Predictive Factors for Pressure Ulcers in an Older Adult Population Hospitalized for Hip Fractures: A Prognostic Cohort Study

Abstract

BackgroundOlder adult patients with fragility hip fractures constitute a population at high risk for complications, in particular pressure ulcers. The aim was to evaluate the incidence of pressure ulcers and potential predictive factors.Methods and FindingsA prospective multicentric prognostic cohort study in orthopedic wards in three Italian public hospitals. Participants were all consecutive patients 65 years of age or older diagnosed with a fragility hip fracture. Outcomes were incidence of pressure ulcers. The exposure variables were grouped into three macro areas in order to facilitate reading: “intrinsic” variables, “extrinsic” variables and variables linked to the organization of patient care. One thousand eighty-three older adult patients with fragility hip fractures were enrolled from October 1st, 2013 to January 31st, 2015, and pressure ulcers developed in 22.7%. At multivariate analysis, the following were found to be risk factors: age> 80 years (odds ratio (OR) 1.03; p = 0.015), the length of time a urinary catheter was used (OR 1.013; p<0.001), the length of time pain was present (OR 1.008; p = 0.008), the absence of side rails on the bed (OR 1.668; p = 0.026) and the use of a foam position valve (OR 1.025; p<0.001). Instead, the protective factors were the presence of a caregiver for at least half a day daily (OR 0.994; p = 0.012) and the number of positionings during the postoperative period (OR 0.897; p = 0.008).ConclusionsThe study allowed the identification of the patients most at risk for developing pressure ulcers, and the construction of a pragmatic predictive model using significant risk or protective factors in order to reduce the number of pressure ulcers.

The prevalence, incidence, and associated factors of pressure injuries among immobile inpatients: A multicentre, cross‐sectional, exploratory descriptive study in China

“…The higher percentage of Stage 1 PIs in the present study may indicate, to some extent, timely assessments and early detection of changes in skin status. Our findings contrasted with the conclusion of several previous studies that Stages 2 and 3 are the most common PI stages …”

“…This study has shown that the risk of PIs was higher for people aged over 65 years than for those aged 18 to 65 years. This result was consistent with the majority of published findings, which have shown a higher risk of PI at older age . However, Wielen et al and Magny et al found no significant association between age and the occurrence of PIs.…”

“…This study reported a period PI prevalence of 3.38% (calculated as 810/23985) and a PI cumulative incidence of 1.23% (calculated as 296/23985). Most previous research has focused on a specific group of patients with restricted mobility, such as ICU patients (PI prevalence: 8.8%–39.3%; PI incidence: 1%–56%), patients diagnosed with spinal cord injuries (PI prevalence: 26.4%–29.7%, PI incidence: 9.6%–49.2%), or elderly individuals with a hip fracture (PI prevalence: 12%–22.7%) . The prevalence and incidence found in the present study was lower than those reported in the literature.…”

“…Most previous research has focused on a specific group of patients with restricted mobility, such as ICU patients (PI prevalence: 8.8%-39.3%; PI incidence: 1%-56%), 16,[25][26][27][28] patients diagnosed with spinal cord injuries (PI prevalence: 26.4%-29.7%, PI incidence: 9.6%- 49.2%), 14,29,30 or elderly individuals with a hip fracture (PI prevalence: 12%-22.7%). 20,31,32 The prevalence and incidence found in the present study was lower than those reported in the literature. This difference may be related to significant variations in PI prevention practices across settings, and the methodologies used to collect prevalence data, which makes it impossible to compare PI prevalence.…”

“…Our findings contrasted with the conclusion of several previous studies that Stages 2 and 3 are the most common PI stages. 3,32 In relation to PI location, about one third (31.33%) of PIs occurred in the sacrum/coccyx area, and 16.89% occurred in the heel. The sacrum/coccyx and heel were identified in the present study as the two most common anatomical areas for PIs to appear, which is consistent with findings from the literature.…”