Risk factors for pressure injuries in critical care patients: an updated systematic review

Abstract

Objective

To update a previously published systematic review identifying independent risk factors of pressure injury development in critically ill patients.

Design

Systematic review.

Methods

Five indexing databases (CINAHL, Cochrane Library, Dissertations & Theses Global, PubMed, and Scopus) were systematically searched for studies published between January 2017 and December 2024. Investigators independently screened studies, extracted data, and assessed study quality using an established appraisal tool. Evidence tables were created, and a narrative synthesis was conducted, organized by relevant domains and subdomains.

Results

This updated review included 33 studies (15 additional studies since the original review). Of these, 14 were rated as high quality, eight as moderate quality, nine as low quality, and 2 as very low quality. The most consistently identified independent risk factors were older age, limited mobility or activity, impaired perfusion, vasopressor use, and longer intensive care unit length of stay. Diabetes also emerged as a notable risk factor in several high-quality studies, although evidence was mixed. Inconsistent measurement approaches for nutrition and skin status continued to limit conclusive findings in these domains. Methodological heterogeneity across studies prevented meta-analysis and limited the generalizability of findings.

Conclusions

The new evidence found in this updated review reinforces previously identified risk factors – age, mobility limitations, poor perfusion, and vasopressor use – while identifying length of stay and diabetes as additional potential contributors to pressure injury risk. Comprehensive risk assessments for critically ill patients should prioritize these factors, especially in older adults with compromised mobility, poor perfusion, or receiving vasopressors. Future research should aim to standardize measurement approaches and explore how multiple risk factors interact to influence pressure injury development.