For ICU patients with COVID-19, routine risk assessment and increased attention to detail are required to prevent pressure injuries.

According to a study published in AACN Advanced Critical Care, nurses and other clinicians should be extra vigilant with assessments and protective interventions for patients who are critically ill with COVID-19 because they are at exceptionally high risk for developing healthcare-associated pressure injuries (HAPrIs).

In a retrospective study titled “Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit,” 1,920 adult patients who were admitted to one of two intensive care units (ICUs) at a Utah teaching hospital between April 2020 and April 2021 were evaluated for pressure injury risk.

The study is a component of the research team’s continuous efforts to create methods for more precisely estimating the risk of pressure damage among ICU patients. The researchers were able to discover new risk factors for device-related HAPrIs in critically ill patients with COVID-19 by comparing the prediction validity of the Braden Scale for Predicting Pressure Sore Risk for patients with COVID-19 with patients who were negative for the disease.


The Braden Scale was created in 1987 and has since grown to be the most popular tool in the United States for assessing the risk of pressure injuries in all care settings. However, a growing body of research indicates that it lacks predictive validity in the ICU population, with results showing that nearly all ICU patients are at high risk.

The study sample totaled 1,920 patients, 407 of whom had been given a COVID-19 diagnosis. Three-quarters of the 354 individuals with at least one HAPrI in the total sample—18%—were thought to be connected to the device. 120 of the 407 COVID-19 patients experienced at least one HAPrI, with nearly half (46%) being thought to be device-related.

The study team examined information on demographics, diagnoses, comorbidities, length of hospital stay, treatment interventions, laboratory testing, nutrition, and outcomes of nurse-performed skin exams.

Two criteria were identified through statistical analysis as possible risk factors for device-related HAPrIs: prone positioning during mechanical ventilation and skin fragility.

In order to provide doctors more data to consider when making decisions about patient care, the researchers also highlight the potential for machine learning techniques and explainable artificial intelligence to enhance the accuracy of HAPrI risk assessments.




Journal reference:
Alderden, J., et al. (2022) Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit. AACN Advanced Critical Care.

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