Incidence and Outcome of Pressure Ulcers in Intensive Care Unit Patients: A Prospective Observational Study

Introduction: Pressure sores are among the most challenging problems healthcare professionals face in patients with mobility limitations. These wounds can deteriorate the underlying condition and can sometimes be vitally threatening, making treatment challenging as well. Pressure sores can have a significant effect on the general health and quality of life of the patient. Aim: To determine the incidence, outcomes, common anatomical sites, and the most common clinical conditions leading to pressure ulcer formation in Intensive Care Unit (ICU) patients. Materials and Methods: A prospective observational study was conducted in the Medical and Surgical Intensive Care Units (ICU) of Yenepoya Medical College Hospital, Mangaluru, Karnataka, India from November 2021 to November 2022. Data were collected using a predesigned proforma and an observational assessment tool-the Pressure Ulcer Scale for Healing (PUSH), which is used to assess and monitor the healing of pressure ulcers. The variables studied included the incidence, aetiopathogenesis, and outcomes of pressure sores. Descriptive statistics were performed using mean and frequency distribution. Results: In present study, the incidence of pressure sores in the Medical Intensive Care Unit (MICU) and Surgical Intensive Care Unit (SICU) over one year was found to be 5.3% (48 out of 906 patients). The mean age of the patients was 55.42 +/- 16.58 years, with a male predominance of 32 (66.7%) cases compared to 16 (33.3%) cases females. Among the 48 patients who developed pressure sores, 20 patients (41.7%) were anaemic, as indicated by haemoglobin levels below 10 g/dL. The most common co-morbidity was diabetes mellitus, observed in 16 (33.3%) patients. Approximately 27 (56.3%) cases of the patients had one or more co-morbidities, while 21 (43.8%) cases had no co-morbidities. The most common anatomical site for pressure sores was the sacral region, affecting 41 (85.4%) patients, followed by the gluteal region, which affected 7 (14.6%) patients. Using the PUSH tool, it was found that 27 (56.3%) patients had epithelial tissue in their sores. A total of 16 (33.3%) patients had closed-type pressure sores, and 5 (10.4%) patients had granulation tissue. The mean wound area was 5.56 +/- 3.175 cm2. The primary clinical conditions in patients who developed pressure sores included septic shock in 14 (29.17%) cases, Cerebrovascular Accident (CVA) in 12 (25%) cases, head injury in 8 (16.7%) cases, malignancy in 4 (8.33%) cases, pneumonia in 3 (6.25%) cases, and pancreatitis and Pott's spine, each in 2 (4.17%) cases. Organophosphate (OP) poisoning, Tuberculosis (TB) meningitis, and Haemophilia were noted in 1 (2.08%) case each. Out of the 48 patients, 41 (85.4%) cases healed during their hospital stay, while 7 (14.6%) cases did not heal, with five of these patients dying due to sepsis and the other two due to CVA and end-stage malignancy. The mean duration for healing was 14.02 +/- 7.58 days, ranging from four to 32 days. Conclusion: Most patients who developed pressure sores were predominantly male, with common co-morbidities like diabetes, hypertension, and CVA. Sacral sores were the most frequent.