Factors influencing the development of decubitus ulcers in critically ill surgical patients

Introduction: Decubitus ulcers confer significant morbidity to critically i ll patients. We sought to determine which patient factors contributed to th e formation of decubitus ulcers in our critically ill patients, and hypothe sized that these ulcers occurred most often in elderly patients with length s of stay >7 days and high severity of illness. Methods: This study was conducted prospectively in two phases. Phase I prov ided an initial analysis of patients who developed decubitus ulcers in the surgical intensive care unit (ICU) of New York Weill Cornell Center from Ja nuary 1, 1993, to June 1, 1997. In phase II of the study, a comparison stud y was made for patients with ICU length of stay (ULOS) >7 days admitted to the same ICU from January 1, 1998, to August 31, 1998. Age, APACHE III scor e, systemic inflammatory response syndrome (SIRS score), multiple organ dys function syndrome (MODS) score, admission status, days without nutrition, U LOS, mortality, days to formation of decubitus ulcers, Cornell ulcer risk s core, and other demographic features were recorded. Univariate and multivar iate analysis of variance were performed to analyze independent risk factor s for development of decubitus ulcers; p < .05. Results: In phase I, 2,615 patients were admitted to surgical over the stud y period, One hundred and one decubitus ulcers occurred (incidence 3.8%) du ring phase I, but the incidence of decubitus ulcers increased significantly over time to 9% (p < .01). Thirty-three decubitus ulcers occurred among th e 412 patients (incidence 8.0%) during phase II. Multivariate analysis reve aled that emergent admission (odds ratio [OR] 36.00, 95% confidence interva l [Cl] Cl 0.2290-0.7694), age (OR 1.08, 95% Cl 0.0026-0.0131), days in bed (OR 1.05, 95% Cl -0.0013-0.0156, and days without nutrition (OR 0.51, 95% C l -0.1095--0.0334) were independent predictors of a decubitus ulcer. Conclusions: The incidence of decubitus ulcers is increasing in critically ill patients. Emergency ICU admission and ULOS >7 days in elderly patients confer significant risk for the formation of decubitus ulcers. Specific int erventions targeting this highrisk population that may be instituted to dec rease the incidence of decubitus ulcers include early nutrition, early mobi lization, and possibly less noxious bedding surfaces.