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Original Article

Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission

Hye Ran Kwak1, Jiyeon Kang2
Korean Journal of Adult Nursing 2015;27(3):347-357.
Published online: June 30, 2015

1Dong-A University Medical Center, CCU, Busan

2Department of Nursing, Dong-A University, Busan, Korea

Corresponding author: Kang, Jiyeon Department of Nursing, Dong-A University, 1 Dongdaesin-dong 3-ga, Seo-gu, Busan 602-714, Korea. Tel: +82-51-240-2871, Fax: +82-51-240-2920, E-mail: jykang@dau.ac.kr
• Received: April 14, 2015   • Accepted: June 8, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was conducted to assess the prevalence rate of, and the risk factors for pressure ulcers in critical patients at the time of intensive care unit (ICU) admission.
  • Methods
    We reviewed the electronic medical records of 2,107 patients who were admitted to the intensive care units in D university hospital between January 1 and December 31, 2012. The collected date were analyzed by x2-test, t-test, and multi-variate logistic regression with forward stepwise selection using the SPSS program version 21.
  • Results
    The prevalence rate of pressure ulcers at the ICU admission was 23.7%. Risk factors significantly affecting pressure ulcers carrying were the age of 80 years or older (OR=3.70, 95% CI: 1.80~7.60), body weight less than 50 kg (OR=2.82, 95% CI: 1.74~4.56), sedated consciousness (OR=6.10, 95% CI: 3.57~10.40), use of ventilator (OR=1.60, 95% CI: 1.02~2.49), use of vasopressors (OR=1.53, 95% CI: 1.09~2.14), ICU admission via operation room (OR=0.49, 95% CI: 0.29~0.85), and hospital admission from nursing homes (OR=13.65, 95% CI: 3.02~61.72).
  • Conclusion
    The findings of this study suggested that the prevention efforts for pressure ulcers should be given in prior to ICU admission. Further research is necessary for developing nursing interventions for preventing pressure ulcers in the pre-ICU stage.
  • Key Words: Pressure ulcer; Prevalence; Risk factors; Intensive care units; Patient admission
Table 1.
Prevalence of Pressure Ulcers at the ICU Admission
Types of ICU Admitted patients Pressure ulcers carrying patients Prevalence (%)
n (%) n (%)
Mixed 637 (31.2) 215 (43.0) 33.8
Neurological 569 (27.0) 116 (23.2) 20.4
Cardiac 901 (47.8) 169 (33.8) 18.8
Total 2,107 (100.0) 500 (100.0) 23.7

ICU=intensive care unit.

Table 2.
The Demographic and Disease-related Characteristics of the Subjects (N=1,024)
Variables Categories PU group (n=408) Non-PU group (n=616) x2 or t p
n (%) or M±SD n (%) or M±SD
Gender Male 240 (58.8) 359 (58.3) 0.03 .863
Female 168 (41.2) 257 (41.7)
Age (year) ＜40 23 (5.6) 53 (8.6) 25.62 ＜.001
40~60 90 (22.1) 191 (31.0) 4.81 ＜.001
60~80 222 (54.4) 316 (51.3)
≥80 73 (17.9) 56 (9.1)
  66.14±14.51 61.64±14.78
Body weight (kg) ＜50 89 (21.8) 61 (9.9) 33.95 ＜.001
50~60 110 (27.0) 157 (25.5)
60~70 128 (31.4) 216 (35.1)
≥70 81 (19.9) 182 (29.5)
  58.78±11.62 63.29±10.91 6.32 ＜.001
Main disease Respiratory 46 (11.3) 40 (6.5) 24.37 .004
Circulatory 131 (32.1) 229 (37.2)
Liver 4 (1.0) 9 (1.5)
Kidney 38 (9.3) 34 (5.5)
Neurological 101 (24.8) 171 (27.8)
Sepsis 13 (3.2) 17 (2.8)
Gastrointestinal 15 (3.7) 24 (3.9)
Cancer 22 (5.4) 57 (9.3)
Metabolic 10 (2.5) 8 (1.3)
Others 28 (6.9) 27 (4.4)
ICU types Mixed 161 (39.5) 155 (25.2) 23.87 ＜.001
Neurological 105 (25.7) 207 (33.6)
Cardiac 142 (34.8) 254 (41.2)
KHNA severity IV (62~92) 0 (0.0) 1 (0.2) 37.90 ＜.001
V (93~141) 260 (63.7) 497 (80.7)
VI (≥142) 148 (36.3) 118 (19.2)

PU=pressure ulcers; ICU=intensive care unit; KHNA=Korean hospital nurses association.

Table 3.
Comparison of Personal Risk Factors between PU Group and Non-PU Group (N=1,024)
Variables Categories PU group (n=408) Non-PU group (n=616) x2 or t p
n (%) or M±SD n (%) or M±SD
Consciousness Alert 57 (14.0) 223 (36.2) 106.28 ＜.001
Drowsy 121 (29.7) 222 (36.0)
Stupor 74 (18.1) 76 (12.3)
Semicoma 20 (4.9) 17 (2.8)
Coma 17 (4.2) 10 (1.6)
Sedation 119 (29.2) 68 (11.0)
Hypertension Yes 251 (61.5) 360 (58.4) 0.97 .326
No 157 (38.5) 256 (41.6)
Diabetes Yes 301 (73.8) 472 (76.6) 1.08 .299
No 107 (26.2) 144 (23.4)
Other comorbidities Yes 321 (78.7) 426 (69.2) 11.27 .001
No 87 (21.3) 190 (30.8)
Albumin (g/dL) ＜2.9 98 (24.0) 61 (9.9) 77.06 ＜.001
2.9~3.3 170 (41.7) 180 (29.2)
≥3.4 140 (34.3) 375 (60.9)
CRP (mg/dL) ≤0.5 63 (15.8) 144 (23.6) 9.23 .002
＞0.5 337 (84.3) 465 (76.4)
Hb (mg/dL) ＜Standard† 270 (66.2) 314 (51.0) 23.15 ＜.001
≥Standard† 138 (33.8) 302 (49.0)
Body temperature (℃) ＜36 99 (24.3) 178 (28.9) 10.41 .015
36.1~37.0 218 (53.4) 347 (56.3)
37.1~38.0 67 (16.4) 64 (10.4)
≥38.1 24 (5.9) 27 (4.4)
Braden scale score   11.27±2.39 13.28±2.70 12.52 ＜.001

PU=Pressure ulcers; CRP=C-reactive protein; Hb=Hemoglobin;

†Male=13 mg/dL, Female=11 mg/dL.

Table 4.
Comparison of Institutional Risk Factors between PU Group and Non-PU Group (N=1,024)
Variables Categories PU group (n=408) Non-PU group (n=616) x2 or t p
n (%) or M±SD n (%) or M±SD
Ventilator Yes 240 (58.8) 275 (44.6) 19.74 ＜.001
No 168 (41.2) 341 (55.4)
CRRT Yes 0 (0.0) 1 (0.2) 0.66 .416
No 408 (100.0) 615 (99.8)
Hypothermia therapy Yes 5 (1.2) 7 (1.1) 0.02 .897
No 403 (98.8) 609 (98.9)
Restraints Yes 41 (10.0) 38 (6.2) 5.19 .023
No 367 (90.0) 578 (93.8)
Vasopressors Yes 198 (48.5) 189 (30.7) 33.25 ＜.001
No 210 (51.5) 427 (69.3)
Sedatives Yes 199 (48.8) 253 (41.1) 5.91 .015
No 209 (51.2) 363 (58.9)
ICU admission route ED 197 (48.6) 292 (48.2) 6.45 .040
OR 132 (32.6) 232 (38.3)
GW 76 (18.8) 82 (13.5)
Hours of hospital stay prior to ICU admission ≤6 126 (32.1) 325 (53.9) 65.66 ＜.001
7~12 79 (20.2) 117 (19.4)
13~24 53 (13.5) 49 (8.1)
25~48 48 (12.2) 48 (8.0)
≥49 86 (21.9) 64 (10.6)
  55.98±149.25 38.90±136.62 1.88 .061
Surgery Yes 146 (35.8) 236 (38.3) 0.67 .413
No 262 (64.2) 380 (61.7)
Hospital admission route Local hospital 195 (49.4) 275 (45.8) 35.28 ＜.001
Nursing home 26 (6.6) 3 (0.5)
Home 174 (44.1) 322 (53.7)

CRRT=continuous renal replacement therapy; ED=emergency department; GW=general ward; ICU=intensive care units; OR=operating room; PU=pressure ulcers.

Table 5.
Multi-variate Analysis of Risk factors for Carrying Pressure Sores at the ICU Admission (N=1,024)
Variables Categories Standardized Odds ratio p x2 (p)
B SE Exp (B) 95% CI
Age (year) ＜40 ref. 　 　   .002 202.93
40~60 0.53 .33 1.70 0.89~3.23 .106 (＜.001)
60~80 0.73 .31 2.07 1.12~3.83 .020
≥80 1.31 .37 3.70 1.80~7.60 ＜.001
Body weight (kg) ＜50 1.04 .25 2.82 1.74~4.56 ＜.001
50~60 0.39 .21 1.47 0.98~2.21 .065
60~70 0.31 .20 1.36 0.92~2.00 .119
≥70 ref. 　 　   ＜.001
Consciousness Alert ref. 　 　   ＜.001
Drowsy 0.77 .22 2.16 1.41~3.29 ＜.001
Stupor 1.25 .25 3.50 2.14~5.71 ＜.001
Semicoma 1.17 .40 3.22 1.47~7.08 .004
Coma 1.52 .47 4.57 1.82~11.48 .001
Sedation 1.81 .27 6.10 3.57~10.40 ＜.001
Ventilator   0.47 .23 1.60 1.02~2.49 .040
Vasopressors   0.42 .17 1.53 1.09~2.14 .015
ICU admission route ED 0.06 .22 1.06 0.69~1.65 .790
OR -0.71 .28 0.49 0.29~0.85 .010
GW ref. 　 　   .003
Hospital admission route Local hospital l 0.10 .16 1.11 0.81~1.51 .514
Nursing home e 2.61 .77 13.65 3.02~61.72 .001
Home ref. 　 　   .003

PU=pressure ulcers; ICU=intensive care units; ED=emergency department; OR=operating room; GW=general ward.

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    Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission
    Korean J Adult Nurs. 2015;27(3):347-357.   Published online June 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.3.347
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    Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission
    Korean J Adult Nurs. 2015;27(3):347-357.   Published online June 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.3.347
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    Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission
    Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission

    Prevalence of Pressure Ulcers at the ICU Admission

    Types of ICU Admitted patients Pressure ulcers carrying patients Prevalence (%)
    n (%) n (%)
    Mixed 637 (31.2) 215 (43.0) 33.8
    Neurological 569 (27.0) 116 (23.2) 20.4
    Cardiac 901 (47.8) 169 (33.8) 18.8
    Total 2,107 (100.0) 500 (100.0) 23.7

    ICU=intensive care unit.

    The Demographic and Disease-related Characteristics of the Subjects (N=1,024)

    Variables Categories PU group (n=408) Non-PU group (n=616) x2 or t p
    n (%) or M±SD n (%) or M±SD
    Gender Male 240 (58.8) 359 (58.3) 0.03 .863
    Female 168 (41.2) 257 (41.7)
    Age (year) ＜40 23 (5.6) 53 (8.6) 25.62 ＜.001
    40~60 90 (22.1) 191 (31.0) 4.81 ＜.001
    60~80 222 (54.4) 316 (51.3)
    ≥80 73 (17.9) 56 (9.1)
      66.14±14.51 61.64±14.78
    Body weight (kg) ＜50 89 (21.8) 61 (9.9) 33.95 ＜.001
    50~60 110 (27.0) 157 (25.5)
    60~70 128 (31.4) 216 (35.1)
    ≥70 81 (19.9) 182 (29.5)
      58.78±11.62 63.29±10.91 6.32 ＜.001
    Main disease Respiratory 46 (11.3) 40 (6.5) 24.37 .004
    Circulatory 131 (32.1) 229 (37.2)
    Liver 4 (1.0) 9 (1.5)
    Kidney 38 (9.3) 34 (5.5)
    Neurological 101 (24.8) 171 (27.8)
    Sepsis 13 (3.2) 17 (2.8)
    Gastrointestinal 15 (3.7) 24 (3.9)
    Cancer 22 (5.4) 57 (9.3)
    Metabolic 10 (2.5) 8 (1.3)
    Others 28 (6.9) 27 (4.4)
    ICU types Mixed 161 (39.5) 155 (25.2) 23.87 ＜.001
    Neurological 105 (25.7) 207 (33.6)
    Cardiac 142 (34.8) 254 (41.2)
    KHNA severity IV (62~92) 0 (0.0) 1 (0.2) 37.90 ＜.001
    V (93~141) 260 (63.7) 497 (80.7)
    VI (≥142) 148 (36.3) 118 (19.2)

    PU=pressure ulcers; ICU=intensive care unit; KHNA=Korean hospital nurses association.

    Comparison of Personal Risk Factors between PU Group and Non-PU Group (N=1,024)

    Variables Categories PU group (n=408) Non-PU group (n=616) x2 or t p
    n (%) or M±SD n (%) or M±SD
    Consciousness Alert 57 (14.0) 223 (36.2) 106.28 ＜.001
    Drowsy 121 (29.7) 222 (36.0)
    Stupor 74 (18.1) 76 (12.3)
    Semicoma 20 (4.9) 17 (2.8)
    Coma 17 (4.2) 10 (1.6)
    Sedation 119 (29.2) 68 (11.0)
    Hypertension Yes 251 (61.5) 360 (58.4) 0.97 .326
    No 157 (38.5) 256 (41.6)
    Diabetes Yes 301 (73.8) 472 (76.6) 1.08 .299
    No 107 (26.2) 144 (23.4)
    Other comorbidities Yes 321 (78.7) 426 (69.2) 11.27 .001
    No 87 (21.3) 190 (30.8)
    Albumin (g/dL) ＜2.9 98 (24.0) 61 (9.9) 77.06 ＜.001
    2.9~3.3 170 (41.7) 180 (29.2)
    ≥3.4 140 (34.3) 375 (60.9)
    CRP (mg/dL) ≤0.5 63 (15.8) 144 (23.6) 9.23 .002
    ＞0.5 337 (84.3) 465 (76.4)
    Hb (mg/dL) ＜Standard† 270 (66.2) 314 (51.0) 23.15 ＜.001
    ≥Standard† 138 (33.8) 302 (49.0)
    Body temperature (℃) ＜36 99 (24.3) 178 (28.9) 10.41 .015
    36.1~37.0 218 (53.4) 347 (56.3)
    37.1~38.0 67 (16.4) 64 (10.4)
    ≥38.1 24 (5.9) 27 (4.4)
    Braden scale score   11.27±2.39 13.28±2.70 12.52 ＜.001

    PU=Pressure ulcers; CRP=C-reactive protein; Hb=Hemoglobin;

    †Male=13 mg/dL, Female=11 mg/dL.

    Comparison of Institutional Risk Factors between PU Group and Non-PU Group (N=1,024)

    Variables Categories PU group (n=408) Non-PU group (n=616) x2 or t p
    n (%) or M±SD n (%) or M±SD
    Ventilator Yes 240 (58.8) 275 (44.6) 19.74 ＜.001
    No 168 (41.2) 341 (55.4)
    CRRT Yes 0 (0.0) 1 (0.2) 0.66 .416
    No 408 (100.0) 615 (99.8)
    Hypothermia therapy Yes 5 (1.2) 7 (1.1) 0.02 .897
    No 403 (98.8) 609 (98.9)
    Restraints Yes 41 (10.0) 38 (6.2) 5.19 .023
    No 367 (90.0) 578 (93.8)
    Vasopressors Yes 198 (48.5) 189 (30.7) 33.25 ＜.001
    No 210 (51.5) 427 (69.3)
    Sedatives Yes 199 (48.8) 253 (41.1) 5.91 .015
    No 209 (51.2) 363 (58.9)
    ICU admission route ED 197 (48.6) 292 (48.2) 6.45 .040
    OR 132 (32.6) 232 (38.3)
    GW 76 (18.8) 82 (13.5)
    Hours of hospital stay prior to ICU admission ≤6 126 (32.1) 325 (53.9) 65.66 ＜.001
    7~12 79 (20.2) 117 (19.4)
    13~24 53 (13.5) 49 (8.1)
    25~48 48 (12.2) 48 (8.0)
    ≥49 86 (21.9) 64 (10.6)
      55.98±149.25 38.90±136.62 1.88 .061
    Surgery Yes 146 (35.8) 236 (38.3) 0.67 .413
    No 262 (64.2) 380 (61.7)
    Hospital admission route Local hospital 195 (49.4) 275 (45.8) 35.28 ＜.001
    Nursing home 26 (6.6) 3 (0.5)
    Home 174 (44.1) 322 (53.7)

    CRRT=continuous renal replacement therapy; ED=emergency department; GW=general ward; ICU=intensive care units; OR=operating room; PU=pressure ulcers.

    Multi-variate Analysis of Risk factors for Carrying Pressure Sores at the ICU Admission (N=1,024)

    Variables Categories Standardized Odds ratio p x2 (p)
    B SE Exp (B) 95% CI
    Age (year) ＜40 ref. 　 　   .002 202.93
    40~60 0.53 .33 1.70 0.89~3.23 .106 (＜.001)
    60~80 0.73 .31 2.07 1.12~3.83 .020
    ≥80 1.31 .37 3.70 1.80~7.60 ＜.001
    Body weight (kg) ＜50 1.04 .25 2.82 1.74~4.56 ＜.001
    50~60 0.39 .21 1.47 0.98~2.21 .065
    60~70 0.31 .20 1.36 0.92~2.00 .119
    ≥70 ref. 　 　   ＜.001
    Consciousness Alert ref. 　 　   ＜.001
    Drowsy 0.77 .22 2.16 1.41~3.29 ＜.001
    Stupor 1.25 .25 3.50 2.14~5.71 ＜.001
    Semicoma 1.17 .40 3.22 1.47~7.08 .004
    Coma 1.52 .47 4.57 1.82~11.48 .001
    Sedation 1.81 .27 6.10 3.57~10.40 ＜.001
    Ventilator   0.47 .23 1.60 1.02~2.49 .040
    Vasopressors   0.42 .17 1.53 1.09~2.14 .015
    ICU admission route ED 0.06 .22 1.06 0.69~1.65 .790
    OR -0.71 .28 0.49 0.29~0.85 .010
    GW ref. 　 　   .003
    Hospital admission route Local hospital l 0.10 .16 1.11 0.81~1.51 .514
    Nursing home e 2.61 .77 13.65 3.02~61.72 .001
    Home ref. 　 　   .003

    PU=pressure ulcers; ICU=intensive care units; ED=emergency department; OR=operating room; GW=general ward.
    Table 1. Prevalence of Pressure Ulcers at the ICU Admission

    ICU=intensive care unit.

    Table 2. The Demographic and Disease-related Characteristics of the Subjects (N=1,024)

    PU=pressure ulcers; ICU=intensive care unit; KHNA=Korean hospital nurses association.

    Table 3. Comparison of Personal Risk Factors between PU Group and Non-PU Group (N=1,024)

    PU=Pressure ulcers; CRP=C-reactive protein; Hb=Hemoglobin;

    Male=13 mg/dL, Female=11 mg/dL.

    Table 4. Comparison of Institutional Risk Factors between PU Group and Non-PU Group (N=1,024)

    CRRT=continuous renal replacement therapy; ED=emergency department; GW=general ward; ICU=intensive care units; OR=operating room; PU=pressure ulcers.

    Table 5. Multi-variate Analysis of Risk factors for Carrying Pressure Sores at the ICU Admission (N=1,024)

    PU=pressure ulcers; ICU=intensive care units; ED=emergency department; OR=operating room; GW=general ward.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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