Determination of bed sore risk factors in craniospinal trauma patients in intensive care units

Decubitus ulcer is a pressure-induced tissue injury that may affect skin, muscle, connective tissue, cartilage and bone. The present study was designed to find out risk factors of decubitus ulcer in head and spinal cord injured patient admitted to intensive care units (ICU). In this cross - seetional analythical study all consecutive craniospinal trauma patients admitted to intensive care unit were included.Upon arrival at the hospital and every 48 hours, all patients were examined for existence of bed sore. Braden scale, age, kind of mattress, site of primary injury and level of consciousness were used to determine risk factors. Data was analyzed using T and Chi square tests and logistic regretion. Among 198 patients (171 male, 27 female with mean age of 31.4=19.8), 166 patients (3.8%) had cranial and 32 (16.2%) patients had spinal trauma. Of samples, 45 (22.7%) patients had 67 sores in 13 different sites. Incidence of bed sore was 22.7% (in cranial and spinal injured patients was 4.54% and 18.18% respectively). The most common sites were intergluteal cleft (33.3%) and sacral regions (28.9%). Bed sores were observed more frequently in immobile patients and those with impaired sensation, the difference were statistically significant (p<0.005 and p<0.005 respectively) hence immobility and impaired sensation are known as risk factors. Patient’s sores were not influenced by age, moisture, activity, nutrition and type of mattress variables. Time of hospital stay in patients with bed sore was significantly more than those without bed sore (P<0.00001). Coma patients (GCS 8) had developed bed sore more frequently than conscious ones (OR=6.1, RR=4.4, P=0.00001). Results show that risk factors of deubitus ulcers in ICU admitted craniospinal trauma patients were decreased sensation, activity and level of conciousness and lenglt of hospital stay.