From the Guidelines
The prevalence of post-stroke pressure ulcers after 90 days is not explicitly stated in the provided evidence, but it is known that patients with hemiplegia, sensory deficits, incontinence, malnutrition, and advanced age are at greatest risk.
Risk Factors and Prevention
The risk factors for post-stroke pressure ulcers include hemiplegia, sensory deficits, incontinence, malnutrition, and advanced age 1. Prevention is critical and includes regular repositioning every 2 hours, use of pressure-redistributing surfaces (specialized mattresses and cushions), daily skin inspection, maintaining good nutrition with adequate protein and hydration, and early mobilization when possible.
- Regular assessment of skin and the use of objective scales of risk such as the Braden scale are valuable in the prevention of skin injury and should be followed by regular skin inspection with documentation 1.
- Agency for Healthcare Research and Quality (AHRQ) guidelines recommend minimizing or eliminating friction, minimizing pressure, providing appropriate support surfaces, avoiding excessive moisture, and maintaining adequate nutrition and hydration 1.
Management and Rehabilitation
For bedridden patients, a turning schedule should be implemented with proper positioning using pillows to offload bony prominences. Moisture management is essential, particularly for incontinent patients, using barrier creams and absorbent products.
- The development of pressure ulcers after stroke significantly impacts rehabilitation outcomes, extends hospital stays, and increases mortality risk.
- Early intervention by a multidisciplinary team including nursing, physical therapy, nutrition, and rehabilitation specialists is crucial for both prevention and management of these complications.
Pathophysiology and Commonly Affected Sites
The pathophysiology involves tissue ischemia from prolonged pressure over bony prominences, with the sacrum, heels, and greater trochanters being most commonly affected sites.
- Regular turning (at least every 2 hours), good hygiene, and the use of special mattresses and proper wheelchair seating to prevent skin injury are essential 1.
From the Research
Prevalence of Post-Stroke Pressure Ulcers
- The prevalence of pressure ulcers in stroke patients is a significant concern, with studies indicating varying frequencies of occurrence 2, 3, 4.
- A study conducted in 2022 found that 8.3% of stroke patients developed pressure ulcers, with the most frequent localization being the sacrum 2.
- Another study published in 2022 reported that high-intensity post-stroke rehabilitation is associated with a lower risk of pressure ulcer development in patients with stroke 3.
- The risk factors for pressure sores in acute ischemic stroke patients include old age, severe neurological disability, being unmarried, low hemoglobin, and history of diabetes mellitus and peripheral vascular disease 4.
Pressure Ulcer Risk Assessment
- Various risk assessment scales, such as the Waterlow scale, Braden scale, and Norton scale, are used to predict the risk of pressure ulcer development 5.
- A study published in 2014 found that the use of the Braden Scale for pressure ulcer risk assessment in a community hospital setting can help trigger preventive interventions 6.
- The study suggested that planning preventive care according to the subscale scores of the Braden Scale may be more effective for prevention of hospital-acquired pressure ulcers (HAPUs) in some cases 6.
Prevention and Management
- Prevention and management of pressure ulcers are crucial to reduce the risk of development and promote healing 2, 3, 6.
- High-intensity post-stroke rehabilitation, proper risk assessment, and preventive interventions can help reduce the risk of pressure ulcer development in stroke patients 3.
- Ongoing education in the prevention and management of pressure ulcers is essential for healthcare professionals to provide optimal care 5.