Bergstrom N, Braden B, Kemp M, Champagne M, Ruby E
University of Nebraska Medical Center College of Nursing, Omaha 68198-5330, USA.
J Am Geriatr Soc. 1996 Jan;44(1):22-30. doi: 10.1111/j.1532-5415.1996.tb05633.x.
To determine the incidence of pressure ulcers in varied populations, and whether demographic characteristics (age, gender, race) and primary diagnosis are factors in pressure ulcer development when the level of risk for developing ulcers is considered. To determine if there is a difference in the type of preventive services prescribed for persons who do or do not develop pressure ulcers when risk is controlled and whether differences can be related to demographic characteristics.
Cohort study.
Two skilled nursing homes, two university operated tertiary care hospitals, and two Veteran's Administration Medical Centers (VAMCs) in Omaha, NE, Durham, NC, and Chicago, IL.
A total of 843 randomly selected patients more than 19 years of age who did not have pressure ulcers on admission to their place of care. Subjects were 63% male, 79% white, and had a mean age of 63 (+/- 16) years.
A head-to-toe skin assessment for pressure ulcers recording site and stage of ulcers, scores for the Braden Scale for Predicting Pressure Sore Risk, demographic characteristics (age, sex, race), and primary diagnosis and preventive interventions (turning or repositioning orders and pressure reduction surface) were documented on the patient record. Observations were made every 48 to 72 hours for a minimum of 1 to a maximum of 4 weeks.
Presence/absence and stage of pressure ulcers.
One hundred eight of 843 (12.8%) subjects developed pressure ulcers. The incidence was 8.5%, 7.4%, and 23.9% in tertiary care, VAMCs, and nursing homes, respectively. Logistic regression demonstrated that lower Braden Scale scores, older age and white race predicted pressure ulcers; gender was not predictive. Primary diagnoses were not significant predictors of pressure ulcer risk when the Braden Scale score was entered into the regression. Prescription of turning was predicted by Braden Scale scores and by white race, whereas prescription of pressure reduction was predicted by Braden Scale scores, white race, and female sex.
Risk assessment, rather than diagnoses or demographic characteristics, is recommended as the basis for prescriptive decisions. Risk assessment should cue health care providers to make more judicious use of turning and support surfaces to prevent pressure ulcers. Persons who are at risk for pressure ulcers should have turning and pressure reduction surfaces consistently prescribed and implemented. The costs and goals of preventive prescription for those not at risk for pressure ulcers should be considered.
确定不同人群中压疮的发生率，以及在考虑发生溃疡的风险水平时，人口统计学特征（年龄、性别、种族）和主要诊断是否为压疮发生的因素。确定在控制风险时，发生或未发生压疮的患者所开具的预防服务类型是否存在差异，以及这些差异是否与人口统计学特征相关。
队列研究。
内布拉斯加州奥马哈市、北卡罗来纳州达勒姆市和伊利诺伊州芝加哥市的两家熟练护理院、两家大学运营的三级护理医院以及两家退伍军人管理局医疗中心（VAMCs）。
总共843名随机选取的19岁以上患者，入院时无压疮。受试者中63%为男性，79%为白人，平均年龄为63（±16）岁。
对压疮进行从头到脚的皮肤评估，记录溃疡部位和分期、预测压疮风险的Braden量表评分、人口统计学特征（年龄、性别、种族）、主要诊断以及预防干预措施（翻身或重新安置医嘱以及减压表面），并记录在患者病历中。每48至72小时进行一次观察，最少观察1周，最多观察4周。
压疮的存在与否及分期。
843名受试者中有108名（12.8%）发生了压疮。在三级护理医院、退伍军人管理局医疗中心和护理院中，发生率分别为8.5%、7.4%和23.9%。逻辑回归显示Braden量表得分较低、年龄较大和白人种族可预测压疮；性别无预测作用。当将Braden量表得分纳入回归分析时，主要诊断不是压疮风险的显著预测因素。翻身医嘱由Braden量表得分和白人种族预测，而减压医嘱由Braden量表得分、白人种族和女性性别预测。
建议将风险评估而非诊断或人口统计学特征作为处方决策的依据。风险评估应促使医疗保健提供者更明智地使用翻身和支撑表面来预防压疮。有压疮风险的人应始终开具并实施翻身和减压表面的医嘱。应考虑无压疮风险者预防处方的成本和目标。
