Pressure Injury Development in Patients Treated by Critical Care Air Transport Teams: A Case-Control Study

Abstract

Although the pressure injury rate of 4.9% in this cohort of patients is consistent with that reported by civilian critical care units, the rate must be interpreted with caution, because civilian study data frequently represent the entire intensive care unit length of stay. Targeted interventions for patients with increased body mass index and 2 or more critical care air transports per patient may help decrease the development of pressure injury in these patients.

Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis

“…Screening of titles and abstracts was done with 11,517 entries where 123 studies were deemed appropriate for full-text analysis. In the end, 67 studies were included in narrative synthesis, with 32 prospective cohort studies [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], 26 retrospective record reviews [ 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ,…”

“…Forty-five studies analysed pressure injury development as a dichotomous outcome [ 18 , 20 , 21 , 23 , 24 , 26 , 27 , 29 , 30 , 32 , 33 , 35 , 36 , 39 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 53 , 54 , 55 , 56 , 57 , 58 , 60 , 61 , 62 , 63 , 65 , 66 , 68 , 71 , 72 , 74 , 75 , 77 , 79 , 82 , 83 ], 20 studies reported time to the development of pressure injuries [ 19 , 22 , 25 , 28 , 31 , 34 , 37 , 38 , 40 ,…”

“…The focus of “outcome measurement” was the assessment of pressure injuries by skilled or trained health worker, e.g., nurses, doctors etc., and the definition of pressure injuries by certain and clearly defined standards. Many studies failed to report an adequate staging or assessment of pressure injury by trained health workers, specific pressure injury definition, or both, which resulted in 40% of studies having moderate [ 18 , 19 , 24 , 25 , 29 , 31 , 32 , 33 , 39 , 42 , 45 , 47 , 51 , 53 , 55 , 57 , 58 , 59 , 62 , 63 , 69 , 72 , 73 , 74 , 76 , 78 , 82 ] and 19% having high risk of bias in this domain [ 18 , 22 , 34 , 36 , 41 , 43 , 52 , 56 , 60 , 64 , 71 , 75 , 79 ].…”

“…Variables related to body size e.g., body mass index (BMI), weight and height were entered in 17 studies [ 18 , 19 , 24 , 26 , 30 , 34 , 43 , 49 , 50 , 53 , 56 , 61 , 62 , 64 , 77 , 83 , 84 ]. Out of 23 entered variables, eight emerged as significant predictors of pressure injury development.…”

“…Out of 23 entered variables, eight emerged as significant predictors of pressure injury development. Two moderate risk of bias studies imply that low BMI contributes to the development of pressure injuries stage ≥ 1 [ 30 , 50 ] whereas one moderate [ 61 ] and one high risk of bias study [ 56 ] attribute the development to high BMI. Lower body mass and greater weight were also independently associated with pressure injury development stage ≥ 1 in one low [ 83 ] and high risk of bias study [ 18 ], respectively.…”