Table 1.

Summary of Studies

Study Authors		Sample and Country	Inclusion Criteria	Design and Analysis	No. in Final Model (PI%), No. of PI and Category	Results: No. of Risk Factors (No. in Model), Model Risk-Factor Names: Odds Ration (95% Confidence Interval)	Study Quality
Compton et al.²⁸		713 general ICU patients in Germany	≥72-hour stay No pressure injury upon admission	Retrospective record review Logistic regression	698 (17%), 121 Categories 2–4	32 (6) Male gender: 1.8 (NR) Moist skin: 2.4 (NR) Edematous skin: 2.2 (NR) Centralized circulation: 2.4 (NR) Mottled skin: 2.0 (NR) Reddened skin: 2.3 (NR)	MQS
Cox¹¹		347 medical–surgical ICU patients in the United States	≥24-hour stay No pressure injuey upon admission Age ≥18 years	Retrospective record review Logistic regression	Model 1: 347 (18.7%), 65 ≥Category 1 Model 2: 327 (13.7%), 45 ≥Category 2	Model 1: 15 (4) Mobility: 0.439 (0.21–0.95) Age: 1.033 (1.003–1.064) Length of ICU stay: 1.008 (1.005–1.011) Cardiovascular disease: 2.952 (1.3–6.4) Model 2: 15 (4) Friction/shear: 5.715 (1.423–22.95) Length of ICU stay: 1.008 (1.004–1.012) Norepinephrine: 1.017 (1.001–1.033) Cardiovascular disease: 3.380 (1.223–9.347)	HQS
Cox & Roche¹⁷		306 medical, surgical, and cardiothoracic ICU patients in the United States	≥24-hour stay No pressure injury upon admission Age ≥18 Received a vasopressor during ICU stay	Retrospective record review Logistic regression	306 (13%), 41 ≥Category 1	11 (5) Cardiac arrest: 3.894 (0.998–15.118) Mechanical ventilation ≥72 hours: 23.604 (0.998–15.118) Hours of MAP less than 60 mm HG while on vasopressors: 1.096 (1.020–1.178) Vasopressin: 4.816 (1.666–13.925) Cardiac diagnosis at admission: 0.035 (0.002–0.764)	HQS
Cremasco et al.¹		160 modical–surgical ICU patients in three ICUs in	≥24-hour stay No pressure injury upon admission	Prospective cohort Logistic regression	160 (34.4%), 55, Category not reported	NR (4) Male gender: 5.4 (1.42–22.09) Length of ICU stay: 1.120 (1.943–1.202) SAPSI score: 1.058 (1.004–1.114)	LQS
		Brazil				NAS score: 0.916 (0.855–0.980)
Eachempati et al.³¹		Phase 2: 412 surgical ICU patients in the United States	Length of stay>7 days	Prospective cohort Logistic regression	55 (60%), 33 ≥Category 2	7 (5) Emergent admission: 36 (0.2290–0.7694) Age: –0.0131) Days in bed: 1.05 (−0.0013–0.0156) CURS day 8: 1.45 (−0.0048–−0.0833) Days without any nutrition: 0.51 (−0.1095– −0.0334)	VLQS
Fife et al.²⁹		186 neurologic ICU patients in the United States	No pressure injury upon admission No diagnosis of brain death on life support pending organ donation	Prospective cohort Logistic regression	186 (12%), 23 ≥Category 2	NR (2) Braden score: NR (NR) Low body mass index (BMI): NR (NR)	MQS
Frankel et al.²		820 surgical ICU patients in the United States	Not reported	Retrospective record review Logistic regression	820 (3%), 25 ≥Category 2	9 (4) Diabetes: 2.7 (1.1–6.4) Age: 2.9 (1.2–7.1) Creatinine: 3.7 (1.2–9.2) Spinal cord injury: 16.8 (1.5–182)	MQS
Kaitani et al.²³		98 ICU and high-care-unit patients in Japan	Age≥20 years No pressure injury upon admisison ≥24-hour stay Unable to make major and frequent position changes independently	Prospective cohort Logistic regression	98 (11.2%), 11 Categories 1–4	6 (2) Scheduled admission: 0.04 (0–0.47) Frequency of turning: 0.45 (0.21–0.97)	LQS
Manzano et al.²¹		299 patients in nine ICUs in Spain	Mechanical ventilation Age≥18 years Nonpregnant	Prospective cohort Logistic regression	299 (15.7%), 47 ≥Category 2	16 (5) Day 1 respiratory SOFA: 1.56 (1.026–2.360) Day 4 cardiovascular SOFA: 1.33 (1.066–1.664) Age: 1.042 (1.013–1.072) Winter: 4.6 (1.99–10.59) Length of mechanical ventilation: 1.042 (1.005–1.080)	HQS
Nijs et al.²²		520 surgical ICU patients in Belgium	Age≥16 years ≥24-hour expected stay Absence of burns	Prospective cohort Logistic regression	463 (28.9%), 134 Categories 2–4	19 (9) Dopamine <5 mcg/kg/min: 6.1 (1.9–19.5) Vascular disease: 4.5 (2.0–10.2) Dialysis: 3.8 (1.0–13.9) “Adequate prevention”: 6.0 (1.9–18.6) Frequency of turning six or more times daily or alternating mattress: 30.2 (12.2–74.8) “Turning”: 6.7 (2.7–16.4) Sedative use: 0.3 (0.1–0.7) Body temperature≤38.5: 0.2 (0.2–0.9) Sitting in chair: 0.1 (0.0–0.3)	HQS
O’Brien et al.¹⁹		2695 surgical and burn ICU patients in the United States	Age≥18 years ≥48-hour ICU stay Underwent a surgical procedure No pressure injury upon admission	Retrospective record review	2695 (10.7%), 288 ≥Category 2	12 (7) Existing airway: 5.28 (3.63–7.67) Low BMI: 2.7 (1.45–5.04) Noncardiac surgery: 1.84 (1.31–2.59) History of heart failure: 1.78 (1.27–2.49) History of renal failure: 1.75 (1.27–2.39) ASA class 4 or 5: 1.63 (1.19–2.29) Age: 1.02 (1.01–1.03)	HQS
Sayar et al.²⁴		140 medical–surgical ICU patients in Turkey	At risk or at high risk on Waterlow pressure ulcer risk scale	Prospective cohort Logistic regression	140 (14.3%), 20 ≥Category 1	5 (2) Length of stay: 1.2 (1.1–1.3) Activity level: 0.3 (.02–0.7)	MQS
Slowikowski & Funk⁴		369 surgical ICU petients in the United States	Age≥16 years	Prospective cohort Logistic regression	369 (23.9%), 88, Category not reported	8 (3) Braden Scale score: 1.3 (1.15–1.47) Diabetes: 1.93 (1.11–3.35) Age≥70 years: 2.14 (1.27–3.62)	HQS
Suriadi et al.¹⁸		253 general ICU patients in Indonesia	Age≥18 years Bedfast No pressure injury upon admission ≥24-hour stay and anticipated stay≥72 hours	Prospective cohort Logistic regression	253 (28.4%), 72 ≥Category 1	NR (3) Interface pressure: 2.2 (1.6–2.9) Body temperature: 2.0 (1.7–2.5) Cigarette smoking: 1.6 (1.1–2.5)	HQS
Tayyib et al.²⁵	84 general ICU patients in Saudi Arabia		Age≥18 years	Prospective cohort	84 (39.3%), 33 Categories 1–4	Model 1 Categories 1–4: 7 (3) Age: 1.254 (1.054–1.492) Longer ICU stay: 1.23 (1.014–3.309) Infrequent repositioning: 250.04 (230–11,954.16) Model 2 Categories 2–4: 3 (2) Longer ICU stay: 1.831 (1.054–1.492) Infrequent repositioning: 2.96 (1.23–7.153)	MQS
Theaker et al.²⁶	286 general ICU patients in the United Kingdom		>24-hour stay No pressure injury upon admission Three or more pressure injury risk factors	Prospective cohort Logistic regression	286 (26.9%), 77 Categories 2–4	18 (5) Norepinephrine infusion: 8.11 (3.64–18) APACHE II≥13: 2.4 (1.4–7.92) Fecal incontinence: 3.27 (1.32–8.3) Anemia: 2.81 (1.24–6.34) Length of stay≥three days: 2.76 (1.06–7.05)	LQS
Ulker Efteli &Yapucu Gunes²⁷	70 general ICU patients in Turkey		Age≥18 years Expected ICU stay≥7 days No pressure injury upon admission Braden Scale score<12	Prospective cohort Logistic regression	70 (33%), 23 ≥Category 1	6 (2) Female gender: 0.15 (0.03–0.71) Lower serum albumin level: 11.6 (1.92–70.4)	MQS
Yepes et al.³⁰	150 ICU patients in Bolivia		Intubated On mechanical ventilation Received vasopressor	Prospective cohort Logistic regression	150 (26.7%), 40 ≥Category 2	3 (3) Presence of infection: 4.39 (6.92–18.25) Length of stay in the ICU: 1.13 (1.06–1.22) APACHE II: 1.06 (1.0–1.12)	LQS

NR = not reported

PI = pressure injury

ICU = intensive care unit

NR = not reported

MQS = moderate-quality study

HQS = high-quality study

MAP = mean arterial pressure

LQS = low-quality study

SAPSI = Simplified Acute Physiology Score

NAS = nursing activities score

VLQS = very-low-quality study

CURS = Corneil ulcer risk score

SOFA = sequential organ failure assessment

ASA = American Society of Anesthesiologists

APACHE =acute physiology and chronic health evaluation