Skin tears in older adult residents of long-term care facilities: prevalence and associated factors.

OBJECTIVE: To determine the prevalence of skin tears, and demographic and clinical factors associated with their presence in older adult residents of long-term care facilities. METHOD: This observational, quantitative, cross-sectional, epidemiological study was conducted with older adult residents of three long-term care facilities in São Paulo, Brazil. For data collection, four instruments were used: a questionnaire assessing sociodemographic and clinical characteristics of the residents; and the Brazilian-Portuguese versions of the Mini-Mental State Examination, Skin Tear Audit Research (STAR) Skin Tear Classification System, and the Katz Index of Independence in Activities of Daily Living. RESULTS: A total of 69 residents took part in the study. The prevalence of skin tears was 11.6%. Skin tears were significantly associated with the presence of haematoma (odds ratio, OR=9.159; p=0.017) and actinic purpura (OR=6.265; p=0.033), which increased the odds of skin tear development nine-fold and six-fold, respectively. CONCLUSION: The findings agree with the international literature. Considering that this was the first epidemiological study on skin tears carried out in long-term care facilities for older adults in Brazil, its contribution lies in the systematisation of data collection and making data available on a field that has not yet been studied in this country.

Incidence of Skin Tears and Risk Factors: A Systematic Literature Review.

Skin tears are traumatic wounds resulting from friction and shearing forces. Clinical practice strongly indicates that skin tears are a prevalent problem but their incidence is not well established in the literature. This systematic literature review identified and evaluated the available literature on the incidence and risk factors for skin tears in adults and the elderly. Inclusion criteria were epidemiological studies published in English, Spanish, or Portuguese languages from January 1990 through June 2014 and available in full text. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem. Five studies reporting incidence of skin tears met the selection criteria. Reported incidence rates of skin tears ranged from 2.23% to 92% in long-term care facilities and varied from 2.1% among men to 4.6% among women living in the community. The most prevalent risk factor for skin tears was old age, followed by impaired mobility, falls and accidental injuries, previous skin tears, cognitive deficit/dementia, dependence in transfers, and upper limbs. Further epidemiological studies on skin tears are necessary to elucidate the cause of these injuries and identify the profile of people at risk for skin tears, contributing to the development and implementation of appropriate preventive interventions.

[Skin tear prevalence and associated factors: a systematic review]. / Prevalência de lesão por fricção e fatores associados: revisão sistemática.

OBJECTIVE: To identify and analyse skin tear prevalence and factors associated with its occurrence. METHOD: Systematic review of literature of studies published until June 2014 including studies published in full in English, Spanish or Portuguese. The studies were analysed according to the Strengthening the Reporting of Observational Studies in Epidemiology and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem. RESULTS: The analysis of eight studies showed skin tear prevalence of 3.3% to 22% in the hospital setting and 5.5% to 19.5% in homecare. Advanced age, dependence on basic activities of daily life, frail elderly, level of mobility, agitated behavior, non-responsiveness, greater risk for concurrent development of pressure ulcers, cognitive impairment, spasticity and photoaging were cited as risk factors. CONCLUSION: Skin tear prevalence ranged from 3.3% to 22% and is mainly associated with advanced age and dependence on basic activities of daily life.

Skin tear prevalence and associated factors: a systematic review / Prevalencia de lesión por fricción y factores asociados: revisión sistemática / Prevalência de lesão por fricção e fatores associados: revisão sistemática

OBJECTIVETo identify and analyse skin tear prevalence and factors associated with its occurrence.METHODSystematic review of literature of studies published until June 2014 including studies published in full in English, Spanish or Portuguese. The studies were analysed according to the Strengthening the Reporting of Observational Studies in Epidemiology and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem.RESULTSThe analysis of eight studies showed skin tear prevalence of 3.3% to 22% in the hospital setting and 5.5% to 19.5% in homecare. Advanced age, dependence on basic activities of daily life, frail elderly, level of mobility, agitated behavior, non-responsiveness, greater risk for concurrent development of pressure ulcers, cognitive impairment, spasticity and photoaging were cited as risk factors.CONCLUSIONSkin tear prevalence ranged from 3.3% to 22% and is mainly associated with advanced age and dependence on basic activities of daily life.

OBJETIVOIdentificar y analizar la prevalencia de lesión por fricción y los factores asociados con su ocurrencia.MÉTODORevisión sistemática de la literatura publicada hasta junio de 2014 con la inclusión de estudios publicados integralmente en inglés, español o portugués. Los estudios fueron analizados según el Strengthening the Reporting of Observational Studies in Epidemiology y el Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem.RESULTADOSLos análisis de ocho estudios mostraron prevalencia de lesión del 3,3% al 22% en el escenario hospitalario y del 5,5% al 19,5% en el domiciliario. Edad avanzada, dependencia para las actividades básicas de vida diarias, anciano frágil, nivel de movilidad, comportamiento agitado, falta de responsividad, mayor riesgo para el desarrollo concomitante de úlcera por presión, afectación cognitiva, espasticidad y fotoenvejecimiento fueron los factores de riesgo citados.CONCLUSIÓNLa prevalencia de lesión varió del 3,3% al 22%, estando asociada principalmente con la edad avanzada y la dependencia para las actividades básicas de vida diarias.

OBJETIVOIdentificar e analisar a prevalência de lesão por fricção e os fatores associados à sua ocorrência.MÉTODORevisão sistemática da literatura publicada até junho de 2014 com a inclusão de estudos publicados na íntegra em inglês, espanhol ou português. Os estudos foram analisados segundo o Strengthening the Reporting of Observational Studies in Epidemiology e o Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem.RESULTADOSAs análises de oito estudos mostraram prevalência de lesão de 3,3% a 22% no cenário hospitalar e 5,5% a 19,5% no domiciliar. Idade avançada, dependência para as atividades básicas de vida diárias, idoso frágil, nível de mobilidade, comportamento agitado, arresponsividade, maior risco para o desenvolvimento concomitante de úlcera por pressão, comprometimento cognitivo, espasticidade e fotoenvelhecimento foram os fatores de risco citados.CONCLUSÃOA prevalência de lesão variou de 3,3% a 22%, estando associada principalmente à idade avançada e dependência para as atividades básicas de vida diárias.

Cultural adaptation, content validity and inter-rater reliability of the "STAR Skin Tear Classification System".

AIMS: to perform the cultural adaptation of the STAR Skin Tear Classification System into the Portuguese language and to test the content validity and inter-rater reliability of the adapted version. METHODS: methodological study with a quantitative approach. The cultural adaptation was developed in three phases: translation, evaluation by a committee of judges and back-translation. The instrument was tested regarding content validity and inter-rater reliability. RESULTS: the adapted version obtained a regular level of concordance when it was applied by nurses using photographs of friction injuries. Regarding its application in clinical practice, the adapted version obtained a moderate and statistically significant level of concordance. CONCLUSION: the study tested the content validity and inter-rater reliability of the version adapted into the Portuguese language. Its inclusion in clinical practice will enable the correct identification of this type of injury, as well as the implementation of protocols for the prevention and treatment of friction injuries.

Cultural adaptation, content validity and inter-rater reliability of the "STAR Skin Tear Classification System" / Adaptação cultural, validade de conteúdo e confiabilidade interobservadores do "STAR Skin Tear Classification System" / Adaptación cultural, validez de contenido y confiabilidad interobservadores del "STAR Skin Tear Classification System"

AIMS: to perform the cultural adaptation of the STAR Skin Tear Classification System into the Portuguese language and to test the content validity and inter-rater reliability of the adapted version. METHODS: methodological study with a quantitative approach. The cultural adaptation was developed in three phases: translation, evaluation by a committee of judges and back-translation. The instrument was tested regarding content validity and inter-rater reliability. RESULTS: the adapted version obtained a regular level of concordance when it was applied by nurses using photographs of friction injuries. Regarding its application in clinical practice, the adapted version obtained a moderate and statistically significant level of concordance. CONCLUSION: the study tested the content validity and inter-rater reliability of the version adapted into the Portuguese language. Its inclusion in clinical practice will enable the correct identification of this type of injury, as well as the implementation of protocols for the prevention and treatment of friction injuries. .

OBJETIVOS: realizar a adaptação cultural do STAR Skin Tear Classification System, para a língua portuguesa e testar a validade de conteúdo e a confiabilidade interobservadores da versão adaptada. MÉTODOS: estudo metodológico com abordagem quantitativa. A adaptação cultural foi desenvolvida em três fases: tradução, avaliação por comitê de juízes e retrotradução. O instrumento foi testado quanto à validade de conteúdo e confiabilidade interobservadores. RESULTADOS: a versão adaptada obteve um nível regular de concordância quando aplicada por enfermeiros em fotografias de lesões por fricção. Quando aplicada na prática clínica, a versão adaptada obteve nível moderado e estatisticamente significativo de concordância. CONCLUSÃO: o estudo atestou a validade de conteúdo e a confiabilidade interobservadores da versão adaptada para a língua portuguesa. Sua inclusão na prática clínica possibilitará a correta identificação desse tipo de lesão, além da implementação de protocolos para a prevenção e tratamento das lesões por fricção. .

OBJETIVOS: realizar la adaptación cultural del STAR Skin Tear Classification System, para el idioma portugués y comprobar la validez de contenido y la confiabilidad interobservadores de la versión adaptada. MÉTODOS: estudio metodológico con abordaje cuantitativo. La adaptación cultural fue desarrollada en tres fases: traducción, evaluación por comité de jueces y retrotraducción. El instrumento fue comprobado en lo que se refiere a su validez de contenido y confiabilidad interobservadores. RESULTADOS: la versión adaptada obtuvo un nivel regular de concordancia cuando fue aplicada por enfermeros utilizando fotografías de lesiones por fricción. Cuando fue aplicado en la práctica clínica, la versión adaptada obtuvo un nivel moderado y estadísticamente significativo de concordancia. CONCLUSIÓN: el estudio comprobó la validez de contenido y la confiabilidad interobservadores de la versión adaptada para el idioma portugués. Su inclusión en la práctica clínica posibilitará la correcta identificación de ese tipo de lesión, además de la implementación de protocolos para la prevención y tratamiento de las lesiones por fricción. .

Incidência de úlceras por pressão em pacientes de Unidade de Terapia Intensiva Cardiopneumológica / La incidencia de las úlceras por presión en los pacientes de unidad de cuidados intensivos cardiopneumológica / Incidence of pressure ulcers in cardiopulmonary intensive care unit patients

RESUMO Objetivo Identificar e analisar os coeficientes de incidência de úlceras por pressão (UP) e os fatores de risco para o seu desenvolvimento em pacientes críticos com doenças cardiopneumológicas. Método Estudo de coorte, prospectivo realizado na Unidade de Terapia Intensiva (UTI) Cardiopneumológica de um hospital de grande porte na cidade de São Paulo, durante os meses de novembro de 2013 a fevereiro de 2014. Participaram do estudo 370 pacientes maiores de 18 anos, que não apresentavam UP na admissão e que estavam na UTI há menos de 24 horas. Os dados foram analisados por meio de análises univariadas e multivariada (Classification And Regression Tree - CART). Resultados Os coeficientes de incidência de UP foram: 11,0% para o total, distribuindo-se em 8,0% entre os homens e 3,0% para as mulheres (p=0,018); 10,0% na raça branca e 6,5% em pessoas com idade igual e superior a 60 anos. Os principais fatores de risco encontrados foram tempo de permanência na UTI igual ou superior a 9,5 dias, idade igual ou superior a 42,5 anos e raça branca. Conclusão O estudo contribui para os conhecimentos relacionados à epidemiologia das UP em pacientes críticos com doenças cardiopneumológicas, favorecendo o planejamento de cuidados preventivos específicos para essa clientela.

RESUMEN Objetivo Identificar y analizar la incidencia de las úlceras por presión (UP) y los factores de riesgo para su desarrollo en los pacientes críticos con enfermedades cardiopneumológicas. Método Estudio prospectivo de cohorte realizado en la Unidad de Cuidados Intensivos (UCI) Cardiopneumológica de un gran hospital en São Paulo, durante los meses de noviembre 2013 hasta febrero de 2014. El estudio incluyó a 370 pacientes mayores de 18 años que no mostraron PU en la admisión a la UCI y que no eran menos de 24 horas. Los datos fueron analizados mediante el análisis univariado y multivariado (regresión y clasificación Tree - CART). Resultados La incidência de UP fue el 11,0% in general; de 8,0% en los hombres y de 3,0% en las mujeres (p=0,018); 10,0% en los caucásicos y 6,5% en personas de 60 años o más. Los principales factores de riesgo fueron la duración de la estancia en la UCI inferior a 9,5 días; edades entre 42,5 años y blancos. Conclusión El estudio contribuye al conocimiento sobre la epidemiología de la UP en pacientes críticamente enfermos con enfermedades cardiopneumológicas ( incidência de 11%), favoreciendo la planificación de la atención preventiva específica para esta clientela.

ABSTRACT Objective Identify and analyze the incidence coefficients of pressure ulcers (PU) and the risk factors for PU development in critical patients with cardiopulmonary diseases. Method A prospective cohort study conducted in the cardiopulmonary intensive care unit (ICU) of a large hospital in the city of São Paulo, from November 2013 to February 2014. In total, 370 patients over 18 years old who did not present PU at admission and who had been in the ICU for less than 24 hours were studied. Data were analyzed by univariate and multivariate analyses (Classification And Regression Tree - CART). Results The incidence coefficients of PU were: 11.0% for total participants, 8.0% for male and 3.0% for female patients (p=0.018); 10.0% for white patients and 6.5% for patients 60 years or older. The main risk factors were length of stay in the ICU for 9.5 days or more, age 42.5 years or older, and being of the white race. Conclusion This study was related to the epidemiology of PU in critical patients with cardiopulmonary diseases, facilitating the planning of specific preventive care for these patients.

Incidence of pressure ulcers in cardiopulmonary intensive care unit patients. / Incidência de úlceras por pressão em pacientes de Unidade de Terapia Intensiva Cardiopneumológica.

Objective Identify and analyze the incidence coefficients of pressure ulcers (PU) and the risk factors for PU development in critical patients with cardiopulmonary diseases. Method A prospective cohort study conducted in the cardiopulmonary intensive care unit (ICU) of a large hospital in the city of São Paulo, from November 2013 to February 2014. In total, 370 patients over 18 years old who did not present PU at admission and who had been in the ICU for less than 24 hours were studied. Data were analyzed by univariate and multivariate analyses (Classification And Regression Tree - CART). Results The incidence coefficients of PU were: 11.0% for total participants, 8.0% for male and 3.0% for female patients (p=0.018); 10.0% for white patients and 6.5% for patients 60 years or older. The main risk factors were length of stay in the ICU for 9.5 days or more, age 42.5 years or older, and being of the white race. Conclusion This study was related to the epidemiology of PU in critical patients with cardiopulmonary diseases, facilitating the planning of specific preventive care for these patients.