Longitudinal Braden Scale Score Trajectories and Their Association With Pressure Injury Development in Mechanically Ventilated Patients: A Retrospective Cohort Analysis

OBJECTIVE: To identify distinct trajectories of Braden Scale scores in critically ill ventilated patients and evaluate their association with pressure injury (PI) development using Latent Growth Mixture Modeling (LGMM), while assessing the prognostic value of these trajectories for early risk identification. METHODS: This retrospective cohort study analyzed data from 7339 adult patients (18 years and above) from the Medical Information Mart for Intensive Care database who received mechanical ventilation for at least 24 hours. Patients required at least 3 Braden score assessments during intensive care unit (ICU) stay. Braden scores were collected from ICU admission up to 48 hours. Latent Growth Mixture Modeling identified distinct trajectories, and competing risk models evaluated the association between trajectories and 14-day PI development, with death as a competing event. RESULTS: Latent Growth Mixture Modeling identified 4 distinct trajectories: steadily improving group (n=1549, 21.1%), rapidly deteriorating group (n=912, 12.4%), stable-slight improvement group (n=3251, 44.3%), and persistently low group (n=1627, 22.2%). The persistently low group showed the highest mortality (42%) and PI incidence (37%). During the first 48 hours, compared with the steadily improving group, adjusted hazard ratios were significantly higher: rapidly deteriorating group (1.49, 95% CI: 1.05-2.12), stable-slight improvement group (2.40, 95% CI: 1.83-3.17), and persistently low group (4.07, 95% CI: 3.04-5.45). Risk remained elevated during 48 to 120 hours but attenuated by 120 to 336 hours. CONCLUSIONS: Early trajectory patterns of Braden scores demonstrate distinct associations with PI risk. The identification of these patterns, particularly during the first 48 hours, may enable earlier risk stratification and more targeted preventive strategies. Dynamic monitoring of Braden scores could enhance PI risk assessment and prevention in ICU settings.