PMU49 Incorporating Clinical Notes to Uncover Etiological Patterns in Surgical ICU Patients with Pressure Injuries

Abstract

Current guidelines for hospital-acquired pressure injury (HAPrI) prevention, management, and care are built on the prevailing thought of “outside-in” etiology, i.e., that localized damage to the skin as a result of external pressure. However, some researchers postulate that HAPrIs are instead a type of organ system failure caused from the “inside-out” by inadequate delivery of oxygen-rich blood, resulting in tissue ischemia. The purpose of this study was to use data from progress notes to determine whether HAPrI occurred in a temporal pattern with other types of organ system failure in critical care patients. We analyzed intake history and physical (HP) and progress notes from 5,101 critical care patients, including 399 patients with HAPrI. Notes were linked to (EHR) data on patients and both quantified and parsed via key phrases and natural language processing (NLP). For these 5,101 patients, we linked 4,983 history and physical notes and 293,244 progress notes. Patients with HAPrIs had significantly more HP notes (p<0.0001) and progress notes (p<0.0001). Additionally, we identified differential distributions of mentions of organ system failure and disease progression within 72 hours of HAPrI formation. Although not conclusive, organ system failure and HAPrI may share a common etiologic pathway, likely related to altered delivery of oxygen-rich blood (ischemia) and subsequent tissue damage. HAPrI may require prevention approaches beyond relieving local pressure. Work is still ongoing to cluster and classify organ system mentions and longitudinal progress.