HODNOTICÍ NÁSTROJE K PREDIKCI RIZIKA VZNIKU DEKUBITŮ U KRITICKY NEMOCNÝCH PACIENTŮ
Assessment Tools for Predicting the Risk of Pressure Ulcers in Critically Ill Patients: a Review Study
DOI:
https://doi.org/10.46585/hc.2026.1.2818Keywords:
pressure ulcers, assessment tools, risk assessment, intensive care, nursingAbstract
Background: Pressure ulcers are a serious complication in the intensive care setting; they have been shown to increase patient mortality and represent a significant clinical and economic burden on the healthcare system. Aim: The objective of this study was to identify and compare assessment tools designed to predict the risk of pressure ulcers in critically ill adult patients hospitalized in intensive care units. Methods: A literature review was conducted from November to December 2025 in the EBSCO, Nursing Ovid, and Web of Science databases. The search was conducted using a combination of the keywords “risk assessment,” “bedsores,” “pressure injuries,” “intensive care,” “critical care,” and “nursing” with the Boolean operators AND and OR. Quantitative studies published in English between 2005 and 2025 were included. Results: A total of 10 studies were included in the review. Specific intensive care tools were identified: CALCULATE, the COMHON index, the Cubbin & Jackson scale, EVARUCI, RAPS-ICU, and Song & Choi. The tools differ in structure, predictive validity, reliability, and clinical utility. Traditional scales developed for standard wards show limited accuracy in the intensive care setting. Conclusion: At present, it is not possible to identify a single, universally best tool for all intensive care patients. Effective risk assessment requires a combination of standardized tools and clinical judgment. Further research should focus on standardizing and validating tools specifically designed for critically ill patients.
References
Alshahrani, B., Middleton, R., Rolls, K., & Sim, J. (2024). Pressure injury prevalence in critical care settings: An observational pre-post intervention study. Nursing Open, 11(2), Article e2110. https://doi.org/10.1002/nop2.2110
Black, J. M., Cuddigan, J. E., Walko, M. A., Didier, L. A., Lander, M. J., & Kelpe, M. R. (2010). Medical device related pressure ulcers in hospitalized patients. International Wound Journal, 7(5), 358–365. https://doi.org/10.1111/j.1742-481X.2010.00699.x
Cobos-Vargas, A., Acosta-Romero, M., Camado-Sojo, L., Alba-Fernández, C., Rodriguez-Delgado, E., & Colmenero, M. (2024). Predictive validity of a pressure injury risk assessment tool at different time-points in patients admitted to the intensive care unit. Nursing in Critical Care, 29(6), 1721–1728. https://doi.org/10.1111/nicc.13059
Coleman, S., Gorecki, C., Nelson, E. A., Closs, S. J., Defloor, T., Halfens, R., Farrin, A., Brown, J., Schoonhoven, L., & Nixon, J. (2013). Patient risk factors for pressure ulcer development: Systematic review. International Journal of Nursing Studies, 50(7), 974–1003. https://doi.org/10.1016/j.ijnurstu.2012.11.019
Dealey, C., Posnett, J., & Walker, A. (2012). The cost of pressure ulcers in the United Kingdom. Journal of Wound Care, 21(6), 261–266. https://doi.org/10.12968/jowc.2012.21.6.261
Delawder, J. M., Leontie, S. L., Maduro, R. S., Morgan, M. K., & Zimbro, K. S. (2021). Predictive validity of the Cubbin-Jackson and Braden tools for measuring skin risk in critically ill patients: A multisite project. American Journal of Critical Care, 30(2), 140–144. https://doi.org/10.4037/ajcc2021111
Digesa, L. E., Baru, A., Shanko, A., Kassa, M., Aschalew, Z., Moga, F., Beyene, B., Mulatu, T., & Yazie, T. S. (2023). Incidence and predictors of pressure ulcers among adult patients in intensive care units at Arba Minch and Jinka Hospitals, Southern Ethiopia. BioMed Research International, 2023, Article 9361075. https://doi.org/10.1155/2023/9361075
European Pressure Ulcer Advisory Panel. (2019). Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline. https://www.epuap.org/guidelines/
Fulbrook, P., & Anderson, A. (2016). Pressure injury risk assessment in intensive care units: Inter-rater reliability of the COMHON Index and three scales. Journal of Advanced Nursing, 72(3), 680–692. https://doi.org/10.1111/jan.12825
González-Méndez, M. I., Lima-Serrano, M., Martín-Castaño, C., Alonso-Araujo, I., & Lima-Rodríguez, J. S. (2018). Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit. Journal of Clinical Nursing, 27(5–6), 1028–1037. https://doi.org/10.1111/jocn.14091
Graves, N., Birrell, F. A., & Whitby, M. (2005). Modeling the economic losses from pressure ulcers among hospitalized patients in Australia. Wound Repair and Regeneration, 13(5), 462–467. https://doi.org/10.1111/j.1067-1927.2005.00066.x
Higgins, J., Casey, S., Taylor, E., Wilson, R., & Halcomb, P. (2020). Comparing the Braden and Jackson/Cubbin pressure injury risk scales in trauma-surgery ICU patients. Critical Care Nurse, 40(6), 52–61. https://doi.org/10.4037/ccn2020874
Chaboyer, W. P., Thalib, L., Harbeck, E. L., Coyer, F. M., Blot, S., Bull, C. F., Nogueira, P. C., & Lin, F. F. (2018). Incidence and prevalence of pressure injuries in adult intensive care patients: A systematic review and meta-analysis. Critical Care Medicine, 46(11), e1074–e1081. https://doi.org/10.1097/CCM.0000000000003366
Keller, P., Wille, J., van Ramshorst, B., & van der Werken, C. (2002). Pressure ulcers in intensive care patients: A review of risks and prevention. Intensive Care Medicine, 28(10), 1379–1388. https://doi.org/10.1007/s00134-002-1487-z
Kim, E., Choi, M., Lee, J., & Kim, Y. A. (2013). Reusability of EMR data for applying the Cubbin and Jackson pressure ulcer risk assessment scale in critical care patients. Healthcare Informatics Research, 19(4), 261–270. https://doi.org/10.4258/hir.2013.19.4.261
Kim, E. K., Lee, S. M., Lee, E., & Eom, M. R. (2009). Comparison of the predictive validity among pressure ulcer risk assessment scales for surgical ICU patients. Australian Journal of Advanced Nursing, 26(4), 87–94.
Pittman, J., Beeson, T., Dillon, J., Yang, Z., & Cuddigan, J. (2019). Hospital-acquired pressure injuries in critical and progressive care: Avoidable versus unavoidable. American Journal of Critical Care, 28(5), 338–350. https://doi.org/10.4037/ajcc2019264
Richardson, A., & Barrow, I. (2015). Part 1: Pressure ulcer assessment – the development of Critical Care Pressure Ulcer Assessment Tool made Easy (CALCULATE). Nursing in Critical Care, 20(6), 308–314. https://doi.org/10.1111/nicc.12173
Richardson, A., & Straughan, C. (2015). Part 2: Pressure ulcer assessment: implementation and revision of CALCULATE. Nursing in Critical Care, 20(6), 315–321. https://doi.org/10.1111/nicc.12172
Santos, C. T., Oliveira, M. C., Pereira, A. G. S., Suzuki, L. M., & Lucena, A. F. (2013). Indicador de qualidade assistencial úlcera por pressão: análise de prontuário e de notificação de incidente. Revista Gaúcha de Enfermagem, 34(1), 111–118. https://doi.org/10.1590/S1983-14472013000100014
Sardo, P. M. G., Teixeira, J. P. F., Machado, A. M. S. F., Oliveira, B. F., & Alves, I. M. (2023). A systematic review of prevalence and incidence of pressure ulcers/injuries in hospital emergency services. Journal of Tissue Viability, 32(2), 179–187. https://doi.org/10.1016/j.jtv.2023.02.001
Souza, M. F. C., Zanei, S. S. V., & Whitaker, I. Y. (2023). Predictive validity of the EVARUCI scale to evaluate risk for pressure injury in critical care patients. Journal of Wound Care, 32(Sup8), clxi–clxv. https://doi.org/10.12968/jowc.2023.32.Sup8.clxi
Strazzieri-Pulido, K. C., González, C. V., Nogueira, P. C., Padilha, K. G., Santos, V. L. C. G., & Caruso, P. (2019). Pressure injuries in critical patients: Incidence, patient-associated factors, and nursing workload. Journal of Nursing Management, 27(2), 301–310. https://doi.org/10.1111/jonm.12710
Theeranut, A., et al. (2020). Comparison of predictive validity of pressure ulcer risk assessment scales in intensive care units. Journal of Nursing Science.
Wåhlin, I., Ek, A., Lindgren, M., Geijer, S., & Restedt, K. (2020). Development and validation of an ICU-specific pressure ulcer risk assessment scale. Scandinavian Journal of Caring Sciences, 34(4), 1045–1054. https://doi.org/10.1111/scs.12891
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Alena Kohlova, Martina Dubovcová
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
