Abstract
Objective
To determine whether a low Braden skin score (BSS), reflecting increased risk for
skin pressure injury, would predict lower survival in cardiac intensive care unit
(CICU) patients after adjustment for illness severity and comorbidities.
Patients and Methods
This retrospective cohort study included consecutive unique adult patients admitted
to a single tertiary care referral hospital CICU from January 1, 2007, through December
31, 2015, who had a BSS documented on CICU admission. The primary outcome was all-cause
hospital mortality, using elastic net penalized logistic regression to determine predictors
of hospital mortality. The secondary outcome was all-cause post-discharge mortality,
using Cox proportional hazards models to determine predictors of post-discharge mortality.
Results
The study included 9552 patients with a mean age of 67.4±15.2 years (3589 [37.6%]
were females) and a hospital mortality rate of 8.3%. Admission BSS was inversely associated
with hospital mortality (unadjusted odds ratio, 0.70; 95% CI, 0.68-0.72; P<.001; area under the receiver operator curve, 0.80; 95% CI, 0.78-0.82), with increased
short-term mortality as a function of decreasing admission BSS. After adjustment for
illness severity and comorbidities using multivariable analysis, admission BSS remained
inversely associated with hospital mortality (adjusted odds ratio, 0.88; 95% CI, 0.85-0.92;
P<.001). Among hospital survivors, admission BSS was inversely associated with post-discharge
mortality after adjustment for illness severity and comorbidities (adjusted hazard
ratio, 0.89; 95% CI, 0.88-0. 90; P<.001).
Conclusion
The admission BSS, a simple inexpensive bedside nursing assessment potentially reflecting
frailty and overall illness acuity, was independently associated with hospital and
post-discharge mortality when added to established multiparametric illness severity
scores among contemporary CICU patients.
Abbreviations and Acronyms:
APACHE (Acute Physiology and Chronic Health Evaluation), AUROC (area under the receiver-operator characteristic curve), BSS (Braden skin score), CI (confidence interval), CICU (cardiac intensive care unit), OASIS (Oxford Acute Severity of Illness Score), OR (odds ratio), PCI (percutaneous coronary intervention), SOFA (sequential organ failure assessment)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evolution of the coronary care unit: clinical characteristics and temporal trends in healthcare delivery and outcomes.Crit Care Med. 2010; 38: 375-381
- Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States.Circ Cardiovasc Qual Outcomes. 2017; 10e003616
- Predictive value of the sequential organ failure assessment score for mortality in a contemporary cardiac intensive care unit population.J Am Heart Assoc. 2018; 7e008169
- Noncardiovascular disease and critical care delivery in a contemporary cardiac and medical intensive care unit.J Intensive Care Med. 2019; 34: 537-543
- Comparison of mortality risk prediction among patients ≥70 versus <70 years of age in a cardiac intensive care unit.Am J Cardiol. 2018; 122: 1773-1778
- Editor's Choice—Frailty and the management of patients with acute cardiovascular disease: a position paper from the Acute Cardiovascular Care Association.Eur Heart J Acute Cardiovasc Care. 2018; 7: 176-193
- The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis.Intensive Care Med. 2017; 43: 1105-1122
- Frailty assessment in the cardiovascular care of older adults.J Am Coll Cardiol. 2014; 63: 747-762
- Frailty and subsequent disability and mortality among patients with critical illness.Am J Respir Crit Care Med. 2017; 196: 64-72
- Outcomes of nonagenarians admitted to the cardiac intensive care unit by the elders risk assessment score for long-term mortality risk stratification.Am J Cardiol. 2017; 120: 1421-1426
- The Braden Scale for Predicting Pressure Sore Risk.Nurs Res. 1987; 36: 205-210
- Evidence-based prevention of pressure ulcers in the intensive care unit.Crit Care Nurse. 2013; 33: 57-66
- Predictive validity of the Braden scale for patients in intensive care units.Am J Crit Care. 2013; 22: 514-520
- Usefulness of the Braden scale in intensive care units: a study based on electronic health record data.J Nurs Care Qual. 2018; 33: 238-246
- Can Braden score predict outcomes for hospitalized heart failure patients?.J Am Geriatr Soc. 2017; 65: 1328-1332
- Clinical implications and validity of nursing assessments: a longitudinal measure of patient condition from analysis of the electronic medical record.BMJ Open. 2012; 2e000646
- The Braden scale, a standard tool for assessing pressure ulcer risk, predicts early outcomes after liver transplantation.Liver Transpl. 2017; 23: 1153-1160
- Derivation and validation of automated electronic search strategies to extract Charlson comorbidities from electronic medical records.Mayo Clin Proc. 2012; 87: 817-824
- Prospective validation of a near real-time EHR-integrated automated SOFA score calculator.Int J Med Inform. 2017; 103: 1-6
- Mapping physicians' admission diagnoses to structured concepts towards fully automatic calculation of acute physiology and chronic health evaluation score.BMJ Open. 2011; 1e000216
- A new severity of illness scale using a subset of Acute Physiology And Chronic Health Evaluation data elements shows comparable predictive accuracy.Crit Care Med. 2013; 41: 1711-1718
- Developing the surveillance algorithm for detection of failure to recognize and treat severe sepsis.Mayo Clin Proc. 2015; 90: 166-175
- Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).Crit Care Med. 2001; 29: 1370-1379
- Regularization and variable selection via the elastic net.J Roy Stat Soc B. 2005; 67: 301-320
- Predictors of hospital mortality in the global registry of acute coronary events.Arch Intern Med. 2003; 163: 2345-2353
- Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit.Am Heart J. 2015; 170: 79-86.e1
- Pressure ulcer risk assessment in critical care: interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units.Int J Nurs Stud. 2010; 47: 671-677
- Performance of variable selection methods for assessing the health effects of correlated exposures in case-control studies.Occup Enrivon Med. 2018; 75: 522-529
Article Info
Footnotes
For Limelight, see page 1915
Potential Competing of Interests: The authors report no competing interests.
Identification
Copyright
© 2019 Mayo Foundation for Medical Education and Research
