Pressure ulcer risk in hip fracture patients

Houwing, Ronald H; Rozendaal, Marja; Wouters-Wesseling, W.; Buskens, Erik; Keller, Paul M.; Haalboom, J. R. E.

doi:10.1080/00016470410001132-1

Cited by 40 publications

(27 citation statements)

References 5 publications

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“…There are only two studies published in the last 10 years in which pressure ulcers stage 2 and higher were identified by clinical examination of hip fracture patients, as in the current study. The incidence in these studies was 20% (n=121) 34 and 24% (n=45), 35 somewhat higher than in the current study. These results may not be comparable because these studies were done in Europe, and in at least one of them, 35 the mean hospital stay was much longer than in the current study.…”

Section: Discussioncontrasting

confidence: 72%

Pressure Ulcers in Elderly Patients with Hip Fracture Across the Continuum of Care

Baumgarten

Margolis

Orwig

et al. 2009

J American Geriatrics Society

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Objectives The aim of this study was to identify care settings associated with increased pressure ulcer risk among elderly hip fracture patients in the post-fracture period. Design Prospective cohort study. Setting Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged. Participants Hip fracture patients age ≥65 years who underwent surgery for hip fracture. Measurements A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed ≥1 new pressure ulcers stage 2 or higher following hospital admission. Results Among 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). Compared to home, the adjusted APU incidence rate was highest during the initial acute hospital stay (relative rate [RR] 2.2, 95% confidence interval [CI] 1.3–3.7) and during re-admission to the acute hospital (RR 2.2, 95% CI 1.1–4.2). The relative rates in rehabilitation and nursing home settings were 1.4 (95% CI 0.8–2.3) and 1.3 (95% CI 0.8–2.1), respectively. Conclusion Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare’s policy of not reimbursing hospitals for the treatment of hospital-acquired pressure ulcers. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals.

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Section: Discussioncontrasting

confidence: 72%

Pressure Ulcers in Elderly Patients with Hip Fracture Across the Continuum of Care

Baumgarten

Margolis

Orwig

et al. 2009

J American Geriatrics Society

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“…The care‐related factor that has received the most attention is interval from hospital admission to surgery. Most studies found a positive association between surgical delay and HAPU occurrence, as in the current study, although three studies found no association, and one found a negative association . There was no association between HAPU occurrence and duration of surgery in two studies, which is consistent with the current study, although surgery duration was positively associated with PU occurrence in three studies and negatively associated in one study .…”

Section: Discussionsupporting

confidence: 87%

Care‐Related Risk Factors for Hospital‐Acquired Pressure Ulcers in Elderly Adults with Hip Fracture

Baumgarten¹,

Rich²,

Shardell³

et al. 2012

J American Geriatrics Society

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OBJECTIVES To identify care-related factors associated with increased incidence of hospital-acquired pressure ulcers (HAPU) DESIGN Prospective cohort study SETTING Nine hospitals in Baltimore Hip Studies network PARTICIPANTS 658 patients age ≥65 years who underwent surgery for hip fracture MEASUREMENTS Skin examinations at baseline and alternating days until hospital discharge. Patients were deemed to have a HAPU if they developed ≥1 new pressure ulcers stage 2 or higher during the hospital stay. RESULTS Longer emergency department stays were associated with lower HAPU incidence (>4-6 hours: adjusted incidence rate ratio [aIRR] 0.68, 95% confidence interval [CI] 0.48-0.96; >6 hours: aIRR 0.68, 95% CI 0.46-0.99, both compared to ≤4 hours). Patients with ≥24 hours between admission and surgery had a higher post-surgery HAPU rate than those with <24 hours (aIRR 1.62, 95% CI 1.24-2.11). Surgery with general anesthesia had a lower post-surgery HAPU rate than surgery with other types of anesthesia (aIRR 0.66, 95% CI 0.49-0.88). There was no significant association of HAPU incidence with timing or type of transport to hospital, or surgery duration. CONCLUSION Most of the factors hypothesized to be associated with higher pressure ulcer incidence were either associated with lower incidence or were not significantly associated, suggesting that HAPU development may not be as sensitive to care-related factors as commonly believed. Rigorous studies of innovative preventive interventions are needed to inform policy and practice.

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“…Our study has shown that some diagnoses, such as neurological diseases, previous stroke and traumas are associated with a condition at risk for PUs, which is in agreement with the results of recent studies. In a survey carried out in Sweden, 53% of 121 patients accepted for femur fracture developed an ulcer before discharge (Houwing et al. 2004).…”

Section: Discussionmentioning

confidence: 99%