Pressure Ulcer Incidence and Risk Factors Among Hospitalized Orthopedic Patients: Results of a Prospective Cohort Study

A variety of pressure ulcer (PU) risk factors has been identified, but not all information is consistent and some applies to specific patient populations only. The purpose of this prospective cohort study was to assess the incidence of and ascertain potential risk factors for PU formation among hospitalized orthopedic patients in the Philippines. All patients consecutively admitted to an orthopedic ward of a tertiary hospital between March 1 and October 31, 2009 were eligible to participate if they were >19 years of age and expected to be confined to a bed or chair for at least 5 days while hospitalized. Eligible patients were seen within 48 hours following admission, and after providing informed consent, patient demographic variables, laboratory values, and other potential risk factors were recorded, including the presence of nonblanchable erythema or dry skin and Braden Risk Assessment Scale variables (sensory perception, moisture, activity, mobility, nutrition, friction shear). The total Braden Risk Score was calculated and dichotomized to at risk (low, medium, high risk) and not at risk. Subsequent skin inspections for the development of a Stage II or greater ulcer occurred weekly. Of the 256 persons admitted, 43 met the inclusion criteria and 40 (31 men and nine women) agreed to participate in the study. Eight patients developed an ulcer a median of 7 days after admission for an overall incidence of 20%; seven ulcers were Stage II, and one ulcer progressed to Stage III. The only significant difference between patients who did and did not develop a PU was the presence of constant moisture (P <0.008) and impaired sensory perception (P <0.0001). The odds ratio (OR) for sensory perception was 45 (95% CI: 5.3–385, P = 0.0001) and for constant moisture was 10.8 (95% CI: 1.8–65, P = 0.008). On multivariate analysis, the adjusted OR was 43 (95% CI: 3.5–513) for sensory perception and 10 (95% CI: 0.85–117) for moisture. The likelihood ratio test showed that both impaired sensory perception and constant moisture were predictive of PU formation (P = 0.0465). Most (six out of eight) patients who developed a PU had a history of spinal cord injury. Study results confirm that limited sensory perception and the presence of constant moisture are risk factors for PU development among hospitalized orthopedic patients. This is the first PU incidence and risk factor study conducted in the Philippines, and the results confirm some of those reported from orthopedic patient studies in other countries.