Incidence and risk factors associated with pressure injury in patients with traumatic brain injury.

The study was done in a neurotrauma reference hospital in Brazil, and the paper says it is the only such referral hospital in the state, so the patients and care protocols may not match other settings. The text says 958 patients were evaluated and gives a sample size of 240, but the included and excluded patients are described in a figure, so the analysed count is not clear from the text alone. Applying the pressure injury prevention protocol was difficult in the emergency room because patients were kept on a rigid board and cervical collar, which may have caused a high incidence. The authors state difficulty stratifying patients by traumatic brain injury severity and evaluating risk factors in each group. Pressure injury classification changed during the study, with two new definitions added, making patient stratification harder to update. Patients received several treatments at once, including surgery, mechanical ventilation, sedation and noradrenaline, so the contribution of any single component cannot be separated. The study did not test a specific pressure injury prevention intervention; nursing staff applied hospital protocols. Braden Scale showed unadjusted differences, but the paper states it was not associated in multivariate analysis, so its independent predictive value is unclear.

The authors declared no conflict of interest and said there was no significant financial support for this work that could have influenced its outcome.

Do not conclude that stopping noradrenaline, changing the Braden Scale score, or applying a particular repositioning routine will prevent pressure injury. This was an observational study of patients receiving multiple treatments, and it reported associations rather than tested interventions.