The challenge of predicting pressure ulcers in critically Ill patients: a multicenter cohort study

Detalhes bibliográficos
Autor(a) principal: Ranzani, Otavio T.
Data de Publicação: 2016
Outros Autores: Simpson, Evelyn Senna, Japiassu, André M., Noritomi, Danilo Teixeira, Amil Critical Care Group
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/32390
Resumo: 2020-04-05
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spelling Ranzani, Otavio T.Simpson, Evelyn SennaJapiassu, André M.Noritomi, Danilo TeixeiraAmil Critical Care Group2019-04-05T12:48:54Z2019-04-05T12:48:54Z2016RANZANI, Otavio T. et al. The challenge of predicting pressure ulcers in critically Ill patients. Annals of the American Thoracic Society, v. 13, n. 10, p. 1775-1783, Oct. 2016.2329-6933https://www.arca.fiocruz.br/handle/icict/3239010.1513/AnnalsATS.201603-154OC2325-6621engAmerican Thoracic SocietyThe challenge of predicting pressure ulcers in critically Ill patients: a multicenter cohort studyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article2020-04-05Amil Critical Care Group. Hospital Paulistano. São Paulo, SP, Brazil / University of São Paulo. Hospital das Clínicas. Heart Institute. Pulmonary Division. Respiratory Intensive Care Unit. São Paulo, SP, Brazil.Amil Critical Care Group. Hospital Paulistano. São Paulo, SP, Brazil.Amil Critical Care Group. Hospital Paulistano. São Paulo, SP, Brazil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Medicina Intensiva. Rio de Janeiro, BrazilAmil Critical Care Group. Hospital Paulistano. São Paulo, SP, Brazil.Rationale: Pressure ulcers are preventable events. Critically ill patients are particularly vulnerable. The Braden scale has been used to identify hospitalized patients at high risk for the development of pressure ulcers; however, this predictive tool has not been adequately validated for critically ill patients. Objectives: We aimed to validate and improve the Braden scale for critically ill patients by adding clinical variables to the original scale. Methods: We conducted a cohort study in 12 intensive care units (ICUs) within a network of hospitals in Brazil during 2013. We excluded patients who stayed less than 48 hours, patients with one or more pressure ulcers at admission, and those who developed a pressure ulcer within the first 48 hours. We evaluated the Braden scale and clinical variables through a competing risk analysis. Discrimination and calibration were evaluated using the Concordance index (C-index) and a calibration plot, respectively. We used bootstrapping to assess internal validation. Measurements and Main Results: Our primary outcome was incident pressure ulcer within 30 days of ICU admission. We analyzed 9,605 patients and observed 157 pressure ulcers (rate of 3.33 pressure ulcers/1,000 patient-days). The majority of pressure ulcers were detected at stage I or II (28.7 and 66.2%, respectively). The Braden scale had good discrimination (C-index, 0.753; 95% confidence interval, 0.712–0.795), although its performance decreased for the most severely ill patients. We derived a modified predictive tool by adding eight clinical variables to the Braden scale: age, sex, diabetes mellitus, hematological malignancy, peripheral artery disease, hypotension at ICU admission, and need for mechanical ventilation or renal replacement therapy in the first 24 hours after ICU admission. The derived score had better discrimination and calibration than the original Braden scale. The best score cutoff was at least 6 points, with a sensitivity of 87% and a specificity of 71%. Conclusions: The original Braden scale measured at ICU admission is a valuable tool for pressure ulcer prediction, although it is not accurate for severely ill patients. To overcome the limitations of the original scale, we derived a modified score with better performance, which may identify high-risk ICU patients and support target interventions. External validation of the proposed clinical prediction score is needed.Pressure ulcerPressure soreBraden scaleValidationIntensive care unitinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83104https://www.arca.fiocruz.br/bitstream/icict/32390/1/license.txt79178e5f2a0eb066867a274556814938MD51ORIGINALve_Ranzani_Otavio_etal_INI_2016.pdfve_Ranzani_Otavio_etal_INI_2016.pdfapplication/pdf663186https://www.arca.fiocruz.br/bitstream/icict/32390/2/ve_Ranzani_Otavio_etal_INI_2016.pdf9bbe3bd703cf4ee73eac2d442da1fdcfMD52TEXTve_Ranzani_Otavio_etal_INI_2016.pdf.txtve_Ranzani_Otavio_etal_INI_2016.pdf.txtExtracted texttext/plain46341https://www.arca.fiocruz.br/bitstream/icict/32390/3/ve_Ranzani_Otavio_etal_INI_2016.pdf.txt3e572988a0226b632cf6ef5da3fd91d4MD53icict/323902021-03-24 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dc.title.pt_BR.fl_str_mv The challenge of predicting pressure ulcers in critically Ill patients: a multicenter cohort study
title The challenge of predicting pressure ulcers in critically Ill patients: a multicenter cohort study
spellingShingle The challenge of predicting pressure ulcers in critically Ill patients: a multicenter cohort study
Ranzani, Otavio T.
Pressure ulcer
Pressure sore
Braden scale
Validation
Intensive care unit
title_short The challenge of predicting pressure ulcers in critically Ill patients: a multicenter cohort study
title_full The challenge of predicting pressure ulcers in critically Ill patients: a multicenter cohort study
title_fullStr The challenge of predicting pressure ulcers in critically Ill patients: a multicenter cohort study
title_full_unstemmed The challenge of predicting pressure ulcers in critically Ill patients: a multicenter cohort study
title_sort The challenge of predicting pressure ulcers in critically Ill patients: a multicenter cohort study
author Ranzani, Otavio T.
author_facet Ranzani, Otavio T.
Simpson, Evelyn Senna
Japiassu, André M.
Noritomi, Danilo Teixeira
Amil Critical Care Group
author_role author
author2 Simpson, Evelyn Senna
Japiassu, André M.
Noritomi, Danilo Teixeira
Amil Critical Care Group
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Ranzani, Otavio T.
Simpson, Evelyn Senna
Japiassu, André M.
Noritomi, Danilo Teixeira
Amil Critical Care Group
dc.subject.en.pt_BR.fl_str_mv Pressure ulcer
Pressure sore
Braden scale
Validation
Intensive care unit
topic Pressure ulcer
Pressure sore
Braden scale
Validation
Intensive care unit
description 2020-04-05
publishDate 2016
dc.date.issued.fl_str_mv 2016
dc.date.accessioned.fl_str_mv 2019-04-05T12:48:54Z
dc.date.available.fl_str_mv 2019-04-05T12:48:54Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.citation.fl_str_mv RANZANI, Otavio T. et al. The challenge of predicting pressure ulcers in critically Ill patients. Annals of the American Thoracic Society, v. 13, n. 10, p. 1775-1783, Oct. 2016.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/32390
dc.identifier.issn.pt_BR.fl_str_mv 2329-6933
dc.identifier.doi.none.fl_str_mv 10.1513/AnnalsATS.201603-154OC
dc.identifier.eissn.none.fl_str_mv 2325-6621
identifier_str_mv RANZANI, Otavio T. et al. The challenge of predicting pressure ulcers in critically Ill patients. Annals of the American Thoracic Society, v. 13, n. 10, p. 1775-1783, Oct. 2016.
2329-6933
10.1513/AnnalsATS.201603-154OC
2325-6621
url https://www.arca.fiocruz.br/handle/icict/32390
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv American Thoracic Society
publisher.none.fl_str_mv American Thoracic Society
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
instacron_str FIOCRUZ
institution FIOCRUZ
reponame_str Repositório Institucional da FIOCRUZ (ARCA)
collection Repositório Institucional da FIOCRUZ (ARCA)
bitstream.url.fl_str_mv https://www.arca.fiocruz.br/bitstream/icict/32390/1/license.txt
https://www.arca.fiocruz.br/bitstream/icict/32390/2/ve_Ranzani_Otavio_etal_INI_2016.pdf
https://www.arca.fiocruz.br/bitstream/icict/32390/3/ve_Ranzani_Otavio_etal_INI_2016.pdf.txt
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