Predictive Validity and Clinical Utility of an Ultrasound-based Quantitative Risk Score for Pressure Injury in Critically Ill Patients

Predictive Validity and Clinical Utility of an Ultrasound-based Quantitative Risk Score for Pressure Injury in Critically Ill Patients: A Two-Phase Sequential Study

Pressure injuries are a common and serious complication for critically ill patients in the intensive care unit (ICU). Early and accurate identification of high-risk patients is crucial for effective prevention. This two-phase sequential study aims to evaluate a new, objective assessment tool: an ultrasound-based quantitative risk score.

Phase 1 is an observational study designed to test the predictive validity of this ultrasound score. Researchers will use bedside ultrasound to examine tissue integrity and determine how accurately the score can predict the development of pressure injuries. Phase 2 is a pilot randomized controlled trial. In this phase, patients will be randomly assigned to receive either standard preventive care or a targeted nursing intervention guided by the ultrasound score. The primary goal is to assess the clinical effectiveness of this score-guided intervention in reducing the occurrence of pressure injuries and improving nursing care for critically ill patients.

Phase 1: Tool Development and Validation (Observational)

Inclusion Criteria (Phase 1):

1. Age > 18 years.
2. Newly admitted to the Intensive Care Unit (ICU) with an expected stay of ≥ 96 hours.
3. Intact skin in the sacrococcygeal region within 24 hours of ICU admission.
4. Provision of signed informed consent.

Exclusion Criteria (Phase 1):

1. Pregnant women or children.
2. Skin conditions (e.g., scarring, burns, or tumors) in the sacrococcygeal region interfering with ultrasound.
3. Clinical instability preventing lateral repositioning for ultrasound.
4. History of major sacrococcygeal surgery or severe trauma.
5. Life expectancy < 48 hours. Phase 2: Randomized Controlled Trial (Interventional)

Inclusion Criteria (Phase 2):

1. Meet all the general inclusion criteria from Phase 1.
2. Meet the pre-defined risk threshold based on the Ultrasound-based Quantitative Risk Score, as determined from the analysis of Phase 1 results.

Exclusion Criteria (Phase 2):

1. Meet all the general exclusion criteria from Phase 1.
2. Previous participation in Phase 1 of this study (to maintain independent samples for the RCT).
3. Current participation in other interventional trials that may impact pressure injury outcomes.