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Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients: A Systematic Review and Meta-Analysis
Journal article   Peer reviewed

Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients: A Systematic Review and Meta-Analysis

Wendy Chaboyer, Lukman Thalib, Emma Harbeck, Fiona Coyer, Stijn Blot, Claudia Bull, Paula Nogueira and Frances Lin
Critical Care Medicine, Vol.46(11), pp.e1074-e1081
2018
DOI: https://doi.org/10.1097/CCM.0000000000003366
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https://doi.org/10.1097/CCM.0000000000003366View
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Abstract

incidence intensive care unit meta-analysis pressure ulcer prevalence systematic review
Objectives: To systematically assess the incidence and prevalence of pressure injuries in adult ICU patients and the most frequently occurring pressure injury sites. Data Sources: MEDLINE, Embase, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature. Study Selection: Observational studies reporting incidence rates, cumulative incidence, and prevalence of pressure injuries. Data Extraction: Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Meta-analyses of pooled weighted estimates were calculated using random effect models with 95% CIs reported due to high heterogeneity. Sensitivity analyses included studies that used skin inspection to identify a pressure injury, studies at low risk of bias, studies that excluded stage 1 and each stage of pressure injury. Data Synthesis: Twenty-two studies, 10 reporting cumulative incidence of pressure injury irrespective of stage, one reporting incidence rate (198/1,000 hospital-days), and 12 reporting prevalence were included. The 95% CI of cumulative incidence and prevalence were 10.0-25.9% and 16.9-23.8%. In studies that used skin inspection to identify pressure injuries, the 95% CI of cumulative incidence was 9.4-27.5%; all prevalence studies used skin inspection therefore the results were unchanged. In studies assessed as low risk of bias, the 95% CI of cumulative incidence and prevalence were 6.6-36.8% and 12.2-24.5%. Excluding stage 1, the 95% CI of cumulative incidence and prevalence were 0.0-23.8% and 12.4-15.5%. Five studies totalling 406 patients reported usable data on location; 95% CI of frequencies of PIs were as follows: sacrum 26.9-48.0%, buttocks 4.1-46.4%, heel 18.5-38.9%, hips 10.9-15.7%, ears 4.3-19.7%, and shoulders 0.0-40.2%. Conclusions: Although well-designed studies are needed to ensure the scope of the problem of pressure injuries is better understood, it is clear prevention strategies are also required.

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