Incidence and risk factors of pressure ulcer development in patients receiving a preventive care bundle in two Italian emergency settings: the RUNTIME Study

Objective: This study aimed to assess the incidence of pressure ulcers (PUs) in two Italian emergency departments (EDs) in a cohort of patients cared for with a standardised preventive care bundle, and to identify risk factors associated with PU development during the ED stay. Method: In the RUNTIME Study-a prospective observational cohort study-patients with any critical illness, ≥18 years of age and at risk of developing a PU were included. Those with a pre-existing PU and significant cognitive decline were excluded. Sociodemographic and clinical characteristics were collected at baseline and follow-up. PU risk was ascertained at admission with the Braden scale. Cumulative survival and risk factors associated with PU were estimated with Kaplan-Meier curves and Cox proportional regression. Results: A total of 201 patients (mean age: 81±8.3 years; male: 53%) were included. After a mean of 84.7±46.6 hours, 12 patients developed a PU (incidence: 6%). Lesions were at the first stage and located at the sacrum. The probability of remaining free from PUs dropped from 98% at 24 hours to 80% at 168 hours. Risk of PU increased with age (hazard ratio (HR): 1.13; p=0.004) and decreased with longer ED stays (HR: 0.36; p<0.001). Conclusion: The findings of this study offer additional knowledge about PU incidence and risk factors in ED patients followed by a standardised preventive bundle. The low incidence and presence of risk factors suggests that a preventive protocol led by ED nurses trained in wound care can reduce the incidence and risk factors for PUs. However, the study included only 12 cases of PU development, which limits the robustness of the statistical conclusions. Therefore, the findings should be interpreted with caution and confirmed in studies with larger populations.