Reed Richard L, Hepburn Kenneth, Adelson Richard, Center Bruce, McKnight Patrick
Department of Family Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.
Gerontology. 2003 Jul-Aug;49(4):255-9. doi: 10.1159/000070407.
Studies of risk factors for clinically significant pressure ulcers in the hospital have been limited by the small number of study subjects that develop pressure ulcers, resulting in contradictory findings regarding some risk factors.
To determine if three risk factors (low serum albumin level, fecal incontinence, and confusion) were significant risk factors when tested in a large data set.
The study design was a longitudinal cohort study using data collected as a component of a multi-site controlled clinical trial. The data were collected at 47 Veterans Affairs Hospitals. 2,771 subjects that required high levels of nursing care were identified to have mobility impairment. Their medical records were abstracted using a standard form to identify a large number of potential risk factors. The subsequent development of stage 2 or greater pressure ulcers was recorded for a maximum of 14 days after admission.
406 patients (14.7%) subsequently developed at least one stage 2 or greater pressure ulcer over a 2-week period. In a multivariate model, the presence of low albumin levels (odds ratio OR = 1.40) and confusion (OR = 1.45) were both found to be statistically significant risk factors, while fecal incontinence was not. Having a Do Not Resuscitate (DNR) order was also a significant risk factor (OR = 1.55). Two other known risk factors also entered the model: being malnourished (OR = 1.69) and requiring a urinary catheter (OR = 1.55).
This study confirmed confusion and low albumin as pressure ulcer risk factors, but not fecal incontinence. A DNR order was found to be a new pressure ulcer risk factor not previously described in the literature.
医院中对具有临床意义的压疮危险因素的研究因发生压疮的研究对象数量较少而受到限制，这导致在一些危险因素方面出现相互矛盾的研究结果。
确定在一个大型数据集中测试时，三个危险因素（低血清白蛋白水平、大便失禁和意识模糊）是否为显著的危险因素。
本研究设计为纵向队列研究，使用作为多中心对照临床试验一部分收集的数据。数据在47家退伍军人事务医院收集。确定2771名需要高水平护理的受试者存在行动障碍。使用标准表格提取他们的病历，以识别大量潜在危险因素。记录入院后最多14天内后续发生的2期或更严重压疮情况。
406名患者（14.7%）在2周内随后发生了至少一处2期或更严重的压疮。在多变量模型中，低白蛋白水平（比值比OR = 1.40）和意识模糊（OR = 1.45）均被发现是具有统计学意义的危险因素，而大便失禁不是。有“不要复苏”（DNR）医嘱也是一个显著的危险因素（OR = 1.55）。另外两个已知危险因素也进入了模型：营养不良（OR = 1.69）和需要留置导尿管（OR = 1.55）。
本研究证实意识模糊和低白蛋白是压疮危险因素，但大便失禁不是。发现DNR医嘱是文献中先前未描述的新的压疮危险因素。
