Cohort study of the incidence of heel pressure sores in patients with leg casts at the Rizzoli Orthopedic Hospital and of the associated risk factors
Forni, C.; Zoli, M.; Loro, L.; Tremosini, M.; Mini, S.; Pirini, V.; Turrini, R.; Durante, S.; Nicolini, A.; Riccioni, F.; Girolami, R.
Assistenza Infermieristica e Ricerca Air 28(3): 125-130
2009
ISSN/ISBN: 1592-5986 PMID: 20050498 Document Number: 631632
Pressure sores, especially at the heel, are a side effect of the cast. To assess the incidence of late skin complications (heel pressure sores) of a cast and determine risk factors. All consecutive patients treated with a leg cast over a 16 months observation time were recruited. Risk factors were identified by the nurse that placed the cast and skin lesions classified with the NPUAP scale when the cast was removed. In the 216 enrolled patients 17.6% (38) developed a pressure sore: 16/124 in orthopedic wards; 22/92 in oncology wards. The multivariate analysis identified the following risk factors: administration of cytotoxic drugs (p = 0.033; OR = 2.61; having a cancer did not increase the risk); skin redness before cast application (p = 0.001; OR = 4.44) and having reported symptoms after the application (p = 0.000; OR = 7.86). Pressure sores were mainly stage 1 and only 6/216 (2.4%) > or = stage II. The type of plaster cast, the material, the number of days it was worn and having had a surgery are not significant risk factors. Pressure sores related to leg plaster casts are a frequent complication in at risk sub-groups. The acknowledgement and identification of specific risk factors may allow to identify and evaluate preventive interventions to improve the care of these patients.