Method for objective assessment and monitoring of positional complications in intensive care unit patients

Introduction. Pressure injuries in intensive care unit (ICU) patients remain a significant clinical problem associated with high interobserver variability and substantial time burden for healthcare staff.
The objective was to evaluate the accuracy and efficiency of the HosHelper mobile application for objective staging of positional skin injuries in immobile patients.
Materials and methods. A prospective single-center study was conducted in 39 ICU patients with pressure injuries. Staging was performed using two approaches: routine visual assessment by medical staff and the HosHelper mobile application. The results were compared with a consensus assessment of three independent experts. Agreement, assessment time, and variability were analyzed.
Results. Agreement between the application and expert evaluation reached 97.3%, whereas agreement between subjective assessment and experts was 82.1%. Use of the application significantly reduced assessment time (3.0 ± 1.1 vs 8.0 ± 1.4 min, p < 0.05) and decreased decision variability. Conclusions. Mobile-assisted staging of positional complications improves diagnostic objectivity and reduces staff workload, potentially enhancing prevention and monitoring of pressure injuries in ICU patients.

1. Osmanov E. G., Shulutko A. M., Yakovlev A. A. et al. Conservative treatment of pressure ulcers using physical methods of воздействия (review). General Reanimatology, 2022, vol. 18, no. 2, pp. 83–89. (In Russ.). https://doi.org/10.15360/1813-9779-2022-2-83-89.

2. National Standard of the Russian Federation GOST R 56819–2015. Good Clinical Practice. Infological Model. Prevention of Pressure Ulcers. (In Russ.).

3. Pasechnik I. N., Novikova T. V. Pressure ulcers: new approaches to treatment. Lechashchiy Vrach (Attending Physician), 2022, vol. 4, no. 25, pp. 38–43. (In Russ.). https://doi.org/10.51793/os.2022.25.4.007.

4. Somov N. O. Pressure ulcers: contemporary approaches to prevention and treatment. Lechashchiy Vrach (Attending Physician), 2023, vol. 7–8, no. 26, pp. 52–62. (In Russ.). https://doi.org/10.51793/os.2023.26.8.008.

5. Alderden J., Rondinelli J., Pepper G. et al. Risk factors for pressure injuries among critical care patients: A systematic review. Int J Nurs Stud, 2017, vol. 71, pp. 97–114. https://doi.org/10.1016/j.ijnurstu.2017.03.012.

6. Crea-Arsenio M., Baumann A., Antonipillai V. et al. Factors associated with pressure ulcer and dehydration in long-term care settings in Ontario, Canada. PLoS One, 2024, vol. 19, no. 1, e0297588. https://doi.org/10.1371/journal.pone.0297588.

7. Du Y., Yu Y., Xu S. et al. Antibiotic bone cement combined with vacuum sealing drainage effectively repairs sacrococcygeal pressure ulcer. Am J Transl Res, 2024, vol. 16, no. 8, pp. 4042–4051. https://doi.org/10.62347/RYCD5610.

8. Han L., Guo J., Zhang H. et al. Validity and reliability of the Waterlow scale for assessing pressure injury risk in critical adult patients: A multi-centre cohort study. J Clin Nurs, 2024, vol. 33, no. 5, pp. 1875–1883. https://doi.org/10.1111/jocn.16987.

9. Kottner J., Raeder K., Halfens R. et al. A systematic review of interrater reliability of pressure ulcer classification systems. J Clin Nurs, 2009, vol. 18, no. 3, pp. 315–336. https://doi.org/10.1111/j.1365-2702.2008.02569.x.

10. Lahmann N., Posnett J. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay. Open Medicine, 2024, vol. 19. https://doi.org/10.1515/med-2023-0839.

11. Lee H. J., Han M. Y., Hwang J. H. et al. Risk factors for heel pressure injury in cardiovascular intensive care unit patients. Int Wound J, 2022, vol. 19, no. 5, pp. 1158–1164. https://doi.org/10.1111/iwj.13711.

12. Vanderwee K., Clark M., Dealey C. et al. Pressure ulcer prevalence in Europe: a pilot study. J Eval Clin Pract, 2007, vol. 13, no. 2, pp. 227–235. https://doi.org/10.1111/j.1365-2753.2006.00684x.

13. Wang L., Jones D., Chapman G. J. et al. A review of wearable sensor systems to monitor plantar loading in the assessment of diabetic foot ulcers. IEEE Trans Biomed Eng, 2020, vol. 67, no. 7, pp. 1989–2004. https://doi.org/10.1109/TBME.2019.2953630.

14. Zaidi S.R.H., Sharma S. Pressure ulcer. 2024 Jan 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. PMID: 31971747.