Incidence and Risk Factors of Pressure Injury in Adult ICU Patients: A Prospective Cohort Study

ABSTRACT Background Pressure injuries (PIs) remain a persistent challenge in intensive care units (ICUs), causing pain, extended hospital stays and increased costs. Data from India are limited. Aim To determine the incidence and risk factors for pressure injuries among adult ICU patients in a tertiary care public hospital. Study Design A prospective cohort study was conducted from August to October 2024 in the adult ICUs of a public hospital in central India. All eligible patients were enrolled via total enumeration. Demographic and clinical variables, Braden and APACHE‐II scores, and nursing hours per patient‐day were collected. New PIs were staged per international guidelines by two nurse‐researchers. Data were analysed using descriptive statistics and univariable logistic regression. Results Of 324 patients, 50 (15.4%; 95% CI: 11.7–19.8) developed 87 new PIs, with an incidence density of 39.1 per 1000 patient‐days (95% CI: 31.32–48.23). Most lesions were stage I/II, primarily sacrococcygeal, with a median onset of 4 days. Among the 16 variables examined using univariable analyses, early fever (OR 7.33, 95% CI 3.38–15.88), exclusive non‐oral feeding (OR 5.73, 95% CI 2.75–11.95), needing repositioning assistance (OR 4.56, 95% CI 2.06–10.09), medical ICU (OR 3.73, 95% CI 1.87–7.46), vasoactive drug‐use (OR 2.31, 95% CI 1.21–4.44), moderate‐to‐obese body build (OR 2.84, 95% CI 1.23–6.57) and longer ICU stay (OR 1.23/day, 95% CI 1.15–1.31) had the strongest associations with PI. Conclusions PIs affect approximately one‐in‐six ICU patients, with several factors associated with higher odds. Multi‐centre studies are needed to examine generalisability and validate ICU‐specific risk assessment tools. Relevance to Clinical Practice High‐risk profiles requiring prioritised preventive measures, as early assessment, nutritional optimisation and mobility support include those with prolonged stays, fever, non‐oral feeding, medical ICU admission, vasoactive drug‐use and non‐thin build.