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Moving average as a method of assessing risk of pressure injury using the COMHON index (Conscious level, Mobility, Hemodynamic, Oxygenation, Nutrition) for patients in intensive care units

Published:December 16, 2021DOI:https://doi.org/10.1016/j.aucc.2021.11.002

      Abstract

      Background

      Moving average is the continuously updated arithmetic mean of the pressure injury (PI) risk score values measured with the COMHON Index (Conscious level, Mobility, Hemodynamics, Oxygenation, Nutrition).

      Objective

      The objective of this study was to validate the moving average as a method to measure the level of risk of PI.

      Method

      This is a cohort study of adult patients admitted for a duration of more than 24 h in an intensive care unit (ICU) of a tertiary-level university hospital, between June 1, 2018, and December 31, 2019. The risk of PI was obtained with the COMHON Index, and its 3-day moving average was used to monitor the risk of PI. To assess the predictive ability of the moving average score, a receiver operating characteristic curve analysis was performed, obtaining the area under the curve, and the Youden Index to determine the optimal cut-off point of the PI risk moving average score using the COMHON Index.

      Results

      A total of 1335 patients (94.6% of admissions) were included, and 82 developed PI (cumulative incidence of 6.1%) in the 18 months of the study. The highest incidence of PI was in the sacrum (49%) followed by the heel (17.6%). The median age was 65 (54–73) years, and the median length of stay was 3.8 (1.9–9) days. The moving average score had an area under the receiver operating characteristic curve of 87% (95% confidence interval: 85%–89%), with a cut-off point of the moving average score ≥11, and the negative predictive value was 99.6%.

      Conclusions

      The moving average score combined with a validated scale is a useful method to predict potential PI of patients admitted to the ICU. Its use is suggested for decision-making during the implementation of the care plan related to the prevention of PI in patients admitted to the ICU.

      Keywords

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      References

        • Edsberg L.E.
        • Black J.M.
        • Goldberg M.
        • McNichol L.
        • Moore L.
        • Sieggreen M.
        Revised national pressure ulcer advisory panel pressure injury staging system: revised pressure injury staging system.
        J Wound, Ostomy Cont Nurs. 2016; 43: 585-597https://doi.org/10.1097/WON.0000000000000281
        • Petzold T.
        • Eberlein-Gonska M.
        • Schmitt J.
        Which factors predict incident pressure ulcers in hospitalized patients? A prospective cohort study.
        Br J Dermatol. 2014; 170: 1285-1290https://doi.org/10.1111/bjd.12915
        • Becker D.
        • Tozo T.C.
        • Batista S.S.
        • Mattos A.L
        • Silva M.C.B.
        • Rigon S.
        • et al.
        Pressure ulcers in ICU patients: incidence and clinical and epidemiological features: a multicenter study in southern Brazil.
        Intensive Crit Care Nurs. 2017; 42: 55-61https://doi.org/10.1016/j.iccn.2017.03.009
        • Kim J.Y.
        • Lee Y.J.
        Medical device-related pressure ulcer (MDRPU) in acute care hospitals and its perceived importance and prevention performance by clinical nurses.
        Int Wound J. 2019; 16: 51-61https://doi.org/10.1111/iwj.13023
        • Keller B.P.
        • Wille J.
        • van Ramshorst B.
        • van der Werken C.
        Pressure ulcers in intensive care patients: a review of risks and prevention.
        Intensive Care Med. 2002; 28: 1379-1388https://doi.org/10.1007/s00134-002-1487-z
        • Llaurado-Serra M.
        • Afonso E.
        Pressure injuries in intensive care: what is new?.
        Intensive Crit Care Nurs. 2018; 45: 3-5https://doi.org/10.1016/j.iccn.2017.12.002
        • Yepes D.
        • Molina F.
        • León W.
        • Pérez E.
        Incidencia y factores de riesgo en relación con las úlceras por presión en enfermos críticos.
        Med Intensiva. 2009; 33: 276-281https://doi.org/10.1016/S0210-5691(09)72195-3
        • Torra-Bou J.E.
        Incidencia de úlceras por presión en unidades de cuidados intensivos. Revisión sistemática con meta-análisis [Tesis].
        Universitat d'Alacant - Universidad de Alicante, Alicante2016
        • Chaboyer W.P.
        • Lin F.F.
        • Thalib L.
        • Harbeck E.L.
        • Bull C.F.
        • Coyer F.M.
        • et al.
        Incidence and prevalence of pressure injuries in adult intensive care patients: a systematic review and meta-analysis.
        Crit Care Med. 2018; 46: e1074-e1081https://doi.org/10.1097/CCM.0000000000003366
        • Barakat-Johnson M.
        • Lai M.
        • Wand T.
        • Li M.
        • White K.
        • Coyer F.
        The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review.
        J Wound Care. 2019; 28: 512-521https://doi.org/10.12968/jowc.2019.28.8.512
        • Agency for Healthcare Research and Quality, (AHRQ)
        AHRQuality indicators™.
        2018 (content last reviewed july Available from:)
        • European pressure ulcer advisory Panel
        national pressure injury advisory Panel and Pan pacific pressure injury alliance. Prevention and treatment of pressure ulcers/injuries: quick reference guide. Haesler, emily ed.
        EPUAP/NPIAP/PPPIA, 2019 (Available from:)
        • Kottner J.
        • Hahnel E.
        • Lichterfeld-Kottner A.
        • Blume-Peytavi U.
        • Büscher A.
        Measuring the quality of pressure ulcer prevention: a systematic mapping review of quality indicators.
        Int Wound J. 2018; 15: 218-224https://doi.org/10.1111/iwj.12854
        • Hyunwook K.
        • Ji Woon K.
        Effectiveness of the intervention programs for pressure ulcer prevention in intensive care units: a meta-analysis.
        J Korean Crit Care Nurs. 2018; 11 (Available from:): 67-78
        • Lovegrove J.
        • Fulbrook P.
        • Miles S.
        Prescription of pressure injury preventative interventions following risk assessment: an exploratory, descriptive study.
        Int Wound J. 2018; 15: 985-992https://doi.org/10.1111/iwj.12965
        • Grupo de desarrollo del Índice COMHON
        Diseño y estudio de la validez y fiabilidad de una nueva escala de valoración del riesgo de úlceras por presión en UCI. Índice COMHON.
        Evidentia. 2013; 10 (Available from:)
        • Harmsen S.M.
        • Chang Y.H.
        • Hattrup S.J.
        Simple moving average: a method of reporting evolving complication rates.
        Orthopedics. 2016; 39: e869-e876https://doi.org/10.3928/01477447-20160517-02
        • Fulbrook P.
        • Anderson A.
        Pressure injury risk assessment in intensive care: comparison of inter-rater reliability of the COMHON (conscious level, mobility, haemodynamics, oxygenation, nutrition) index with three scales.
        J Adv Nurs. 2016; 72: 680-692https://doi.org/10.1111/jan.12825
        • Leal-Felipe M.A.
        • Arroyo-López M.C.
        • Robayna-Delgado M.C.
        • Gómez-Espejo A.
        • Perera-Díaz P.
        • Chinea-Rodríguez C.D.
        • et al.
        Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: a diagnostic accuracy study.
        Aust Crit Care. 2018; 31: 355-361https://doi.org/10.1016/j.aucc.2017.11.003
        • Knaus W.A.
        • Draper E.A.
        • Wagner D.P.
        • Zimmerman J.E.
        Apache II: a severity of disease classification system.
        Crit Care Med. 1985; 13: 818-829https://doi.org/10.1097/00003246-198510000-00009
        • Azuh O.
        • Gammon H.
        • Burmeister C.
        • Frega D.
        • Nerenz D.
        • DiGiovine B.
        • et al.
        Benefits of early active mobility in the medical intensive care unit: a pilot study.
        Am J Med. 2016; 129: 866https://doi.org/10.1016/j.amjmed.2016.03.032
        • Cox J.
        • Roche S.
        • Murphy V.
        Pressure injury risk factors in critical care patients: a descriptive analysis.
        Adv Skin Wound Care. 2018; 31: 328-334https://doi.org/10.1097/01.ASW.0000534699.50162.4e
        • González-Méndez M.I.
        • Lima-Serrano M.
        • Martín-Castaño C.
        • Alonso-Araujo I.
        • Lima-Rodríguez J.S.
        Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit.
        J Clin Nurs. 2018; 27: 1028-1037https://doi.org/10.1111/jocn.14091
        • Babamohamadi H.
        • Ansari Z.
        • Nobahar M.
        • Mirmohammadkhani M.
        The effects of peppermint gel on prevention of pressure injury in hospitalized patients with head trauma in neurosurgical ICU: a double-blind randomized controlled trial.
        Compl Ther Med. 2019; 47: 102223https://doi.org/10.1016/j.ctim.2019.102223
        • Medeiros A.B.A.
        • Fernandes M.I.C.D.
        • Tinôco J.D.S.
        • Cossi M.S.
        • Lopes M.V.O.
        • Lira A.L.B.C.
        Predictors of pressure ulcer risk in adult intensive care patients: a retrospective case-control study.
        Intensive Crit Care Nurs. 2018; 45: 6-10https://doi.org/10.1016/j.iccn.2017.09.007
        • Lima Serrano M.
        • González Méndez M.I.
        • Carrasco Cebollero F.M.
        • Lima Rodríguez J.S.
        Risk factors for pressure ulcer development in intensive care units: a systematic review.
        Med Intensiva. 2017; 41: 339-346https://doi.org/10.1016/j.medin.2016.09.003
        • El-Marsi J.
        • Zein-El-Dine S.
        • Zein B.
        • Doumit R.
        • Kurdahi Badr L.
        Predictors of pressure injuries in a critical care unit in Lebanon: prevalence, characteristics and associated factors.
        J Wound, Ostomy Cont Nurs. 2018; 45: 131-136https://doi.org/10.1097/WON.0000000000000415
        • Tayyib N.
        • Coyer F.
        • Lewis P.
        Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: a prospective cohort study.
        Int Wound J. 2016; 13: 912-919https://doi.org/10.1111/iwj.12406
        • Kaitani T.
        • Tokunaga K.
        • Matsui N.
        • Sanada H.
        Risk factors related to the development of pressure ulcers in the critical care setting.
        J Clin Nurs. 2010; 19: 414-421https://doi.org/10.1111/j.1365-2702.2009.03047.x