Pressure Injury Stage Research Articles

A Prospective Study of Pressure Injury Healing Rate and Time and Influencing Factors in an Acute Care Setting.

To determine pressure injury (PI) healing rate and time and identify influencing factors. A prospective cohort research design was used. Data collection was performed between May 2015 and August 2018. The study participants were 77 inpatients who developed at least one PI during their stay in a university hospital. Researchers assessed participants' demographic (age, sex); physical (incontinence, activity of daily living, and nutrition status); physiologic (serum total protein, albumin, and creatinine, blood glucose, and hemoglobin levels); and disease- (diagnosis, number of comorbidities, and cardiovascular comorbidity), wound- (PI stage and size at first detection, and Pressure Ulcer Scale for Healing score), and treatment-related (IV nutrition supply and albumin infusion) factors. Across the 77 patients, 91 PIs developed. Of these, 54 (59.3%) healed with a mean healing time of 17.63 days. The healing rate was better, and the healing time was shorter for stage 2 PIs compared with unstageable or deep-tissue PIs. Factors influencing PI healing rate were number of comorbidities, cardiovascular comorbidity, incontinence, PI stage at first detection, IV nutrition supply, and mean serum creatinine level. Factors influencing PI healing time were number of comorbidities, cardiovascular comorbidity, and PI stage at first detection. To reduce hospital stays, PI-related complications, and mortality, evidence-based management strategies for PIs are needed. The findings of the present study may contribute to the development of such strategies.

Prevalence of skin pressure injury in critical care patients in the UK: results of a single-day point prevalence evaluation in adult critically ill patients

ObjectivesHospital-acquired pressure injuries (PIs) are a source of morbidity and mortality, and many are potentially preventable.DesignThis study prospectively evaluated the prevalence and the associated factors of PIs in adult critical...

Mini Nutritional Assessment Score and Visceral Proteins as Potential Predictors of Pressure Injuries in Home Care Patients With Stroke

This study aimed to determine the presence of pressure injuries and their severity based on Mini Nutritional Assessment (MNA) score and visceral protein levels in stroke patients receiving home care services. A case-control study was conducted in a case group with pressure injury (n = 54) and in a control group with no pressure injury (n = 54). The MNA scores and serum albumin and prealbumin values were significantly lower in the case group than in the control group (P < .001). There were also significant differences according to the pressure injury stages. Lower MNA score and low levels of serum albumin and prealbumin are associated with the presence of pressure injuries and increased severity of pressure injuries.

An artificial intelligence-enabled smartphone app for real-time pressure injury assessment.

The management of chronic wounds in the elderly such as pressure injury (also known as bedsore or pressure ulcer) is increasingly important in an ageing population. Accurate classification of the stage of pressure injury is important for wound care planning. Nonetheless, the expertise required for staging is often not available in a residential care home setting. Artificial-intelligence (AI)-based computer vision techniques have opened up opportunities to harness the inbuilt camera in modern smartphones to support pressure injury staging by nursing home carers. In this paper, we summarise the recent development of smartphone or tablet-based applications for wound assessment. Furthermore, we present a new smartphone application (app) to perform real-time detection and staging classification of pressure injury wounds using a deep learning-based object detection system, YOLOv4. Based on our validation set of 144 photos, our app obtained an overall prediction accuracy of 63.2%. The per-class prediction specificity is generally high (85.1%–100%), but have variable sensitivity: 73.3% (stage 1 vs. others), 37% (stage 2 vs. others), 76.7 (stage 3 vs. others), 70% (stage 4 vs. others), and 55.6% (unstageable vs. others). Using another independent test set, 8 out of 10 images were predicted correctly by the YOLOv4 model. When deployed in a real-life setting with two different ambient brightness levels with three different Android phone models, the prediction accuracy of the 10 test images ranges from 80 to 90%, which highlight the importance of evaluation of mobile health (mHealth) application in a simulated real-life setting. This study details the development and evaluation process and demonstrates the feasibility of applying such a real-time staging app in wound care management.

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

Assessment of Hyperspectral Imaging in Pressure Injury Healing.

ABSTRACTOBJECTIVETo analyze the blood oxygen concentrations (StO2) of different stages of pressure injury (PI) tissue using hyperspectral images to serve as a guideline for the treatment and care of PIs.METHODSThis study used a prospective design. A total of 30 patients with sacral PIs were recruited from the rehabilitation ward of a teaching hospital. The authors used a hyperspectral detector to collect wound images and the Beer-Lambert law to estimate changes in tissue StO2 in different stages of PI.RESULTSThe tissue StO2 of healthy skin and that of stage 1 PI skin were similar, whereas the tissue StO2 of the wound in stage 2 PIs was significantly higher than that of healthy skin and scabbed tissue (medians, 82.5%, 74.4%, and 68.3%; P < .05). In stage 3 PIs, StO2 was highest in subcutaneous tissue and adipose tissue (82.5%) and lowest in peripheral scabs (68.35%). The tissue StO2 was highest in subcutaneous tissue in stage 4 PIs, and this tissue was red in the hyperspectral spectrum. The scab-covered area of unstageable PIs had the lowest StO2 of all PI tissue types (median, 44.3%).CONCLUSIONSHyperspectral imaging provides physiologic information on wound microcirculation, which can enable better evaluation of healing status. Assessing tissue StO2 data can provide a clinical index of wound healing.

Medical device related pressure injuries in COVID-19 patients followed up in an intensive care unit

Aim: The aim of this study is to determine the prevalence of medical device-related pressure injuries in COVID-19 patients.&#x0D; Material and Method: This study was conducted with a cross-sectional and retrospective design. The data of 436 patients who were followed up and treated in the Anesthesia and Reanimation Intensive Care Unit with the diagnosis of COVID-19 disease between 11.03.2020- 31.02.2021 in a Training and Research Hospital in İstanbul were included in the study. The sample of the study consisted of 32 patients out of 436 patients who met the sampling criteria. The data obtained by retrospective reviewing of the patient records were analyzed through the "Patient Information Form" and "Pressure Injury Stage" forms.&#x0D; Results: Medical device-related pressure injury developed in 32 (7.3%) of 436 patients examined in the study on the specified dates. 90.6% of these patients were male, and the average age was 67.5. 43.7% had comorbid diseases. According to the Braden Risk Assessment Scale, 25% of these patients had medium and 71.8% high risk. Medical devices that cause pressure injury were continuous positive airway pressure mask (n=13), intubation tube (n=7), nasogastric tube (n=5), nasal cannula (n=3), gel pads (n=3), and oxygen mask (n=1).&#x0D; Conclusion: In this study, the potential factors in the study that may have led to the incidence of medical device-related pressure injury specific to COVID-19 disease include the rapid increase in the need for respiratory support, ischemia caused by this infection, and the use of prone position.

Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis.

Pressure injuries remain a serious health complication for patients and nursing staff. Evidence from the past decade has not been analysed through narrative synthesis yet. PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews/sources were screened. Risk of bias was evaluated using a slightly modified QUIPS tool. Risk factor domains were used to assign (non)statistically independent risk factors. Hence, 67 studies with 679,660 patients were included. In low to moderate risk of bias studies, non-blanchable erythema reliably predicted pressure injury stage 2. Factors influencing mechanical boundary conditions, e.g., higher interface pressure or BMI < 18.5, as well as factors affecting interindividual susceptibility (male sex, older age, anemia, hypoalbuminemia, diabetes, hypotension, low physical activity, existing pressure injuries) and treatment-related aspects, such as length of stay in intensive care units, were identified as possible risk factors for pressure injury development. Health care professionals’ evidence-based knowledge of above-mentioned risk factors is vital to ensure optimal prevention and/or treatment. Openly accessible risk factors, e.g., sex, age, BMI, pre-existing diabetes, and non-blanchable erythema, can serve as yellow flags for pressure injury development. Close communication concerning further risk factors, e.g., anemia, hypoalbuminemia, or low physical activity, may optimize prevention and/or treatment. Further high-quality evidence is warranted.

Pressure Injuries in Critical Care Patients in US Hospitals: Results of the International Pressure Ulcer Prevalence Survey.

PURPOSE:The purpose of this secondary analysis was to examine pressure injury (PI) prevalence, PI risk factors, and prevention practices among adult critically ill patients in critical care units in the United States using the International Pressure Ulcer Prevalence™ (IPUP) Survey database from 2018 to 2019.DESIGN:Observational, cohort study with cross-sectional data collection and retrospective data analysis.SUBJECTS AND SETTING:The sample comprised 41,866 critical care patients drawn from a sample of 296,014 patients in US acute care facilities who participated in the 2018 and/or 2019 IPUP surveys. The mean age among critical care patients was 63.5 years (16.3) and 55% were male. All geographic regions of the United States were represented in this sample, with the greatest percentages from the Southeast (47.5%) and Midwest (17.5%) regions.METHODS:Overall critical care PI prevalence and hospital-acquired PI (HAPI) rates were obtained and analyzed using the 2018/2019 IPUP survey database. Critical care PI risk factors included in the database were analyzed using frequency distributions. Prevention practices among critically ill patients were analyzed to evaluate differences in practices between patients with no PIs, superficial PIs (stage 1, stage 2), and severe PIs (stage 3, stage 4, unstageable, deep tissue pressure injury).RESULTS:The overall PI prevalence for critical care patients was 14.3% (n = 5995) and the overall HAPI prevalence was 5.85% (n = 2451). In patients with severe HAPIs, the most common risk factors were diabetes mellitus (29.5%), mechanical ventilation (27.6%), and vasopressor agents (18.9%). Significant differences between patients with no PIs as compared to those with superficial or severe HAPIs (P = .000) for all prevention practices were found.CONCLUSIONS:Study findings support the gaps elucidated in previous critical care studies on PI development in this population. The 2 most persistent gaps currently challenging critical care practitioners are (1) accurate risk quantification in this population and (2) the potential for unavoidability in PI development among critically ill patients.

Pressure Injury Prevalence in Acute Care Hospitals With Unit-Specific Analysis: Results From the International Pressure Ulcer Prevalence (IPUP) Survey Database.

The purpose of this study was to determine overall pressure injury (PI) prevalence and hospital-acquired pressure injury (HAPI) prevalence in US acute care hospitals. Additionally, analysis of patient characteristics associated with HAPIs will be presented. Observational, cross-sectional cohort study. An in-depth analysis of data was performed from the International Pressure Ulcer Prevalence™ (IPUP) Survey database for years 2018-2019 that included 296,014 patients. There were 914 participating US acute care facilities in 2018 and 887 in 2019. Overall PI prevalence and HAPI prevalence over time were also examined for 2006-2019 acute care data from 2703 unique facilities (1,179,108 patients). Overall PI prevalence and HAPI prevalence were analyzed from the 2006-2019 IPUP survey database. Recent data for 2018-2019 PI prevalence are reported separately for medical-surgical, step-down, and critical care unit types. PI stages, anatomic locations, Braden score associated with HAPIs, and body mass index were analyzed. Overall PI prevalence and HAPI prevalence data declined between 2006 and 2019; however, the prevalence plateaued in the years 2015-2019. Data from 2018 to 2019 (N = 296,014) showed that 26,562 patients (8.97%) had at least one PI and 7631 (2.58%) had at least one HAPI. Patients cared for in medical-surgical inpatient care units had the lowest overall PI prevalence (7.78%) and HAPI prevalence (1.87%), while critical care patients had the highest overall PI prevalence (14.32%) and HAPI prevalence (5.85%). Critical care patients developed more severe PIs (stage 3,4, unstageable, and deep-tissue pressure injuries [DTPIs]), which were proportionally higher than those in the step-down or medical-surgical units. The sacrum/coccyx anatomic location had the highest overall PI prevalence and HAPI prevalence, except for DTPIs, which most common occurred on the heel. Overall and HAPI prevalence has plateaued 2015-2019. Prevalence of HAPIs, especially in critical care units, remain high. While medical advancements have improved survival rates among critically ill patients, survival may come with unintended consequences, including PI development.

Surgical treatment of pressure injuries in children: A multicentre experience.

Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas. They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1–17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum (6/18 patients), lower limb (3/18 patients), thoracic spine (2/18 patients), ischium (3/18 patients, bilateral in one patient), temporal area (3/18 patients), hypogastrium (1/18 patients) and were associated to medical devices in three cases. Flaps were followed for a minimum of 19 months and up to 13 years. Only two patients developed true recurrences that were treated again surgically. Pressure injuries are infrequent in children and rarely need surgical treatment. Pedicled flaps have a high success rate. Recurrences, contrary to what is reported in the literature, were rare.

Predicting the different progressions of early pressure injury by ultraviolet photography in rat models.

Early pressure injury (PI) can result in either spontaneous healing (SH) or deterioration into ulcer (DU). However, determining whether PI will progress into SH or DU on the basis of non‐blanchable erythema only is difficult. In this study, we constructed two animal PI models to mimic SH and DU injuries and observed haemorrhage by using ultraviolet (UV) photography to develop potential clinical indicators for predicting the progression of early PI. Macroscopy, UV photography, and skin temperature observations were obtained. In the SH group, macroscopic observation showed the erythema was obvious at 0.5 hours after decompression and faded gradually had almost disappeared at 72 hours. In the DU group, the erythema persisted, and an erosion appeared at 24 hours after decompression and expanded at 36 hours. The erythema developed into an obvious ulcer at 48 hours and enlarged at 72 hours. The obvious ulcer found at 48 hours through macroscopic observation was clearly visible at 36 hours with UV photography, and a significant difference in grey values between the two groups was found at as early as 18 hours (P < .05). This study provided evidence showing that UV photography can predict the different progression stages of early PI. Additionally, when combined with the transparent disc method, UV photography also can be used to identify the circulatory disorders of early PI, such as haemorrhage or hyperaemia and even congestion.

Classification of Pressure Injury Stages and Skin Damage Photographs by RNs and Nursing Students in Spain: An Observational Comparison Study.

The purpose of this study was to evaluate and classify pressure injuries (PIs) and other skin lesions according to the judgment of hospital-based RNs and nursing students who recently trained in wound care using photographs and comparing findings to those of wound care experts. Cross-sectional observational survey. RNs working at Manacor Hospital, Mallorca, Spain, and third-year nursing students from the University of the Balearic Islands. Data were collected in June 2017. The survey instrument was accompanied by a set of 24 photographs in 7 categories of skin lesions, such as PIs or moisture-associated skin damage, which the respondents were asked to classify. Descriptive analysis of the classifications was carried out, and levels of agreement using the chi-square test were compared with evaluations/classifications of a panel of experts. In total, 314 surveys (199 RNs and 115 students) were included in the analyses. Findings showed a wide variability among participants with levels of agreement, with expert opinion ranging from 91.4% to 15.61%. The levels of agreement were substantially lower for unstageable PIs (47.92%), those caused by moisture (53.50%), and mixed etiology (38.37%) than for stages 1-4 PIs. Of note, 62.12% of RNs had not received PI training or continuing education during the previous 2 years. This lack of education was statistically significantly associated with the accuracy of the classification made by the RNs for some of the photographs evaluated such as moisture-associated skin damage. We found discrepancies in the classification of PIs and other wounds/lesions among experts, RNs, and students. The regular provision of up-to-date information in training and continuing education programs is imperative to maintain nurses' abilities to identify and classify PIs and other skin-related damage.

118. Reduction of facial pressure injuries after prone positioning in spine surgery: a multidisciplinary approach

<h3>BACKGROUND CONTEXT</h3> Spine surgery requiring prone positioning subjects the skin to friction, shear, moisture, and pressure. These factors increase the risk of facial pressure injuries. Prone positioning for thoracolumbar spine surgery allows the surgeon access to the dorsal spine and is the most common positioning method. Facial pressure injury must be carefully considered during prone positioning with pressure sore rates reported between 5%-66%. These injuries may result in longer hospital stays, patient morbidity and increased health care costs. Literature addressing facial pressure injury prevention strategies during prone spinal surgery is limited. <h3>PURPOSE</h3> The purpose of this study was to assess the efficacy of a multidisciplinary-derived pressure ulcer prevention bundle intended to prevent facial pressure injuries during prone spinal surgery. <h3>STUDY DESIGN/SETTING</h3> Review of pre- and postintervention consecutive cases. <h3>PATIENT SAMPLE</h3> Patients undergoing prone spinal surgery between November 2018 and August 2020. <h3>OUTCOME MEASURES</h3> Total case volume, pre- and postintervention monthly case volumes, total and monthly facial pressure ulcer rates. <h3>Methods</h3> A multidisciplinary group at a quaternary academic medical center developed a plan to address facial pressure injuries. The group reviewed institutional baseline facial pressure injury data and a literature review was conducted for previously studied prevention techniques. A pressure injury prevention bundle was developed including the following elements: (1) prophylactic placement of silicone foam dressings on the chin and forehead, (2) use of a contoured foam head positioner, and (3) application of a skin barrier wipe prior to securing the endotracheal tube with tape. A preoperative baseline skin assessment was performed. Postoperative pressure injury staging was assessed on our inpatient unit postoperatively. Monthly ulcer rates were calculated by dividing the number of pressure injuries by the monthly case volume. Differences in monthly ulcer rates were evaluated between intervention groups. A cross-tabulation of intervention group versus presence/absence of an ulcer was performed and an odds ratio of ulcer occurrence was calculated. <h3>Results</h3> Intervention compliance was greater than 90% within 1 week of bundle implementation. There were 22 total months of data reviewed with 2,331 total prone spinal procedures. Mean cases per month for the entire period was 106.0±23 (range 20-127). There were no significant differences in mean cases per month between intervention groups (P>0.05). There were 17 total facial ulcers encountered across all 2,331 cases (0.73%). There were 15/992 (1.50%) total ulcers in the preintervention group and only 2/1339 (0.15%) ulcers in the postintervention group. Monthly ulcer rates were calculated and displayed a non-normal distribution. The median monthly ulcer rate was significantly lower in the postintervention vs the preintervention group (0.000% vs 0.820%, P=0.021). Cross-tabulation of the intervention group vs presence/absence of an ulcer revealed a 10.1x higher odds of sustaining an ulcer in the preintervention group (odds ratio 10.1; 95% confidence interval 2.3-44.2). <h3>Conclusions</h3> Utilizing a standardized pressure injury prevention bundle during prone spinal surgery reduces the occurrence of facial pressure injuries. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Examining the Concordance in the Documented Pressure Injury Site, Stage, and Count in Medical Information Mart for Intensive Care-III.

This study aimed to compare the concordance of pressure injury (PI) site, stage, and count documented in electronic health records (EHRs); explore if PI count during each patient hospitalization is consistent based on PI site or stage count in the diagnosis or chart event records; and examine if discrepancies in PI count were associated with patient characteristics. Hospitalization records with the International Classification of Diseases ninth edition (ICD-9) codes, chart events from two systems (CareVue, MetaVision), and clinical notes on PI were extracted from the Medical Information Mart for Intensive Care (MIMIC)-III database. PI site and stage counts from individual hospitalization were computed. Hospitalizations with the same or different counts of site and stage according to ICD-9 codes (site and stage), CareVue (site and stage), or MetaVision (stage) charts were defined as consistent or discrepant reporting. Chi-squared, independent t-, and Kruskal-Wallis tests were examined if the count discrepancy was associated with patient characteristics. ICD-9 codes and charts were also compared for people with one site or stage. A total of 31,918 hospitalizations had PI data. Within hospitalizations with ICD-9-coded sites and stages, 55.9% reported different counts. Within hospitalizations with CareVue charts on PI, 99.3% reported the same count. For hospitalizations with stages based on ICD-9 codes or MetaVision chart data, only 42.9% reported the same count. Discrepancies in counts were consistently and significantly associated with variables including PI recording in clinical notes, dead/hospice at discharge, more caregivers, longer hospitalization or intensive care unit stays, and more days to first transfer. Discrepancies between ICD-9 code and chart values on the site and stage were also reported. Patient characteristics associated with PI count discrepancies identified patients at risk of having discrepant PI counts or worse outcomes. PI documentation quality could be improved with better communication, care continuity, and integrity. Clinical research using EHRs should adopt systematic data quality analysis to inform limitations.

A Fully Automated Pulsating Support System for Pressure Injury Prevention and Treatment in 10 Belgium Nursing Homes: An Observational Study.

We studied pressure injury (PI) stage II-IV cumulative incidence and the change of PI status in the sacral area of nursing home residents associated with the use of a fully automated pulsating support system air mattress in use for 30 days. We also assessed caregivers', residents', and their family members' experiences and perceptions of mattress comfort and other factors such as pain. Multicenter cohort study. A convenience sample of 40 residents residing in 10 Belgian nursing homes was recruited. Pressure injury classification was confirmed using the European Pressure Ulcer Advisory Panel classification system. The Pressure Ulcer Scale for Healing (PUSH) tool was used to assess and measure PI status change. A comfort assessment was performed at end of the study. Cumulative PI incidence of stages II-IV was calculated, and frequencies and percentages were used to describe the results of the comfort assessments. Residents were allocated to the prevention group (n = 22) and to the treatment group (n = 18). The cumulative PI incidence was 4.5% (n = 1/22) in the prevention group. In the treatment group, the mean score on the PUSH tool decreased from 9.36 to 7.70 during the observation period, indicating an overall improvement. Four of the existing PIs healed, 17 PIs remained stable, and 1 PI deteriorated. The comfort questionnaires were completed by 76 nursing home caregivers, 21 family members, and 11 residents in the 10 participating nursing homes; the mattress comfort was perceived as very good, and pain was noted to decrease. Low cumulative PI incidence findings were observed with use of the mattress for the prevention of PIs and resulted in improvements in existing PIs, results which are consistent with several existing studies. The majority of the caregivers, residents, and family members evaluated the mattress as comfortable. Future research is needed to corroborate findings in larger randomized clinical trials.

An innovative approach to teaching pressure injury staging

Ericka Rooney is a home health nurse at UC Davis Home Health Services in Sacramento, Calif. The author has disclosed no financial relationships related to this article.

Disinfection capabilities of a 222 nm wavelength ultraviolet lighting device: a pilot study.

To demonstrate the efficacy of the SafeZone UVC (Ushio Inc., Japan) 222 nm ultraviolet C (UVC) light to reduce bacterial burden in pressure ulcers (PUs) in human patients. This research is the first human clinical trial using 222 nm UVC in eradicating bacteria in human wounds. Patients with Stage 2 or 3 (as defined by the revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System) sacral or gluteal pressure ulcers (PUs) were subjected to four sessions of 222 nm UVC light therapy over two weeks. Pre- and post-UVC therapy, wound cultures were taken and quantitative analysis of bacterial colony forming units (CFU) were performed. A total of 68 UV light sessions across 16 different patients were conducted. Of these sessions, 59 (87.0%) sessions showed a reduction in CFU counts, with 20 (29.4%) showing complete eradication of bacteria. Bacteria identified included meticillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella Pneumoniae. The overall median reduction in CFU of the 68 sessions was 78.9%. No adverse events were reported in any of the UV sessions. In this study, 222 nm UVC light was safe and effective in reducing bacterial CFU counts in sacral and gluteal PUs across numerous different species of bacteria.

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.

“Sem Pressão”: application with guidelines for identification, staging and prevention of pressure injuries

Objective: develop an application with guidance on the identification, staging and prevention of pressure injuries in adults. Method: the descriptive method used started with the search for applications in the area of pressure injuries on the Google © and Apple © platforms. Afterwards, the content was developed, based mainly on the recommendations of the National Pressure Injury Advisory Panel. A prototype was created at www.fábricadeaplicativos.com.br and sent for evaluation of form and content. Six health professionals completed a questionnaire evaluating the application and two of them suggested changes. The application was adequate to the suggestions and reassessed by three stomatherapist nurses who did not suggest changes. Results: the application was developed on the “application factory” website and named “Sem Pressão” (No Pressure), with seven tabs. Conclusion: the application was created with guidelines on identification, staging and prevention of pressure injuries in adults, and made available for free download.