Prevalence of pressure ulcer in Iran's intensive care units: A systematic review and a meta-analysis

  • Shadi Sohrabi Akhkand Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
  • Jamal Seidi Department of Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
  • Abbas Ebadi Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Teheran, Iran
  • Reza Ghanei Gheshlagh Mail Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
pressure ulcer; prevalence; Iran; meta-analysis



Background: Pressure ulcer (PU) is a costly, painful, and often a preventable problem with varying prevalence in different health centers. PU is associated with prolonged length of stay and mortality. This systematic review and meta-analysis aimed to estimate the prevalence of PU in Iran’s intensive care units (ICUs).

Method: In this research, 9 articles published in Persian and English were studied. National (Science Information Database (SID) and MagIran) and international databases (PubMed, Scopus, and Web of Science) were searched using the keywords of pressure ulcers, bedsore, pressure sore, decubitus ulcer, pressure injury, Iran, and all of possible combinations without time limitations. Data were analyzed using meta-analysis and the random effects model. The heterogeneity between studies was investigated by I2 statistic, and the Stata software (version 11).

Results: The total prevalence of PU in Iran’s ICUs was 19.59% (95% confidence interval [CI]: 13.15- 25.97). The prevalence of PU in region 1 of the country was 28.55% (95% CI: 12.27-44.84), and it was 10.31 (95% CI: 3.88-16.75) in other areas of the country. Meta-regression results showed a significant correlation between the prevalence of PU and the mean age of the patients (P = 0.122) as well as study sample size (P = 0.043).

Conclusion: We found that the overall prevalence of PU in Iran’s ICUs was relatively high. Considering the high prevalence of PU in Iranian ICUs, it seems necessary to investigate and implement effective interventions to control and reduce this problem.

Keywords: Pressure ulcer, prevalence, Iran, meta-analysis


1. Rafiei H, Abdar ME, Iranmanesh S, Lalegani H, Safdari A, Dehkordi AH. Knowledge about pressure ulcer prevention, classification and management: A survey of registered nurses working with trauma patients in the emergency department. International Journal of Orthopaedic and Trauma Nursing. 2014;18(3):135-42.
2. Martin D, Albensi L, Van Haute S, Froese M, Montgomery M, Lam M, et al. Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence‐Based Practice. Worldviews on Evidence‐Based Nursing. 2017;14(6):473-83.
3. Karimian M, Sarokhani D, Sarokhani M, Sayehmiri K, Mortazavi Tabatabai SA. Prevalence of bedsore in Iran: a systematic review and meta-analysis. Journal of Mazandaran University of Medical Sciences. 2016;26(136):202-10.
4. Boyko TV, Longaker MT, Yang GP. Review of the current management of pressure ulcers. Advances in wound care. 2018;7(2):57-67.
5. Vanderwee K, Clark M, Dealey C, Gunningberg L, Defloor T. Pressure ulcer prevalence in Europe: a pilot study. Journal of evaluation in clinical practice. 2007;13(2):227-35.
6. Usher K, Woods C, Brown J, Power T, Lea J, Hutchinson M, et al. Australian nursing students’ knowledge and attitudes towards pressure injury prevention: A cross-sectional study. International journal of nursing studies. 2018;81:14-20.
7. Hommel A, Gunningberg L, Idvall E, Bååth C. Successful factors to prevent pressure ulcers–an interview study. Journal of Clinical nursing. 2017;26(1-2):182-9.
8. Barratt E. Pressure sores. Putting risk calculators in their place. Nursing Times. 1987;83(7):65.
9. Ghanee R GH. Bed sores in icu. The Journal of Urmia Nursing and Midwifery Faculty. 2010;8(2):90-113.
10. Weststrate JT, Heule F. Prevalence of PU, risk factors and use of pressure-relieving mattresses in ICU patients. The value of pressure ulcer risk assessment and interface pressure measurements in patients A nursing perspective. 2001;1(77-82).
11. Coyer F, Miles S, Gosley S, Fulbrook P, Sketcher-Baker K, Cook J-L, et al. Pressure injury prevalence in intensive care versus non-intensive care patients: a state-wide comparison. Australian Critical Care. 2017;30(5):244-50.
12. Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence and incidence in intensive care patients: a literature review. Nursing in critical care. 2008;13(2):71-9.
13. Lawrence P, Fulbrook P, Miles S. A survey of Australian nurses' knowledge of pressure injury/pressure ulcer management. Journal of Wound, Ostomy and Continence Nursing. 2015;42(5):450-60.
14. Claudia G, Diane M, Daphney SG, Danièle D. Prevention and treatment of pressure ulcers in a university hospital centre: a correlational study examining nurses' knowledge and best practice. International journal of nursing practice. 2010;16(2):183-7.
15. Stinson M, Gillian C, Porter-Armstrong A. A literature review of pressure ulcer prevention: weight shift activity, cost of pressure care and role of the OT. British Journal of Occupational Therapy. 2013;76(4):1-10.
16. Keller PB, Wille J, van Ramshorst B, van der Werken C. Pressure ulcers in intensive care patients: a review of risks and prevention. Intensive care medicine. 2002;28(10):1379-88.
17. García‐Fernández FP, Agreda JJS, Verdú J, Pancorbo‐Hidalgo PL. A new theoretical model for the development of pressure ulcers and other dependence‐related lesions. Journal of Nursing Scholarship. 2014;46(1):28-38.
18. Moore ZE, Cowman S. Repositioning for treating pressure ulcers. Cochrane Database of Systematic Reviews. 2015(1):1-6.
19. Hulsenboom MA, Bours GJ, Halfens RJ. Knowledge of pressure ulcer prevention: a cross-sectional and comparative study among nurses. BMC nursing. 2007;6(1):2-6.
20. Bolourchifard F, Abdolrahimi M, Yaghmaei F, AKBARZADEH BA. Factors associated with pressure sore in patients admitted to the orthopedic ward. Journal of Health Promotion Management. 2015;4(2):27-33.
21. Etafa W, Argaw Z, Gemechu E, Melese B. Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC nursing. 2018;17(1):14-21.
22. Nuru N, Zewdu F, Amsalu S, Mehretie Y. Knowledge and practice of nurses towards prevention of pressure ulcer and associated factors in Gondar University Hospital, Northwest Ethiopia. BMC nursing. 2015;14(1):34-9.
23. Afkar A MM, Mehrabian F, Farmanbar R, Ghahramani F, Nezhad EK, et al. Predictive factors of ICU bedsores using Braden scale. Journal of Kermanshah University of Medical Sciences. J Kermanshah Univ Med Sci. 2014;18(4):220-5.
24. Rafiei H. Incidence of pressure ulcer in patients who were admitted to open heart cardiac surgery intensive care unit. International Journal of Epidemiologic Research, 2016. 2016;3(1):8-12.
25. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine. 2009;151(4):264-9.
26. Farrugia M, Kirsch A. Application of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement to publications on endoscopic treatment for vesicoureteral reflux. Journal of pediatric urology. 2017;13(3):320-5.
27. Ades A, Lu G, Higgins J. The interpretation of random-effects meta-analysis in decision models. Medical Decision Making. 2005;25(6):646-54.
28. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629-34.
29. Iranmanesh S, Rafiei H, Sabzevari S. Relationship between Braden scale score and pressure ulcer development in patients admitted in trauma intensive care unit. International wound journal. 2012;9(3):248-52.
30. Nassaji M, Askari Z, Ghorbani R. Cigarette smoking and risk of pressure ulcer in adult intensive care unit patients. International journal of nursing practice. 2014;20(4):418-23.
31. Valizadeh M, Abbasivash R, Dinparast R, Adeli S, Param H. Evaluation of the prevalence of the pressure ulcers and their predisposing factors in patients admitted in intensive care unit of Urmia Imam Khomeini Hospital at 2011-2012. J Iran Soc Anaesthesiol Intensive Care. 2012;35:0.
32. Zarei E, Madarshahian E, Nikkhah A, Khodakarim S. Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran. Journal of tissue viability. 2019;28(2):70-4.
33. Azimian J RH AHM, Senmar M. Prevalence of pressure ulcer among patients who were admitted to open heart surgery intensive care unit. International Journal of Novel Research in Healthcare and Nursing. 2016;3(3):28-33.
34. Shokati Ahmadabad M R H, Alipoor Heydari M, Bokharaei M, Amiri M. . Incidence of pressure ulcer in patients who were admitted to open heart cardiac surgery intensive care unit. International Journal of Epidemiologic Research. 2016;3(1):12-8.
35. Rahimi–Bashar F, Samami H, Torabian S. Bedsore Incidence in Trauma Patients Admitted to the ICU. 2014.
36. Sari AA, Doshmanghir L, Neghahban Z, Ghiasipour M, Beheshtizavareh Z. Rate of pressure ulcers in intensive units and general wards of Iranian hospitals and methods for their detection. Iranian journal of public health. 2014;43(6):787.
37. Amirah M, Rasheed A, Parameaswari P, Awajeh A, Issa M, Abdallah M. Pressure Injury Prevalence and Risk Factors among Adult Critically Ill Patients at a Large Intensive Care Unit. J Intensive Crit Care. 2019;5(2):9.
38. Kwak HR, Kang J. Pressure ulcer prevalence and risk factors at the time of intensive care unit admission. Korean Journal of Adult Nursing. 2015;27(3):347-57.
39. Costa ACO, Pinho CPS, Santos ADAd, Nascimento ACSd. Úlcera por presión: incidencia y factores demográficos, clínicos y nutricionales asociados en pacientes de una unidad de cuidados intensivos. Nutrición hospitalaria. 2015;32(5):2242-52.
40. Bauer K, Rock K, Nazzal M, Jones O, Qu W. Pressure Ulcers in the United States' Inpatient Population From 2008 to 2012: Results of a Retrospective Nationwide Study. Ostomy/wound management. 2016;62(11):30-8.
41. Latifa K, Sondess S, Hajer G, Souhir K, Nadia B, Abir J, et al. Evaluation of physiological risk factors, oxidant-antioxidant imbalance, proteolytic and genetic variations of matrix metalloproteinase-9 in patients with pressure ulcer. Scientific reports. 2016;6:29371.
42. Serrano ML, Mendez MG, Cebollero FC, Rodriguez JL. Risk factors for pressure ulcer development in Intensive Care Units: A systematic review. Medicina Intensiva (English Edition). 2017;41(6):339-46.
43. Bours G, Laat dE, Halfens R, Lubbers M. Prevalence, risk factors and prevention of pressure ulcers in Dutch intensive care units. Intensive care medicine. 2001;27(10):1599-605.
How to Cite
Sohrabi Akhkand S, Seidi J, Ebadi A, Ghanei Gheshlagh R. Prevalence of pressure ulcer in Iran’s intensive care units: A systematic review and a meta-analysis. NPT. 7(1):12-20.
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