International Journal of Advanced Culture Technology

The International Promotion Agency of Culture Technology (국제문화기술진흥원)
권호 표지
DOI QR코드

DOI QR Code

Hospital-Acquired Pressure Injury: Clinical Characteristics and Outcomes in Critical Care

  • Received : 2019.04.15
  • Accepted : 2019.05.25
  • Published : 2019.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Electronic health records (EHRs) enable us to use and re-use electronic data for various multiple purposes, such as public reporting, quality improvement, and patient outcomes research. Current hospital-acquired pressure injury (HAPI) risk assessment instruments have not been specifically developed for intensive care unit (ICU) patients and showed false positive rates in this specific populations. Previous research studies report a number of risk factors; however, it is still not clear what factors influence ICU HAPI in this population. As part of a larger research study, we performed an exploratory analysis by using a large electronic health record data. The aims of this study were to compare characteristics of patients who developed HAPIs during their ICU stay with those who did not, and to determine whether the two groups were different in the aspects of length of ICU stay, discharge disposition, and discharge destinations. We conducted chi-square test and t-test for group comparison. Association was examined by using bivariate analyses. Pearson correlation coefficients were used to examine correlation between LOS and number of medications. Our findings suggest a number of consistent and potentially modifiable risk factors, such as sedation, feeding tubes, and the number of medications administered. The mortality of the HAPI group was significantly higher than the non-HAPI group in our data. Discharge disposition was significantly different between the groups. 67% of the HAPI group transferred to intermediate or long-term care hospitals whereas 57.7% of the non-HAPI group went home after discharge. Awareness of these risk factors can lead to clinical interventions that can be preventative in the ICU setting.

Keywords

E1GMBY_2019_v7n2_28_f0001.png 이미지

Figure 1. Comparison between HAPIs and non-HAPIs

E1GMBY_2019_v7n2_28_f0002.png 이미지

Figure 2. Comparison between HAPIs and non-HAPIs

Table 1. Comparison of clinical characteristics between the HAPI and non-HAPI groups

E1GMBY_2019_v7n2_28_t0001.png 이미지

Table 2. Comparison of outcomes between the HAPI and non-HAPI groups

E1GMBY_2019_v7n2_28_t0002.png 이미지

References

  1. Hripcsak G, Friedman C, Alderson PO, DuMouchel W, Johnson SB, Clayton PD. Unlocking Clinical Data from Narrative Reports: A Study of Natural Language Processing. Ann Intern Med 1995, 122(9):681-688. PMID: 7702231 https://doi.org/10.7326/0003-4819-122-9-199505010-00007
  2. National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury. http://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-interminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-injury/
  3. Lima Serrano M, Gonzalez Mendez M, Carrasco Cebollero F, Lima Rodríguez J. Risk factors for pressure ulcer development in Intensive Care Units: A Systematic review. Med Intensiva 2017, 41(6):339-346. doi: 10.1016/j.medin.2016.09.003.
  4. Tayyib N, Coyer F, Lewis P. Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: a prospective cohort study. Int Wound J 2016, 13(5):912-919. doi: 10.1111/iwj.12406.
  5. Alderden J, Rondinelli J, Pepper G, Cummins M, Whitney J. Risk factors for pressure injuries among critical care patients: A systematic review. Int J Nurs Stud Epub 2017 Mar 28, 71:97-114. doi: 10.1016/j.ijnurstu.2017.03.012.
  6. Rao A, Preston A, Strauss R, Stamm R, Zalman D. Risk Factors Associated With Pressure Ulcer Formation in Critically Ill Cardiac Surgery Patients: A Systematic Review. J Wound Ostomy Continence Nurs 2016, 43(3):242-247. doi: 10.1097/WON.0000000000000224.
  7. Kaewprag P, Newton C, Vermillion B, Hyun S, Huang K, Machiraju R. Predictive models for pressure ulcers from intensive care unit electronic health records using Bayesian networks. BMC Med Inform Decis Mak 2017, 17(Suppl 2):65. doi: 10.1186/s12911-017-0471-z.
  8. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: A practical scale. Lancet 1974, 304(81-84). PMID: 4136544. https://doi.org/10.1016/S0140-6736(74)91639-0
  9. Category Names, Results, and Descriptions https://druginfo.nlm.nih.gov/drugportal/drug/categories
  10. Bly D, Schallom M, Sona C, Klinkenberg D. A Model of Pressure, Oxygenation, and Perfusion Risk Factors for Pressure Ulcers in the Intensive Care Unit. Am J Crit Care 2016, 25(2):156-164. doi: 10.4037/ajcc2016840.
  11. Lyder CH, Wang Y, Metersky M, Curry M, Kliman R, Verzier N, Hunt D. Hospital-acquired pressure ulcers: results from the national Medicare Patient Safety Monitoring System study. J Am Geriatr Soc 2012, 60(9):1603-1608. doi: 10.1111/j.1532-5415.2012.04106.x.