Incidence of hospital-acquired pressure ulcers in patients with "minimal risk" according to the "Norton-MI" scale

Autoři: Isabel Díaz-Caro aff001;  Soledad García Gómez-Heras aff003
Působiště autorů: International Doctoral School, Rey Juan Carlos University, Madrid, Spain aff001;  Nurse of Hospital University Severo Ochoa, Madrid, Spain aff002;  Basic Health Science Department, Health Science Faculty, Rey Juan Carlos University, Madrid, Spain aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227052



Pressure ulcers (PUs) nowadays are a major health problem in society, associated with increased morbidity and increased health care costs. The incidence of HAPU is an indicator of health care quality.


To describe the profile of patients with minimal risk on the Norton-MI scale who developed PUs during hospitalization, and to identify the incidence of hospital-acquired pressure ulcers (HAPU).


Retrospective cohort study conducted between 2014 and 2017.

Study population

Patients over 18 years of age classified as "minimum risk" according to Norton-MI, admitted to acute hospital units of the Severo Ochoa University Hospital—Madrid-Spain. Patients were classified as patients with hospital-acquired pressure ulcers (PWHAPU) if they developed one or more new PU during their hospitalization.


Sociodemographic variables, hospitalization units, Morton-MI score and characteristics of the risk factors of HAPU were studied.


The risk of PU was evaluated in 5530 patients, being 1260 patients classified as "minimum risk", with a median of 16 points in the Norton-MI scale. The average age was 76 years old and 52.5% were women. Principal causes of admission: traumatological pathologies (20.8%) and cardiovascular pathologies (20%). 129 HAPU were diagnosed in 112 patients, implying an incidence of HAPU of 8.89% (CI95%: 7.44–10.59). 106 PWHAPU (94.6%) presented up to 6 risk factors. The excess pressure and altered skin sensibility were identified as statistically significant risk factors as predictive factors of HAPU. In terms of severity, 55% of the HAPU were category I and 42.6% were category II, mainly with anatomical sacro-coxygeal location. In 65.2% of the patients the HAPU appeared in the first week of hospitalization.


In our study the incidence of HAPU in patients classified as minimum risk with Norton-MI scale was 8.89%. This elevated risk suggests for future investigations to develop new validity studies of the Norton-MI scale and to maintain a continuo training of professionals in the knowledge of PU risk assessment scales for their safe application in the patients, since it directs the practice of care in the prevention of PUs. It would be advisable to specially control the risk of PUs in care units, mainly in the first week of their hospital stay to minimize the HAPU incidence.

Klíčová slova:

Diagnostic medicine – Hospitalizations – Hospitals – Nosocomial infections – Nurses – Surgical and invasive medical procedures – Traumatic injury risk factors – Ulcers


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