Tissue Perfusion and the Braden Scale as Predictors of Pressure Injury Risk in the Intensive Care Unit Patient

Abstract

Purpose: The national rate of pressure injury (PI) in the intensive care unit (ICU) 2016-2018 was 5.97%, while at one hospital in Honolulu, Hawaii it averaged 13%. The Braden scale is the gold standard PI risk assessment tool. Researchers have reported the Braden scale has limited value in the ICU setting and consider tissue perfusion to be the better indicator. The aim was to determine if tissue perfusion, as measured by noninvasive transcutaneous tissue oxygen levels, was a predictor of PI risk development.Methods: Electronic medical records of 161 patients admitted from January 1, 2017 to June 30, 2019 were retrospectively reviewed. Patients’ characteristics were summarized using descriptive statistics. Bivariate associations with the development of PI were examined using Fisher’s exact test for the categorical variables, and Wilcoxon rank-sum test for the continuous variables. A multivariable logistic model was fitted for the development of PI with adjustments for potential confounders.Results: Of 161 patients, 125 met the inclusion criteria. Length of stay, Acute Physiology and Chronic Health Evaluation II score, use of vasopressors, and the Braden score were statistically significant predictors of PI risk development; tissue perfusion was not significant.Conclusion: ICU patients have a higher mortality and severity of illness. The Braden score guides implementation of PI preventative measures. The relationship between tissue perfusion and PI development may warrant further research. A broader clinical picture to incorporate the Braden scale and other risk factors in PI development such as Acute Physiology and Chronic Health Evaluation II score and use of vasopressors should be considered.