injuries, aiding healthcare professionals in decision-making. Additionally, there are plans to develop and validate a new scale that is quick and easy to apply, with good predictive capacity, high sensitivity, and high specificity, suited to critical healthcare patients.