Community-acquired Pressure Injuries Research Articles

Development and validation of a risk prediction model for community-acquired pressure injury in a cancer population: A case-control study

BackgroundPatients with cancer are susceptible to pressure injuries, which accelerate deterioration and death. In patients with post-acute cancer, the risk of pressure injury is ignored in home or community settings. ObjectiveTo develop and validate a community-acquired pressure injury risk prediction model for cancer patients. MethodsAll research data were extracted from the hospital's electronic medical record system. The identification of optimal predictors is based on least absolute shrinkage and selection operator regression analysis combined with clinical judgment. The performance of the model was evaluated by drawing a receiver operating characteristic curve and calculating the area under the curve (AUC), calibration analysis and decision curve analysis. The model was used for internal and external validation, and was presented as a nomogram. ResultsIn total, 6257 participants were recruited for this study. Age, malnutrition, chronic respiratory failure, body mass index, and activities of daily living scores were identified as the final predictors. The AUC of the model in the training and validation set was 0.87 (95 % confidence interval [CI], 0.85–0.89), 0.88 (95 % CI, 0.85–0.91), respectively. The model demonstrated acceptable calibration and clinical benefits. ConclusionsComorbidities in patients with cancer are closely related to the etiology of pressure injury, and can be used to predict the risk of pressure injury. Implications for practiceThis study provides a tool to predict the risk of pressure injury for cancer patients. This suggests that improving the respiratory function and nutritional status of cancer patients may reduce the risk of community-acquired pressure injury.

Prevalence of pressure injury on the medical wards of public general hospitals in Kuwait: a national cross-sectional study

BackgroundPressure injury is a severe problem that can significantly impact a patient’s health, quality of life, and healthcare expenses. The prevalence of pressure injuries is a widely used clinical indicator of patient safety and quality of care. This study aims to address the research gap that exists on this topic in Kuwait by investigating the prevalence of pressure injuries and preventive measures on the medical wards of the country’s public general hospitals.MethodsA cross-sectional research design was adopted to measure the point prevalence of pressure injuries on 54 medical wards in the public general hospitals. Data, including variables pertaining to hospitals, patients, pressure injuries and preventive practices, were collected using an online form. The data were processed and analysed using Microsoft Excel and SPSS 23 (α level = 0.05). Analysis provided an overview of patient, pressure injury characteristics and preventive measures, and the relationships between the patient and pressure injury characteristics and the prevalence of pressure injuries. A model for predicting the determinants of pressure injury prevalence was constructed from a linear regression analysis.ResultsThe mean national prevalence of pressure injury was 17.6% (95% CI: 11.3–23.8). Purely community-acquired pressure injuries represent the majority of pressure injuries nationally (58.1%). Regarding preventive measures, “pressure injury assessment on admission” has been provided to 65.5% of patients. Correlation analysis revealed that the only statistically significant correlation with the prevalence of hospital-acquired pressure injury was “pressure injury assessment on admission”, which was strongly negative (ρ = −0.857). Therefore, this was the only variable included in the regression analysis as a predictor of pressure injury prevalence (Beta = 0.839). The results showed many statistically significant differences between hospitals with respect to the variables studied.ConclusionsThe national pressure injury prevalence is high compared to the global rate. The higher percentage of purely community-acquired pressure injuries requires particular attention. Many risk factors for the development of pressure injuries are public health concerns, and effective mitigating strategies are needed. Further research is required to assess the knowledge, attitude, and behaviour of nurses with respect to pressure injuries, and to evaluate preventive and management practices.

Socio-economic and environmental factors associated with community-acquired pressure injuries: A mixed method study

AimsTo: (1) report on the prevalence of community-acquired pressure injuries (CAPIs) in patients admitted into the acute care setting; (2) examine the socio-economic and home environment associated with CAPIs; and (3) understand the challenges of caring for patients with CAPIs at home. MethodsThis mixed-method study recruited patients admitted with CAPIs in the acute care hospital between March 2021 to June 2022. The hospital's pressure injury (PI) database was used to screen patients admitted with CAPIs. A purposive sample of CAPI patients and their caregivers participated in this study. A cross-sectional survey study was first performed to examine the prevalence of CAPIs and the socio-economic and home environment factors. Semi-structured interviews were conducted to understand the caregivers' challenges in caring for patients with CAPIs at home. ResultsThe CAPI prevalence was reported at 1.1 % during the study period (1039 had CAPIs out of 97 912 patients admitted to the hospital). A total of 70 caregivers and patients consented to participate in the study. The mean age of patients was 84.2 (SD = 10.4) years old; 68.6 % (n = 48) were females. Majority presented with a deep tissue injury (DTI) (37.1 %; n = 26) or unstageable PI (31.4 %; n = 22). More than half of the patients had alternating air mattresses at home (54.3 %; n = 38), and only 10 % (n = 7) had positioning wedges and used a sliding sheet for turning. The mean age of the caregivers was 43.4 years old (SD = 13.1), and 84.3 % (n = 59) were female. Continuous data were summarised using means and standard deviations, and categorical data were summarised using frequencies and percentages. Logistic regression found no significant socio-demographic and clinical predictors of patients having PI stages 2, 3, and 4 compared to patients with DTI and unstageable PI. Challenges to caring for PI at home included high financial burden, physical limitations, and personal challenges in CAPIs management. ConclusionCAPIs are prevalent among older patients admitted to the acute care setting. Understanding the influence of socio-economic factors is crucial for developing comprehensive strategies to mitigate the occurrence and impact of PIs. Ongoing support and education to the caregivers in the community is essential to address the reported challenges in PI care.

Development of a decision support tool to prevent community acquired pressure injuries for use in the spinal cord injury clinic using the delphi technique.

Delphi Technique. Describe the development of a decision support tool to prevent community-acquired pressure injuries (CAPrIs) in individuals with spinal cord injury (SCI) for use in SCI clinics, called the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT). Veteran Health Administration Hospital, Chicago, Illinois, USA. Concept mapping of current pressure injury (PrI) guidelines and qualitative research describing risks, actions, and resources needed to prevent CAPrIs associated with SCI were used to develop 40 veteran checklist items (Items) along with 37 associated provider actions (Actions) for the tool. The Delphi technique was used to refine Items and Actions with a panel of interprofessional SCI providers (n = 15), veterans with SCI (n = 4), and caregivers (n = 3) to determine consensus on a 4-point Likert scale (strongly agree-strongly disagree) for each Item and Action. A 75% agreement was set for responses rated as strongly agree or agree. Panelists were 60% female, 62% White, 33% veterans with SCI or caregivers, 33% wound care certified with a mean age of 59 years. Two survey rounds were required for consensus for 41 Item and 38 Action CAPP-FIT. Response rate was 95% for both rounds. Delphi round 1 showed all but two Actions affirming agreement above 75%. Substantive comments from panelists required revision to 5 Items and 9 Actions and one additional Item/Actions related to coping, meeting threshold percent agreement in Round 2. The CAPP-FIT could become a useful tool for Veterans living with SCI, caregivers, and SCI providers.

Triangulation of veteran and provider models of preventing community-acquired pressure injuries in spinal cord injury to reveal convergence and divergence of perspectives

Context/Objective Community-acquired pressure injuries (CAPrI) are a common and costly complication of spinal cord injury (SCI). The majority of PrIs occur in the community, but there is little guidance in CAPrI prevention. This study describes how provider and veteran perspectives of CAPrI prevention converge and diverge. Design The Farmer triangulation method was used to compare two models from previous qualitative research describing provider and veteran perspectives of CAPrI prevention based on the framework of CAPrI risks, resources, and preventive activities. The previous qualitative research revealed the provider model of CAPrI prevention using semi-structured interviews with interprofessional SCI providers at the Veteran Health Administration (VA) (n = 30). A qualitative descriptive design using photovoice (n = 30) with or without guided tours (n = 15) revealed the Veteran model of CAPrI prevention. Setting The previous qualitative research was conducted at three geographically different VA spinal cord injury/disorder centers in the United States (north, south, west). Participants 30 interprofessional SCI providers; 30 Veterans living with SCI at three VA SCI Centers in the United States. Interventions n/a. Outcome Measures Provider-Veteran perspectives of CAPrI prevention that demonstrated agreement, partial agreement, divergence, and silence. Results Providers and veterans agreed on what is basic care, and the importance of family, caregiver and health provider/system supports, but they viewed motivation, veteran role, informal supports, and adequacy of supports differently. Conclusion Understanding how SCI providers and veterans living with SCI view prevention in the community informs how to promote preventive care in the context of veterans’ lives.

Development and Validation of a Risk Nomogram Model for Predicting Community-Acquired Pressure Injury Among the Older Adults in China: A Case-Control Study.

PurposeA predictive model of community-acquired pressure injury (CAPI) was established and validated to allow the early identification of the risk of pressure injuries by family caregivers and community workers.Patients and MethodsThe participants were hospitalized patients 65 years and older from two branches of a tertiary hospital in China, one for model training set and the other for validation set. This study was a case-control study based on hospital electronic medical records. According to the presence of pressure injury at admission, patients were divided into a case group and a control group. In the model training set, LASSO regression was used to select the best predictors, and then logistic regression was used to construct a nomogram. The performance of the model was evaluated by drawing the receiver operating characteristic curve (ROC) and calculating the area under the curve (AUC), calibration analysis, and decision curve analysis. The model used a 10-fold crossover for internal and external validation.ResultsThe study included a total of 20,235 subjects, including 11,567 in the training set and 8668 in the validation set. The prevalence of CAPI in the training and validation sets was 2.5% and 1.8%, respectively. A nomogram was constructed including eight variables: age ≥ 80, malnutrition status, cerebrovascular accidents, hypoproteinemia, respiratory failure, malignant tumor, paraplegia/hemiplegia, and dementia. The AUC of the prediction model in the original model, internal validation, and external validation were 0.868 (95% CI: 0.847, 0.890), mean 0.867, and 0.840 (95% CI: 0.807,03.873), respectively. The nomogram showed acceptable calibration and clinical benefit.ConclusionWe constructed a nomogram to predict CAPI from the perspective of comorbidity that is suitable for use by non-specialists. This nomogram will help family caregivers and community workers with the early identification of PI risks.

Provider perspectives of community-acquired pressure injury prevention in veterans with spinal cord injury

Context/Objective Community-acquired pressure injuries (CAPrI) are a common and costly complication of spinal cord injury (SCI). Most studies and interventions focus on the prevention of pressure injuries acquired in the hospital. The goal of this study is to better understand SCI provider perspectives of the risks, actions and resources needed to prevent CAPrIs. Design Qualitative descriptive, semi-structured interviews of SCI providers analyzed using a deductive-inductive approach. Setting Three geographically different veteran health administration spinal cord injury/disorder centers. Participants 30 interprofessional SCI providers. Interventions Not applicable. Outcome Measures Provider perspective of risks, actions and resources for CAPrI prevention in veterans with SCI. Results 30 interviews revealed a model of provider perspectives of CAPrI prevention including veteran risk characteristics, veteran preventive activities and provider, family, community caregiving resources. Conclusion Understanding provider perspectives of Veteran CAPrI preventive risks, actions and resources guides more appropriate interventions to prevent CAPrIs in individuals living with SCI.

Risk factors for hospital-acquired and community-acquired pressure injuries: a multicentre mixed case–control study

ObjectivesTo separately examine and comprehensively compare the risk factors for hospital-acquired (HAPIs) and community-acquired pressure injuries (CAPIs).DesignA mixed case–control study.SettingFour medical centres in China.ParticipantsInclusion criteria included patients who were (1)...

Veteran model of preventing community-acquired pressure injuries associated with spinal cord injury: A qualitative descriptive study

Context/Objective Pressure injuries (PrIs) are the second leading cause of hospitalization in people with spinal cord injury (SCI). The majority of PrIs occur in the community, but there is little known about prevention of community acquired PrI (CAPrI). The purpose of this study was to better understand risks, resources, and actions associated with CAPrI prevention from the perspective of veterans living with SCI in the community. Methods A qualitative descriptive design using photovoice (n = 30) with or without guided tours (n = 15) was conducted with Veterans living with SCI at 3 sites across the United States to determine environmental/lifestyle risks at home, prevention activities, resources used, and challenges in CAPrI prevention. Interviews were audio-recorded, transcribed and analyzed using thematic analysis, followed by inductive thematic synthesis. Results Qualitative analyses revealed a model describing veteran’s perspective of preventing CAPrIs associated with SCI. The model included 3 themes and 9 subthemes: Factors that Lead to Risk for Pressure Injury (Challenges and Barriers), Factors that Affect Chosen Actions (Veteran Motivators, Veteran Values, Veteran Satisfaction with Provider Relationships, and Veteran Supports), and Preventive Activities within Context of Life (Physical Care, Coping, Advocacy). Conclusion Incorporating the veteran model of prevention within the context of life into clinical care could support provider-veteran collaboration to identify and integrate successful strategies that prevent CAPrIs while also improving veteran quality of life.

Association Between Charlson Comorbidity Index and Community-Acquired Pressure Injury in Older Acute Inpatients in a Chinese Tertiary Hospital.

PurposeTo explore the correlation between community-acquired pressure injury (CAPI) and comorbidities in elderly patients with emergency admission.Patients and MethodsPatients aged 65 years or above were enrolled from multiple departments, such as Internal Medicine, Surgery, Geriatrics, and Intensive Care Unit of Wuhan Third Hospital, which is affiliated to Wuhan University, from January to December 2020. Comorbidity data were extracted using the 10th edition of the International Classification of Diseases (ICD-10) from the hospital electronic medical record system, and the Charlson Comorbidity Index (CCI) was calculated using these data. Participants were divided into two groups according to whether pressure injury was present at admission. The baseline characteristics of the two groups were compared using Student’s t-tests, Mann–Whitney U-tests, and chi-square tests. Univariate and multivariate logistic regression models were constructed to explore the relationship between CAPI and the CCI. Smooth curve fitting was used to show the relationship between the CCI and CAPI. By drawing the receiver operating characteristic curve, the CCI was used to predict CAPI.ResultsA total of 5759 participants with an average age of 75.1 ± 7.6 were included in this population-based study. The prevalence of CAPI was 4.3%. In logistic regression analysis, there was a positive relationship between the CCI and CAPI after adjustment for sex, age, hypoproteinemia, and anemia (OR = 1.37, 95% CI = 1.29–1.45, p < 0.001, trend test p < 0.001). The area under the receiver operating characteristic curve was 0.75, and the maximum value of the Youden index was 0.35, with a critical value of 5.5.ConclusionThe development of CAPI was positively correlated with the CCI. The risk of developing pressure injury increases with the number and severity of comorbidities. This study shows that the CCI has certain reference value in predicting CAPI.

Community-Acquired Pressure Injuries in the Acute Care Setting.

To explore the population of patients with a community-acquired pressure injury (CAPI) admitted to an acute care facility from December 2018 to December 2019. The specific aims of the study were to identify the (1) number of patients admitted with a CAPI, (2) type and frequency of pressure injury (PI), (3) location of residence prior to admission, (4) general demographics of the patient, and (5) condition of the PI at discharge. In this retrospective descriptive study, participants were identified and pulled from the hospital database at a 260-bed level 2 trauma center. Patients' charts were identified by searching for nursing documentation of CAPIs. The exclusion criterion was charts that did not include verification of PI by a certified wound nurse. Data were pulled from the electronic medical record, verified by the certified wound nurse, and reviewed for participant demographics and implementation of PI prevention and treatment. Over the course of the year, 88 patients had a CAPI. The majority lived at home (86.4%), were male (68.2%), and had stage 2 PIs (37%) on the sacrum (30.7%) or coccyx (51.1%). All participants had multiple comorbidities. Few PIs were from postacute care settings (11%) or another acute care hospital (1.1%). On average, patients had more than one PI. All patients had decreased or impaired mobility and mean body mass index of 26.38 ± 7.23 kg/m2. No one developed a new PI while in the acute care setting, and many of the CAPIs either healed (69.3%) or stabilized (22.7%). Providers have an opportunity to make a difference in the prevalence of PIs occurring outside of acute and postacute care settings.

Third Annual Pressure Injury Issue: Insights to Improve Practice.

Our journal was founded in February 1988 by Dr Roberta Abruzzese to gather the latest evidence on pressure injuries (PIs) in one resource for busy clinicians.1 In keeping with this mission, this is our third annual themed issue on PIs. As is fitting for an international journal, our authors come from several countries including China, Iran, and the US. The articles cover a range of PI topics; there are some common themes, and some of the theoretical frameworks described by authors in their articles may be controversial. We have highlighted a few of the articles below to contextualize these advances. In the continuing education article by Cox and colleagues, they propose a conceptual schema for PIs in critical care patients. After their comprehensive literature review, they separate risk factors into three categories: static intrinsic (eg, older age), dynamic intrinsic (eg, respiratory failure), and dynamic extrinsic (eg, mechanical ventilation). This schema “illustrates complex relationships between risk factor duration and intensity and the underlying etiology of PI development.” They suggest that “focusing on the etiologic bases for PI development… may also provide a framework to explore alternatives to current formal PI risk.” From California come data about a new proposed PI risk assessment tool. These researchers retrospectively reviewed the data from 406,032 hospital admissions for a 3-year period. From the 1,299 PI cases, they developed a decision tree and selected predictors from the demographic and clinical variables to construct what they have named the Shieh Score. Based on these data, hospital-acquired PIs were more common in men. Several other factors were more than doubled in individuals who developed PIs: length of stay (median, 8 vs 2 days), lower glomerular filtration rate (median 32 vs 66 mL/min), diabetes (57.3% vs 29.9%), and coronary artery disease (32.2% vs 16.0%). These data may serve as a research base for considering other factors in addition to the Braden Scale to prospectively identify patients at highest risk of hospital-acquired PIs. In their online-only article, Singh and colleagues provide data from their retrospective review of hospital records for a 1-year period in their level 2 US trauma center on community-acquired PIs (CAPIs). There was an increased incidence of CAPI in older adult men with low body mass index. These CAPIs were located on either the sacrum or coccyx and were either at stage 1 or 2. They report that the majority of the injuries had healed prior to discharge. The articles from Shieh and Singh support earlier research discussing PI risk beyond formal risk assessment scales. For example, two studies by Delmore and colleagues2,3 reported that other independent factors beyond those listed in the Braden Scale (diabetes, vascular disease, perfusion issues, impaired nutrition, age over 65 years, mechanical ventilation, and surgery) should be considered for patients at risk of heel PIs. The extent of the global PI problem is illustrated in the article by Wang and colleagues. They report PI prevalence and incidence for a 10-year period in their retrospective analysis of patient records in their tertiary hospital in China. From 2009 to 2018, the prevalence increased from 0.19% to 1.00%, increasing with patient age. Further, Qin and colleagues provide data about risk factors for 156 intubated ICU patients over 1 year in their hospital in China. There was an endotracheal (ET) intubation-related PI rate of 23.7%; the most common location was the lip. Factors involved the type of ET intubation, amount of time the ET catheter was in place, catheter fixation, and fixator types (P < .05). Among their conclusions are the importance of early identification of risk factors and interventions to prevent medical device-related PIs. Finally, knowledge that is based on clinical practice is essential. The significance of nutrition in PI prevention and treatment is highlighted in this issue with a succinct, useful installment of our Practice Points department in a table format (enabler for translation to practice). This issue (print and online) is jam-packed with new insights into PI prevention, management, and treatment for practice. Through our assemblage of international, interprofessional viewpoints and focus on a variety of aspects of PI care, we hope that our readers are challenged with new concepts to improve patient care. Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN Gary R. Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM

Developing a decision support tool to prevent community-acquired pressure injuries in spinal cord injury in ambulatory care: A nurse-led protocol for mix methods research

BackgroundThere is a lack of formal guidelines and decision support tools to prevent community-acquired pressure injuries (CAPrIs) in Veterans with spinal cord injury (SCI). PurposeIn this article we present our research protocol that describes our plans to create and test a decision support tool to prevent CAPrIs in SCI. MethodsIn Aim 1, we identified mental-models of CAPrI prevention from the perspectives of Veterans (using photovoice, guided tours), and Veterans Health Administration SCI providers (using interviews), and triangulation to compare the two mental-models. This led to a decision support tool developed and validated using Delphi approaches in Aim 2 and will be followed by tool automation and system redesign for pilot implementation in Aim 3. FindingsThe nurse-led research protocol provides a map to systematically explore, address and translate research into evidence-based practice. DiscussionRefinement of the protocol will guide future research and implementation.

Clinical evidence of the nursing diagnosis Adult pressure injury.

To identify clinical evidence of the nursing diagnosis Adult pressure injury. Cross-sectional study with 138 adult patients, with community-acquired or hospital-acquired pressure injuries, admitted to clinical, surgical, and intensive care units. Data collected from Electronic health records (EHR) and from the clinical assessment of patients at the bedside, analyzed through descriptive statistics. The partial thickness loss of dermis presenting as a shallow open ulcer, intact or open/ruptured blister, consistent with a stage II pressure injury, was the significant defining characteristic. Significant related factors were pressure on bony prominence, friction surface, shear forces, and incontinence. The population at significant risk was that at age extremes (≥60 years). Significant associated conditions were pharmacological agent, physical immobilization, anemia, decreased tissue perfusion, and impaired circulation. The clinical indicators assessed in the patients showed evidence of the nursing diagnosis Adult pressure Injury, with significant lesions consistent with stage II, resulting from pressure, especially in elderly individuals, and in those on various medications.

Stage-related implications of community-acquired pressure injuries for the acute medical inpatients.

To analyse the prevalence of any-stage pressure injuries at hospital admission and their impact on short-, mid- and late-term mortality. Patient characteristics associated with pressure injuries and the impact on hospital costs were also investigated. In medical patients acutely admitted to hospital, no study analysed the presence of pre-existing pressure injuries and the related short- and long-term mortality according to the overall stages of severity thereof. Retrospective cohort study following the STROBE guideline. In a population of 7217 acute medical inpatients, the presence and staging of pressure injuries were assessed at hospital admission. The impact of pressure injury on 30-, 180- and 365-day mortality was analysed by multivariate Cox regression models. The prevalence of community-acquired pressure injuries was 14.9% (stage-1: 8.1%; stage-2: 3.5%; stage-3: 1.6%; stage-4: 1.1%; unstageable: 0.5%). Hemiplegia/paraplegia, anaemia, poor functional status, high nutritional risk, clinical instability and systemic inflammatory response, but not hydration status, were found to be associated with the occurrence of stage-2-and-above pressure injuries. An increasing difference was found in Diagnosis-Related Groups (DRG) weight according to pressure injury stages. A distinct and progressively increasing risk-of-death for any-stage pressure injury was shown after 365-days. A significantly increased mortality risk for all considered time intervals was found for unstageable and stage-4 pressure injuries. In acute medical inpatients, the presence of community-acquired pressure injuries is part of a multidimensional clinical complexity. The presence and staging of pressure injuries have an independent dramatic impact on of early-to-late mortality and hospital costs. This study documented as community-acquired pressure injuries are highly prevalent and represents an independent predictor of outcomes in strict dependence of the progression of thereof stage. The presence of community-acquired pressure injuries should be interpreted as a critical marker of frailty and increased vulnerability.

The prevalence and incidence of community-acquired pressure injury: A protocol for systematic review and meta-analysis.

Background:Pressure injury (PI) is a serious problem in health care settings globally. It leads to tremendous burden both individuals and healthcare systems. Since 2008, hospital-acquired pressure injuries have been a major focus of nursing quality improvement programs within hospitals and are considered never events. However, insufficiency attention has been paid to community-acquired pressure injuries (CAPI) or pressure ulcers that occur at home or in nursing homes. The prevalence or incidence of community-acquired pressure injury has been reported but never been synthesized in a meta-analysis manner. To fill the gaps in the evidence matrix, the aims of this study are to estimate the prevalence of CAPI in the general population and to pool the overall incidence of CAPI in the general population.Methods:PubMed, Web of Science, EMBASE, CINHAL, the Cochrane Library, Chongqing VIP, and China National Knowledge Infrastructure were electronically searched to identify eligible studies updated to May 2020 to collect studies on the prevalence or incidence of community-acquired pressure injuries. Two reviewers independently will screen the literature, extracted data, and assess the risk of bias of included studies using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline. Meta-analyses of pooled weighted estimates will be calculated using random effect models with 95% CIs reported due to high heterogeneity.Results:Of the 5242 studies initially identified, of the 22 studies (total 479,761 participants) 17 reporting prevalence of community-acquired pressure injury and 5 reporting incidence were included. Other results of this study will be published in a peer-reviewed journal.Conclusion:This study will summarize the pooled estimate prevalence and incidence of community-acquired pressure injuries and the pooled estimate of frequencies of different anatomic sites.Ethics and dissemination:Ethics approval and patient consent are not required, because this study is a meta-analysis based on published studies.INPLASY registration number:INPLASY202080044

Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted With Community-Acquired Pressure Injury: A Retrospective Cohort Study.

Community-acquired pressure injuries (CAPIs) are present among approximately 3% to 8% of patients admitted to acute care hospitals. In the critical care population, little is known about hospital-acquired pressure injury (HAPI) development among patients with CAPIs because most studies exclude patients with CAPIs. The purpose of our study was to determine the incidence of HAPI development and the associated risk factors among surgical critical care patients with CAPIs. Retrospective cohort study. We used electronic health record data from adult critical care patients admitted to the surgical and cardiovascular surgical intensive care units (ICUs) at a level 1 trauma center and academic medical center between 2014 and 2018. Univariate analysis was used to compare patients with CAPIs who developed a HAPI and those who did not, as well as logistic regression analysis to identify independent risk factors for HAPIs among patients with CAPIs. Among 5101 patients admitted to 2 surgical critical care units, 167 (3%) patients were admitted with CAPIs. Hospital-acquired pressure injuries were 4 times more common among patients with CAPIs compared to patients without CAPIs. Among the 167 patients with CAPIs, 47 patients (28%) went on to also develop a HAPI, whereas in the 4934 patients without CAPIs, 352 patients (7%) went on to develop a HAPI. Findings from the multivariate logistic regression analysis (n = 151) showed that decreased serum albumin (odds ratio [OR] = 0.47; 95% confidence interval [CI], 0.25-0.85; P = .02) and excessively dry skin (OR = 2.6; 95% CI, 1.1-6.22; P = .03) were independent predictors of HAPI development among patients admitted with CAPIs. Results from our study show that patients with CAPIs are at high risk for developing a HAPI, particularly among patients with decreased serum albumin or excessively dry skin. Patients with excessively dry skin may benefit from the application of skin moisturizers.

Community acquired pressure injuries in a work-related spinal cord injury population: Problem characterization and assessment of a working solution

BackgroundTo characterize the problem of community-acquired pressure injuries (CAPIs) in a work-related spinal cord injury (SCI) population in Canada and assess the benefits of a person-centered solution. Characterization of the problem and a solution, albeit in an insured Worker's Compensation Board of British Columbia (WorkSafeBC) cohort, may inform the supply of solutions in the larger SCI population with disparate access to healthcare. MethodsFor this observational study, data on 244 WorkSafeBC clients, who received an intervention featuring pressure injury (PI) assessment between 2011 and 2015, were used to characterize the problem. Data on observed injuries, risk, referrals, and outcomes were linked to healthcare service claims. Employing an activity-based costing methodology, total expenditures on attributed services were calculated for clients with 1 or more PIs. Intervention cost and benefits from the insurer's perspective are considered. Results84 of 244 clients had 1 or more PIs at assessment, with attributed mean cost of $56,092 in 2015 Canadian dollars (CAD). Mean cost by PI severity range from $9580 to $238,736. At an intervention cost of $820,618, detection of less severe injuries provided an opportunity to prevent progression and achieve $3 million in cost avoidance. Follow-up data suggest reasonable returns. Reductions in the incidence, number, and risk of pressure injuries were also observed. ConclusionsThe analysis establishes the cost of CAPIs in a Canadian-based work-related SCI population and suggests preventative and early intervention is not only feasible but also practical. Results are relevant to decisions regarding the use of proactive prevention-based treatment models as opposed to reactive, solutions in the larger SCI population.

Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation.

To describe the prevalence and predictors of pressure injuries among older adults with limited mobility, within the first 36hr of their hospital admission in Australia. Pressure injuries are significant health, safety and quality of care issues for patients and healthcare organisations. The early implementation of the recommended pressure injury prevention international clinical practice guidelines is a way to reduce hospital-acquired pressure injuries. There is a paucity of evidence on the number of older persons who are admitted hospital with a pre-existing pressure injury. Prospective correlational study conducted in eight tertiary referral hospitals across Australia. Our sample comprised of 1,047 participants aged ≥65years with limited mobility, drawn from a larger Australian pragmatic cluster randomised trial. Using the STROBE statement, observational data were collected on participants' age, gender, presence of a pressure injury, Body Mass Index score, number of comorbidities and place of residence. These variables were analysed as potential predictors for pressure injuries within the first 36hr of hospitalisation. From our sample, 113/1047 (10.8%) participants were observed to have a pressure injury within the first 36hr of hospital admission. Age, multiple comorbidities and living in an aged care facility predicted the prevalence of pressure injury among older people within the first 36hr of hospitalisation. Our findings confirm that older adults, those with multiple comorbidities and individuals living in aged care facilities are more likely to come to hospital with a pre-existing pressure injury or develop one soon after admission. Many older patients come to hospital with a community-acquired pressure injury or develop a pressure injury soon after admission. This highlights the importance of the early detection of pressure injuries among older persons so that timely management strategies can be implemented along with the potential to reduce unnecessary financial penalties.

Pressure Injuries at Intensive Care Unit Admission as a Prognostic Indicator of Patient Outcomes.

Pressure injuries, also known as pressure ulcers, are a serious complication of immobility. Patients should be thoroughly examined for pressure injuries when admitted to the intensive care unit to optimize treatment. Whether community-acquired pressure injuries correlate with poor hospital outcomes among critically ill patients is understudied. To determine whether pressure injuries present upon admission to the intensive care unit can serve as a predictive marker for longer hospitalization and increased mortality. This study retrospectively analyzed admissions of adult patients to a 24-bed medical-surgical intensive care unit in a large level I trauma center in the northeast United States from 2010 to 2012. The association of pressure injuries with mortality and length of stay was assessed, using multivariable logistic regression and generalized linear models, adjusted for age, comorbidities, Acute Physiology and Chronic Health Evaluation III score, and other patient characteristics. Among 2723 patients, 180 (6.6%) had a pressure injury at admission. Patients with a pressure injury had longer mean unadjusted stay (15.6 vs 10.5 days; P < .001) and higher in-hospital mortality rate (32.2% vs 18.3%; P < .001) than did patients without a pressure injury at admission. After multivariable adjustment, pressure injuries were associated with a mean increase in length of stay of 3.1 days (95% CI 1.5-4.7; P < .001). Pressure injuries were not associated with mortality after adjusting for the Acute Physiology and Chronic Health Evaluation III score, but they may serve as a marker for increased risk of mortality if an Acute Physiology and Chronic Health Evaluation III score is unavailable. Pressure injuries present at admission to the intensive care unit are an objective, easy-to-identify finding associated with longer stays. Pressure injuries might have a modest association with higher risk of mortality.