Evaluation of Current Pressure Ulcer Staging

Stefanopoulos, Stavros; Qiu, Qiong; Al-Shaibani, Khalid; Bauer, Karen; Ahmed, Ayman; Nazzal, Munier; Osman, Mohamed

doi:10.1177/00031348211038574

Cited by 3 publications

(4 citation statements)

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“…Overall, most studies, including our own, demonstrate moderate reporting accuracy of PI category, with evidence suggesting that more severe PIs and unstageable PIs are identified less well. The reasons for this are unclear, although 61.6% of health professionals ( n = 88) who participated in a survey at a United States national wound care meeting felt that the current NPUAP/NPIAP PI classification system (Edsberg et al, 2016 United States update of NPUAP et al, 2014) was not easily reproducible, whilst most (58.0%) agreed it was easy to use (Stefanopoulos et al, 2021). Although participants in this study included physicians, nurse practitioners and allied health professionals, it was not clear how many were nurses.…”

Section: Discussionmentioning

confidence: 99%

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Reporting accuracy of pressure injury categorisation in an acute tertiary hospital: A four‐year analysis

Fulbrook

Lovegrove

2023

Journal of Clinical Nursing

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AimTo determine the reporting accuracy of pressure injury categorisation by bedside clinicians, compared with nurse experts.BackgroundPressure injuries are an enduring complication of hospitalisation. The categorisation of pressure injury affects treatment and management decision‐making and use of resources, and severe hospital‐acquired pressure injury incidence is used to benchmark quality of care. However, it is unclear how accurately pressure injuries are categorised by clinicians in practice.DesignSecondary analysis of hospital pressure injury incident and validation data.MethodsAll pressure injuries reported in adults between 2016 and 2019 that were subsequently validated by nurse experts were analysed. Absolute agreement is reported using percentages, with inter‐rater agreement reported using Kappa measure of agreement. The GRRAS reporting guideline was followed.ResultsOf 6186 pressure injuries that were analysed, the category was reported correctly in 67.3% (n = 4163), with an overall moderate level of inter‐rater agreement by category (Κ = .567, p < .001). Of those found to be non‐pressure injuries when validated (18.3%, n = 1129), most were reported originally as stage II (41.2%, n = 465) or stage I (30.5%, n = 344), and 13.4% (n = 151) were categorised initially as unstageable. The majority reported initially as stage I, stage II, suspected deep tissue injury or mucosal pressure injury were validated, whereas half of those reported initially as stage III or IV were validated and less than a third of those reported initially as unstageable pressure injuries were validated.ConclusionsThis study provides important insight into the accuracy of pressure injury categorisation. Whilst moderate agreement of categorisation was found between reporting clinicians and nurse experts, pressure injury differential diagnosis and categorisation of severe injuries were inadequate.Relevance to Clinical PracticeThese results may be used for benchmarking and provide a focal point for future education and practice improvement efforts.Patient or Public ContributionNeither patients nor the public were directly involved in the project.

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Section: Discussionmentioning

confidence: 99%

“…A later Korean study (Lee et al, 2016) agreed it was easy to use (Stefanopoulos et al, 2021). Although participants in this study included physicians, nurse practitioners and allied health professionals, it was not clear how many were nurses.…”

Section: Initially Reported Pressure Injury Categorymentioning

confidence: 95%

Reporting accuracy of pressure injury categorisation in an acute tertiary hospital: A four‐year analysis

Fulbrook

Lovegrove

2023

Journal of Clinical Nursing

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“…To further confirm the risk factors associated with PI, patients were divided into two groups: postoperative PI group (NPIAP stage 2 or higher) and non-PI group (NPIAP stage 1 and no PI). 6…”

Section: Methods Study Designmentioning

confidence: 99%

Prediction Model for Postoperative Pressure Injury in Patients with Acute Type A Aortic Dissection

Wang,

Feng,

et al. 2024

Adv Skin Wound Care

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OBJECTIVE To establish a risk assessment model to predict postoperative National Pressure Injury Advisory Panel stage 2 or higher pressure injury (PI) risk in patients undergoing acute type A aortic dissection surgery. METHODS This retrospective assessment included consecutive patients undergoing acute type A aortic dissection surgery in the authors’ hospital from September 2017 to June 2021. The authors used LASSO (logistic least absolute shrinkage and selection operator) regression analysis to identify the most relevant variables associated with PI by running cyclic coordinate descent with 10-times cross-validation. The variables selected by LASSO regression analysis were subjected to multivariate logistic analysis. A calibration plot, receiver operating characteristic curve, and decision curve analysis were used to validate the model. RESULTS There were 469 patients in the study, including 94 (27.5%) with postoperative PI. Ten variables were selected from LASSO regression: body mass index, diabetes, Marfan syndrome, stroke, preoperative skin moisture, hemoglobin, albumin, serum creatinine, platelet, and d-dimer. Four risk factors emerged after multivariate logistic regression: Marfan syndrome, preoperative skin moisture, albumin, and serum creatinine. The area under the receiver operating characteristic curve of the model was 0.765. The calibration plot and the decision curve analysis both suggested that the model was suitable for predicting postoperative PI. CONCLUSIONS This study built an efficient predictive model that could help identify high-risk patients.

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“…Stage IV ulcers exhibit complete skin thickness loss with extensive damage to muscle, bone, or supporting structures. Ulcers that are unstageable involve full-thickness tissue loss, where eschar or necrotic tissue obscures the extent of damage (2). The development of pressure ulcers is a complex interplay of factors such as reduced blood flow, tissue hypoxia, and cellular damage.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Serum Vitamin D Levels and its Association with Increased Risk of Pressure Ulcer among Non-Ambulatory Patients

Khan,

Amjad,

Naeem

et al. 2024

JHRR

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Background: Pressure ulcers are a significant health concern for non-ambulatory patients, often resulting from prolonged immobility. Vitamin D, recognized for its role in skin health and wound healing, may influence the development of these ulcers. This study examines the relationship between serum vitamin D levels and the prevalence of pressure ulcers in individuals unable to walk or move independently. Objective: To explore the association between serum Vitamin D levels and the risk of pressure ulcers, aiming to contribute to the literature and improve patient outcomes through evidence-based healthcare practices. Methods: A cross-sectional study was conducted at Sheikh Zayed Hospital and Bahria International Hospital, Lahore, from August 2023 to January 2024. Seventy non-ambulatory patients were recruited using a non-probability convenient sampling method. The Braden scale was employed to assess pressure ulcer severity, and serum vitamin D levels were measured through blood samples. Results: Participants had a mean age of 38.5 years (SD = 6.27) and a mean non-ambulatory duration of 13.72 days (SD = 5.22). Gender distribution was 55.7% female and 44.3% male. Historical pressure ulcer incidence was 10%. The leading reasons for hospitalization were stroke (28.6%), neuromuscular conditions (31.4%), and road traffic accidents (38.6%). A significant positive correlation was found between Braden scale scores and vitamin D levels (11.91 ± 3.40 and 11.40 ± 3.40 respectively, Pearson correlation coefficient = 0.71, p < 0.01). Conclusion: There is a significant association between low serum vitamin D levels and an increased risk of developing pressure ulcers in non-ambulatory patients, supporting the need for vigilant monitoring and management of vitamin D levels.

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Evaluation of Current Pressure Ulcer Staging

Cited by 3 publications

References 5 publications

Reporting accuracy of pressure injury categorisation in an acute tertiary hospital: A four‐year analysis

Reporting accuracy of pressure injury categorisation in an acute tertiary hospital: A four‐year analysis

Prediction Model for Postoperative Pressure Injury in Patients with Acute Type A Aortic Dissection

Evaluation of Serum Vitamin D Levels and its Association with Increased Risk of Pressure Ulcer among Non-Ambulatory Patients

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