CEEG electrode-related pressure ulcers in acutely hospitalized patients. Issue 1 (February 2017)

• Record Type: Journal Article
• Authors: Moura, Lidia M.V.R.; Carneiro, Thiago S.; Kwasnik, David; Moura, Valdery F.; Blodgett, Christine S.; Cohen, Joseph; McKenna Guanci, Mary; Hoch, Daniel B.; Hsu, John; Cole, Andrew J.; Westover, M. Brandon
• Is Part Of: Neurology. Volume 7:Issue 1(2017)
• Publication Date: 2017-02
• Subjects: Nervous system -- Diseases -- Periodicals; Neurology -- Periodicals; Neurology -- United States -- Periodicals; 616.8
• DOI: 10.1212/CPJ.0000000000000312
• Languages: English
• ISSNs: 2163-0402

Abstract

Abstract: Background: Pressure ulcers resulting from continuous EEG (cEEG) monitoring in hospitalized patients have gained attention as a preventable medical complication. We measured their incidence and risk factors. Methods: We performed an observational investigation of cEEG-electrode-related pressure ulcers (EERPU) among acutely ill patients over a 22-month period. Variables analyzed included age, sex, monitoring duration, hospital location, application methods, vasopressor usage, nutritional status, skin allergies, fever, and presence/severity of EERPU. We examined risk for pressure ulcers vs monitoring duration using Kaplan-Meyer survival analysis, and performed multivariate risk assessment using Cox proportional hazard model. Results: Among 1, 519 patients, EERPU occurred in 118 (7.8%). Most (n = 109, 92.3%) consisted of hyperemia only without skin breakdown. A major predictor was monitoring duration, with 3-, 5-, and 10-day risks of 16%, 32%, and 60%, respectively. Risk factors included older age (mean age 60.65 vs 50.3, p < 0.01), care in an intensive care unit (9.37% vs 5.32%, p < 0.01), lack of a head wrap (8.31% vs 27.3%, p = 0.02), use of vasopressors (16.7% vs 9.64%, p < 0.01), enteral feeding (11.7% vs 5.45%, p = 0.04), and fever (18.4% vs 9.3%, p < 0.01). Elderly patients (71–80 years) were at higher risk (hazard ratio 6.84 [1.95–24], p < 0.01), even after accounting for monitoring time and other pertinent variables in multivariate analysis. Conclusions: EERPU are uncommon and generally mild. Elderly patients and those with more severe illness have higher risk of developing EERPU, and the risk increases as a function of monitoring duration.