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

Abstract

Aims: 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.

Background: 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.

Design: Retrospective cohort study following the STROBE guideline.

Methods: 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.

Results: 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.

Conclusions: 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.

Relevance to clinical practice: 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.

Keywords: Comorbidity; DRG weight; hydration; inflammation; mortality; nursing; nutrition; pressure injuries; stages.