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Bundle of symptoms and blood results 'may indicate pressure ulcer risk', finds study

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A quick check for the presence of four symptoms, along with age and laboratory blood results, could help nurses identify patients most likely to be at risk from pressure ulcers, according to researchers.

A new study has suggested that using patient-reported symptoms and standard laboratory blood results to supplement the use of screening tools may improve identification of those at risk from pressure ulcers.

Researchers found a group of symptoms – vomiting, severe pain while at rest, urination problems and shortness of breath – and also lower albumin levels were indicators of patients being more at risk. In addition, patients who reported feeling nervous were less likely to develop ulcers.

“A quick assessment of symptoms, age and laboratory blood results could assist nurses in identifying patients most likely to be at risk”

JCN paper on pressure ulcer risk

The Norwegian study, published in the Journal of Clinical Nursing, looked at 328 patients on medical wards in an acute general hospital in Oslo between September 2012 and May 2014.

Those behind the research paper noted previous studies had questioned whether the usefulness of pressure ulcer screening tools actually came from the resulting raised awareness of the nurse using it, which in turn improved their clinical judgement – rather than the tool itself.

They also highlighted other research had suggested it was more useful to limit screening to groups of patients who were most at risk of pressure ulceration, because screening all of them did not lead to direct changes in types of care given.

Therefore, they said they wanted to explore the potential association between pressure ulcer risk – as defined by the Braden scale screening tool – and patients’ symptoms, socio-demographic factors, comorbidities and blood results.

“Four of the symptoms can all, for various reasons and at different levels, be related to all six items in the Braden scale”

JCN paper on pressure ulcer risk

The results showed “not surprisingly” that older age was the most significant predictor of pressure ulcer risk. They found patients aged 80 years or above were more than four times more likely to be at risk than patients younger than 65 years of age.

In addition, high distress due to vomiting was the strongest symptom predictor, followed by severe pain at rest, according to the study – titled Supplementing the Braden scale for pressure ulcer risk among medical inpatients: the contribution of self-reported symptoms and standard laboratory tests.

Urination problems and high distress due to shortness of breath more than doubled the likelihood of pressure ulcer risk.

Meanwhile, patients who reported feeling nervous were 70% less likely to be at risk for pressure ulcers than patients without nervousness.

In terms of laboratory results, patients with albumin levels below 35g/l were four times as likely as patients with higher albumin levels to be at risk for pressure ulcers.

“Four of the symptoms (i.e. vomiting, severe pain at rest, urination problems and shortness of breath) can all, for various reasons and at different levels, be related to all six items in the Braden scale (i.e. sensory perception, moisture, activity, mobility, nutrition, and friction and shear),” said the study authors.

“In a world of increasing need for cost-effectiveness and efficiency, it is necessary to thoroughly evaluate each new task introduced in hospital settings”

JCN paper on pressure ulcer risk

“Symptom assessment is a routine for nurses and is performed on a regular basis. This study shows that patient-reported symptoms, older age and low albumin may help identify which patients are at risk for pressure ulcers,” they said.

The researchers highlighted that it could be “valuable knowledge” for nurses in their clinical judgment of patients and could serve as a supplement to existing pressure ulcer risk tools.

“In a world of increasing need for cost-effectiveness and efficiency, it is necessary to thoroughly evaluate each new task introduced in hospital settings,” they stated.

“In contrast to systematically screening all patients admitted to acute general hospitals for pressure ulcer risk, a quick assessment of symptoms, age and laboratory blood results could assist nurses in identifying which patients are most likely to be at risk, so that further risk screening and prevention efforts could be targeted to these patients,” they added.

However, the researchers acknowledged that further studies were needed to validate the use of symptom assessment, laboratory blood results and age as useful indicators of pressure ulcer risk.

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