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Doctoral Thesis
DOI
10.11606/T.7.2017.tde-19052017-093929
Document
Author
Full name
Nariani Souza Galvão
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2016
Supervisor
Committee
Santos, Vera Lucia Conceicao de Gouveia (President)
Alves, Paulo Jorge Pereira
Carvalho, Viviane Fernandes de
Serpa, Letícia Faria
Woo, Kevin
Title in Portuguese
Prevalência de feridas agudas e crônicas e fatores associados em pacientes de hospitais públicos em Manaus-AM
Keywords in Portuguese
Enfermagem
Ferimentos e lesões
Hospital
Prevalência
Abstract in Portuguese
Introdução: As feridas agudas e crônicas provocam alterações físicas, psíquicas, sociais e econômicas para o indivíduo e família. Embora bem estabelecidos os dados epidemiológicos sobre essas lesões no contexto internacional, ainda são incipientes no Brasil, principalmente na Região Amazônica. Objetivo: Identificar e analisar a prevalência e fatores demográficos e clínicos associados à ocorrência de algumas feridas agudas e crônicas (Lesão por Fricção LF, Dermatite Associada à Incontinência DAI, Ferida Operatória Complicada FOC, Lesão por Pressão LP e Úlcera Diabética - UD) em pacientes hospitalizados. Métodos: Trata-se de estudo epidemiológico, observacional, transversal, analítico e descritivo, realizado em sete hospitais da cidade de Manaus. Os dados foram coletados por meio de consulta aos prontuários, entrevistas com os pacientes ou responsáveis legais e exame físico de todos os pacientes internados, durante o período de março a junho de 2015. As lesões encontradas foram avaliadas utilizando-se os seguintes instrumentos: Sistema de Classificação STAR - Lesão por Fricção para as LF; Incontinence Associated Dermatitis Intervention Tool (IAD-IT) para DAI; Pressure Ulcer Scale for Healing PUSH pernas, para FOC, Pressure Ulcer Scale for Healing PUSH UP para LP e Classificação de Wagner para as UD. Ademais, instrumento para levantamento dos dados sociodemográficos e clínicos e a Escala de Braden também foram empregados. Os dados foram analisados por meio de: teste Qui-quadrado ou exato de Fisher para as variáveis categóricas e teste t para as numéricas. Modelo de árvore de decisão com o algoritmo Classification and Regression Tree (CART) foi utilizado para identificação dos fatores associados à presença das feridas, de maneira simultânea e isolada. Resultados: A amostra (n=775) foi predominantemente do sexo masculino (457/ 58,9%), com média de idade de 60,4 anos (DP=18,7) raça parda (240/30,9%); situação conjugal com companheiro (413/53,2%) e ensino fundamental (403/52,0%). Cento e setenta e oito pacientes apresentaram lesões durante a coleta de dados, acarretando prevalência pontual global de 23%. Com média de 1,1 ferida (DP=0,4) por paciente, predominaram as LP (n=80/ 10,3%), seguidas de UD (n=66/ 8,5%). Os demais tipos de feridas mostraram prevalências de 2,7% (n=21) para FOC; 0,9% (n=7) para LF e 0,5% (n=4) para DAI. A maior ocorrência das lesões quanto às regiões corporais foram o dorso da mão E para a LF; região dos grandes lábios para DAI; perna E para FOC; região sacra para LP e: planta do pé E para UD. O CART mostrou Diabetes Mellitus, uso de anticoagulante, presença de rigidez, escore de Braden sem risco (>18), presença de curativo e de hematoma como os fatores associados à presença de todas as feridas, de forma simultânea, repetindo-se algumas dessas condições para LP e UD. Conclusão: O estudo, inédito na região amazônica, possibilitou um diagnóstico mais acurado da epidemiologia de algumas das mais importantes e prevalentes feridas agudas e crônicas, em pacientes hospitalizados, como a LF (0,9%), DAI (0,5%), FOC (2,7%), LP (10,3%) e UD (8,5%). Com prevalências pontuais inferiores à maioria dos resultados de estudos nacionais e internacionais, o estudo suscita a necessidade de mais investigações na região, particularmente estudos de incidência, mesmo que a maioria dos fatores associados constatados nos pacientes hospitalizados amazonenses esteja também presente na literatura.
Title in English
The prevalence of acute and chronic wounds and associated factors in public hospitals in Manaus-AM
Keywords in English
Hospital
Nursing
Prevalence
Wounds and Lesions
Abstract in English
Introduction: Acute and chronic wounds provoke physical, psychological, social and economic changes for individuals and their families. While, in an international context, epidemiological data regarding these wounds and lesions is well established, it is still in an incipient stage in Brazil, particularly in the Amazon Basin Region. Objective: To identify and analyze the prevalence and demographic and clinical factors associated with the occurence of several acute and chronic wounds (frictional lesions - frictional keratosis, incontinence-associated dermatitis - IAD, post-operative wound complications, pressure sores and diabetic ulcers) in hospitalized patients. Methods: This is an observational, transverse, analytical and descriptive epidemiological study conducted in seven hospitals in the city of Manaus. The data was collected by consulting hospital records, interviews with patients or legal guardians and physical examinations of all hospitalized patients, during the period from March through June 2015. The lesions found were evaluated using the following instruments: Classification System STAR -- Frictional Lesion for frictional lesions; Incontinence Associated Dermititis Intervention Tool (IAD-IT) for IAD; Pressure Ulcer Scale for Healing - PUSH UP for pressure sores and Wagner Classification for diabetic ulcers. Moreover, an instrument for socio-demographic and clinical data collection and the Braden Scale were also employed. The data was analyzed by way of the Chi-squared distribution test or T-Test for numerical ones. The decisionmaking tree model using the Classification and Regression Tree (CART) algorithm was utilized in the identification of factors associated with the presence of lesions, simultaneously and in isolation. Results: The study sample (n=775) was predominantly of the male sex (457 / 58,9%) with an average age of 60.4 years (DP=18.7) mulatto (240/30.9%); marital situation with spouse (413/53.2 %) and elementary school complete (403/52.0%). One hundred and seventy-eight patients presented lesions during the datacollection period, leading to an overall point prevalence of 23%. With an average of 1.1 lesions (DP=0.4) per patient, pressure sores predominated (n=80/10.3%), followed by diabetic ulcers (n=66/8.5%). The remaining types of lesions showed a prevalence of 2.7% (n=21) for post-operative wound complications; 0.9% (n=7) for frictional lesions and 0.5% (n=4) for incontinence associated dermititis (IAD). The primary occurence of lesions to particular parts of the body were frictional lesions to the back of the left hand; incontinence associated dermititis lesions to the region of the outer labia; post-operative wound complications to the left leg; pressure sores to the sacrum; and diabetic ulcers to the sole of the left foot. CART showed Diabetes Mellitus, the use of anticoagulants, the presence of rigidness, the Braden score without risk (>18), the presence of bandages and bruises as factors simultaneously associated with the presence of lesions, repeating some of these conditions for pressure sores and diabetic ulcers. Conclusion: The study, unprecedented in the Amazon Basin region, made a more accurate epidemiological diagnosis possible of some of the most important and prevalent acute and chronic lesions in hospitalized patients, such as frictional lesions (0.9%), IAD (0.5%), post-operative wound complications (2.7%), pressore sores (10.3%) and diabetic ulcers (8.5%). With point prevalences inferior to the majority of national and international studies, despite the fact that the majority of the associated factors found in hospitalized Amazonian patients are the same as those present in a review of the literature, this study evokes the need for more investigation throughout the region,.particularly incidence studies.
 
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Publishing Date
2017-05-31
 
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