Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

dc.contributor.authorBoulanger, Carole
dc.description.abstractPurpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9-27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6-16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2-1.8), stage II (OR 1.6; 95% CI 1.4-1.9), and stage III or worse (OR 2.8; 95% CI 2.3-3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.en_US
dc.description.admin-notepublished version, accepted version (12 month embargo)en_US
dc.description.fundingThis project received funding from the European Society of Intensive Care Medicine (ESICM), the Flemish Society for Critical Care Nurses, and the HOGENT Fund for Applied Research. SB holds a research mandate from the Special Research Fund at Ghent University. In the UK, infrastructure support was provided by the National Institute for Health Research (NIHR) Imperial Bio‑medical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. LR was funded by a TD Nursing Professorship in Critical Care Research from Sunnybrook Research Institute, Toronto, Canada. The ESICM financed and co-administered the online data collection platform, provided a study webpage, and supported study administration. The other funding sources had no role in this work.en_US
dc.description.noteThis article is available to RD&E staff via NHS OpenAthens (subject to any publisher embargo). Click on the Publisher URL, and log in with NHS OpenAthens if prompted.en_US
dc.identifier.citationLabeau SO et al. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Med. 2021 Feb;47(2):160-169. doi: 10.1007/s00134-020-06234-9. Epub 2020 Oct 9. Erratum in: Intensive Care Med. 2021 Apr;47(4):503-520.en_US
dc.identifier.journalIntensive Care Medicineen_US
dc.rights© 2020 The Author(s), corrected publication 2020 This article is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
dc.rightsCC0 1.0 Universal*
dc.subjectDecubitus epidemiologyen_US
dc.subjectPressure injuryen_US
dc.subjectPressure ulceren_US
dc.subjectRisk factorsen_US
dc.titlePrevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs studyen_US
dc.typeJournal Articleen_US
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