Cox et al performed a decision tree analysis for predicting pressure injury for an adult in the intensive care unit (ICU). This can help to identify a patient who may benefit from more aggressive management. The authors are from Rutgers University.
Study group: 1,460 patients, 25% with injuries
Patient selection: adult
Outcome: pressure injury (most often Stage 2, most often over the sacrum)
Parameters:
(1) administered norepinephrine
(2) length of stay in ICU in days
(3) age in the ICU (called average age in decision tree)
(4) Braden scale score (from 6 to 23; the lower the score the greater the risk)
|
Nor-epinephrine
|
LOS ICU
|
age
|
Braden Scale
|
Percent Pressure Injury
|
|
no
|
NA
|
NA
|
NA
|
10%
|
|
yes
|
> 26.11
|
NA
|
NA
|
59%
|
|
yes
|
<= 26.11
|
<= 64.7
|
NA
|
22%
|
|
yes
|
<= 26.11
|
> 64.7
|
> 14.5
|
27%
|
|
yes
|
<= 9.74
|
> 64.7
|
<= 14.5
|
64%
|
|
yes
|
9.75 to 26.11
|
> 64.7
|
<= 14.5
|
44%
|
where:
• Norepinephrine is a potent pressor agent and implies significant hypotension. The impact of other pressor agents is a little unclear.
Additional risk factors:
(1) malnutrition
(2) vascular disease (cardiovascular, peripheral)
(3) hemodialysis
(4) pneumonia
(5) cardiovascular surgery
(6) septic shock
