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Craven BC, Bateman EA, Flett H, Farahani F, Wolfe DL, Askari S, Omidvar M, Alavinia M. The Changing Prevalence of Pressure Injury among Ontarians with SCI/D at Rehabilitation Admission: Opportunities for Improvement. Healthcare (Basel) 2024; 12:1084. [PMID: 38891159 PMCID: PMC11171508 DOI: 10.3390/healthcare12111084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/10/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Despite preventability, 20-50% of patients with acute spinal cord injury/disease (SCI/D) develop hospital-acquired pressure injuries (PIs). The Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC) aimed to mitigate PI risk through patient-reported daily skin checks alongside usual care. METHODS This quality improvement initiative utilized an interrupted time series design, encompassing adults ≥ 18 years admitted for inpatient rehabilitation across five Ontario sites from 2020 to 2023. Patient demographics, etiology, and impairment data were obtained from a national registry, while participating sites gathered data on PI onset, location, and severity. Run charts depicted temporal trends, and statistical analyses, including chi-square and logistic regression, compared patients with and without PIs. RESULTS Data from 1767 discharged SCI/D patients revealed that 26% had ≥1 PI, with 59% being prevalent and 41% incident. Most severe PIs (stages III and IV and unstageable) were acquired prior to admission. Process indicator fidelity was reasonable at 68%. Patients with PIs experienced longer hospital stays, lower Functional Independence Measure (FIM) changes, and FIM efficiency during rehabilitation. CONCLUSIONS PI prevalence is increasing, particularly sacral injuries at admission, while incident cases have decreased since 2021 due to regular skin checks. This trend calls for proactive health system interventions to reduce costs and improve patient outcomes.
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Affiliation(s)
- Beverley Catharine Craven
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Emma A. Bateman
- Parkwood Institute Research, St Joseph’s Health Care London, London, ON N6A 4V2, Canada; (E.A.B.); (D.L.W.)
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Heather Flett
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Farnoosh Farahani
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Dalton L. Wolfe
- Parkwood Institute Research, St Joseph’s Health Care London, London, ON N6A 4V2, Canada; (E.A.B.); (D.L.W.)
- Faculty of Health Sciences, School of Health Studies, Western University, London, ON N6A 5C1, Canada
| | - Sussan Askari
- Faculty of Physical Medicine and Rehabilitation, Providence Care Hospital, Queen’s University, Kingston, ON K7L 4X3, Canada;
| | - Maryam Omidvar
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Mohammad Alavinia
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
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Wang I, Walker RM, Gillespie BM, Scott I, Sugathapala RDUP, Chaboyer W. Risk factors predicting hospital-acquired pressure injury in adult patients: An overview of reviews. Int J Nurs Stud 2024; 150:104642. [PMID: 38041937 DOI: 10.1016/j.ijnurstu.2023.104642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries remain a significant patient safety threat. Current well-known pressure injury risk assessment tools have many limitations and therefore do not accurately predict the risk of pressure injury development over diverse populations. A contemporary understanding of the risk factors predicting pressure injury in adult hospitalised patients will inform pressure injury prevention and future researchers considering risk assessment tool development may benefit from our summary and synthesis of risk factors. OBJECTIVE To summarise and synthesise systematic reviews that identify risk factors for hospital-acquired pressure injury development in adult patients. DESIGN An overview of systematic reviews. METHODS Cochrane and the Joanna Briggs Institute methodologies guided this overview. The Cochrane library, CINAHL, MEDLINE, and Embase databases were searched for relevant articles published in English from January 2008 to September 2022. Two researchers independently screened articles against the predefined inclusion and exclusion criteria, extracted data and assessed the quality of the included reviews using "a measurement tool to assess systematic reviews" (AMSTAR version 2). Data were categorised using an inductive approach and synthesised according to the recent pressure injury conceptual frameworks. RESULTS From 11 eligible reviews, 37 risk factors were categorised inductively into 14 groups of risk factors. From these, six groups were classified into two domains: four to mechanical boundary conditions and two to susceptibility and tolerance of the individual. The remaining eight groups were evident across both domains. Four main risk factors, including diabetes, length of surgery or intensive care unit stay, vasopressor use, and low haemoglobin level were synthesised. The overall quality of the included reviews was low in five studies (45 %) and critically low in six studies (55 %). CONCLUSIONS Our findings highlighted the limitations in the methodological quality of the included reviews that may have influenced our results regarding risk factors. Current risk assessment tools and conceptual frameworks do not fully explain the complex and changing interactions amongst risk factors. This may warrant the need for more high-quality research, such as cohort studies, focussing on predicting hospital-acquired pressure injury in adult patients, to reconsider these risk factors we synthesised. REGISTRATION This overview was registered with the PROSPERO (CRD42022362218) on 27 September 2022.
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Affiliation(s)
- Isabel Wang
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Australia.
| | - Rachel M Walker
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; The Princess Alexandra Hospital, Brisbane, Australia. https://twitter.com/rachelmwalker
| | - Brigid M Gillespie
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast, Australia. https://twitter.com/bgillespie6
| | - Ian Scott
- The Princess Alexandra Hospital, Brisbane, Australia; School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | | | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia. https://twitter.com/WendyChaboyer
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Fähndrich C, Gemperli A, Baumberger M, Harder M, Roth B, Schaefer DJ, Wettstein R, Scheel-Sailer A. Risk factors of major complications after flap surgery in the treatment of stage III and IV pressure injury in people with spinal cord injury/disorder: a retrospective cohort study. Spinal Cord 2024; 62:34-41. [PMID: 38123748 PMCID: PMC10783547 DOI: 10.1038/s41393-023-00944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 10/23/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To identify risk factors associated with major complications after flap surgery in people with spinal cord injury or disorder (SCI/D) and stage III and IV pressure injury (PI). SETTING Swiss hospital specialized in the treatment of people with SCI/D using the Basel Decubitus Approach. METHODS We examined 60 risk factors for major postoperative complications in PIs over sacrum/coccyx, ischium or trochanter between 01/2016 and 12/2021. We performed descriptive analysis and computed global p-values using likelihood ratio tests adjusted for clustering of PIs in individuals. RESULTS We included 220 PI treatment procedure from 149 individuals. The study population consisted of 163 (74%) men, 133 (60%) traumatic SCI, 136 (58%) stage IV PI, 198 (90%) individuals with paraplegia, 93 (42%) with osteomyelitis, and 85 (39%) with recurrent PI. Major complications 42 (19%) occurred more often in individuals with stage IV PI (p < 0.01), individuals without osteomyelitis (p < 0.03), and individuals with pathological blood concentrations of cystatin c (p < 0.028), calcium (p < 0.048), and vitamin B12 (p < 0.0049) as well as normal blood concentrations of HbA1c (p < 0.033). Immobilization (p < 0.0089) and hospital stay (p < 0.0001) of individuals with major complications was longer. CONCLUSION In the Basel Decubitus Approach, stage IV PI, absence of osteomyelitis, reduced vitamin B12 and calcium, elevated cystatin c, and normal HbA1c should be addressed to reduce major complications.
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Affiliation(s)
- Carina Fähndrich
- Swiss Paraplegic Research, Nottwil, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Armin Gemperli
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center of Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | | | | | - Bianca Roth
- Department of Infectious diseases, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Reto Wettstein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Anke Scheel-Sailer
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Centre, Nottwil, Switzerland
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Liu H, Xie L, Xing C. Pathogenic bacteria and treatment resistance in older cardiovascular disease patients with lung infection and risk prediction model. Open Life Sci 2023; 18:20220756. [PMID: 38152575 PMCID: PMC10751996 DOI: 10.1515/biol-2022-0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 12/29/2023] Open
Abstract
This study analyzes the distribution of pathogenic bacteria and their antimicrobial susceptibilities in elderly patients with cardiovascular diseases to identify risk factors for pulmonary infections. A risk prediction model is established, aiming to serve as a clinical tool for early prevention and management of pulmonary infections in this vulnerable population. A total of 600 patients were categorized into infected and uninfected groups. Independent risk factors such as older age, diabetes history, hypoproteinemia, invasive procedures, high cardiac function grade, and a hospital stay of ≥10 days were identified through logistic regression. A predictive model was constructed, with a Hosmer-Lemeshow goodness of fit (P = 0.236) and an area under the receiver operating characteristic curve of 0.795, demonstrating good discriminative ability. The model had 63.40% sensitivity and 82.80% specificity, with a cut-off value of 0.13. Our findings indicate that the risk score model is valid for identifying high-risk groups for pulmonary infection among elderly cardiovascular patients. The study contributes to the early prevention and control of pulmonary infections, potentially reducing infection rates in this vulnerable population.
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Affiliation(s)
- Hongbo Liu
- The Municipal Hospital of Qingdao Cadre Health Section, Qingdao, Shandong 266000, China
| | - Liyan Xie
- Qingdao Municipal Hospital, Health Care Clinic, Qingdao, Shandong 266000, China
| | - Cong Xing
- Health Promotion Centre, Baoji Maternal and Child Health Care Hospital, Baoji, Shaanxi 721000, China
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Prabhu K, Nasr AJ, Kasitinon D, Cabrera A, Lin YS. Perioperative Outcomes, Comorbidities, and Complications following Total Shoulder Arthroplasty in Wheelchair Users: A Retrospective Cohort Analysis of a Nationwide Database. J Clin Med 2023; 12:5799. [PMID: 37762740 PMCID: PMC10532280 DOI: 10.3390/jcm12185799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Impaired shoulder function hinders the ability of wheelchair users to maintain independence. The current state of the literature delineates the risks and benefits of surgical techniques for the management of shoulder pathologies. To the best of our knowledge, there is no study that has investigated complications following total shoulder arthroplasty (TSA) in wheelchair users. Utilizing the PearlDiver Mariner national administrative database, 72,108 patients were identified who underwent TSA with a concurrent diagnosis of a rotator cuff tear. Two matched cohorts, one of wheelchair users and one of non-wheelchair users, were created. Due to limitations within PearlDiver, one-year outcomes, including comorbidity and complication rates and readmission statistics, were compared between the two cohorts. Each matched cohort of 869 patients underwent TSA with a concurrent diagnosis of a rotator cuff tear. The rate of readmission in wheelchair users was greater than in non-wheelchair users (24.05% vs. 9.55%, OR: 3.00, CI: 2.279, 3.946). Patients in the wheelchair cohort exhibited higher rates of complications and comorbidities (p < 0.001). Among the most likely to be readmitted after TSA were patients with osteoarthritis, pulmonary heart disease, rheumatoid arthritis, and hypertension (p < 0.05). Significant differences in surgical outcomes existed between wheelchair and non-wheelchair users in terms of preoperative comorbidities, postoperative complications, and readmission rates.
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Affiliation(s)
- Kevin Prabhu
- UT Southwestern Medical Center, Medical School, Dallas, TX 75390, USA
| | - Andrew J. Nasr
- Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Donald Kasitinon
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Alison Cabrera
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Yen-Sheng Lin
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
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Neuhauser C, Sailer CO, Najmanova K, Baumberger M, Paez-Granados D, Schaefer DJ, Wettstein R, Scheel-Sailer A. Risk constellation of hospital acquired pressure injuries in patients with a spinal cord injury/ disorder - focus on time since spinal cord injury/ disorder and patients' age. Spinal Cord 2023; 61:453-459. [PMID: 37407644 DOI: 10.1038/s41393-023-00910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES The aim of this study was to evaluate how time since spinal cord injury/disorder (SCI/D) and patients' age influence risk constellation for hospital acquired pressure injuries (HAPI) in patients with a SCI/D. SETTING Acute care and rehabilitation clinic specialized in SCI/D. METHODS We collected patients' characteristics and 85 risk factors for HAPI development in adults with SCI/D with at least one HAPI during their inpatient stay between August 2018 and December 2019. We analyzed patients' characteristics and HAPI risk factors using descriptive statistics according to time since SCI/D ( < 1 year, 1-15 years, > 15 years) and patients' age (18-35 years, 35-65 years, > 65 years). RESULTS We identified 182 HAPI in 96 patients. Comparing patients with SCI/D < 1 year with the other groups, autonomic dysreflexia (p < 0.001), abnormal body temperature (p = 0.001), hypertensive episode (p = 0.005), and pneumonia (p < 0.001) occurred more frequently; mean hemoglobin (p < 0.001), albumin (p = 0.002) and vitamin D levels (p = 0.013) were significantly lower, and patients with time since SCI/D < 1 year scored fewer points (10-12) on the Braden Scale (p < 0.001). Comparing groups per patients' age, only the SCIPUS score was higher in patients > 65 years compared to the other two groups (p = 0.002). CONCLUSIONS Different risk factor constellation seem to be underlying HAPI development with more differences in patients time since SCI/D than patients' age. Awareness of these differences in risk factor constellation depending on time since SCI/D in these patients might lead to different HAPI prevention strategies. SPONSORSHIP The study team didn't receive any additional sponsorship.
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Affiliation(s)
| | - Clara O Sailer
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Department of Clinical Research, University of Basel, Basel, Switzerland
| | | | | | - Diego Paez-Granados
- SCAI-Lab, Department of Health Science and Technology, ETH Zürich, Zürich, Switzerland
| | - Dirk Johannes Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Reto Wettstein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Balasuberamaniam P, Wasim A, Shrikumar M, Chen T, Anthony T, Phillips A, Nathens A, Chapman M, Crawford E, Schwartz CE, Finkelstein J. Predictors of hospital-acquired pressure injuries in patients with complete spinal cord injury: a retrospective case-control study. BMC Musculoskelet Disord 2023; 24:329. [PMID: 37101130 PMCID: PMC10131324 DOI: 10.1186/s12891-023-06369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Despite current best practices, pressure injuries (PI) remain a devastating and prevalent hospital-acquired complication for patients with acute traumatic spinal cord injuries (SCIs). This study examined associations between risk factors for PI development in patients with complete SCI, such as norepinephrine dose and duration, and other demographic factors or lesion characteristics. METHODS This case-control study included adults with acute complete SCIs ASIA-A, who were admitted to a level-one trauma center between 2014-18. A retrospective review was implement using data on patient and injury characteristics, including age, gender, level of SCI (cervical vs. thoracic), Injury Severity Score (ISS), length of stay (LOS) and mortality; presence/absence of PI during their acute hospital stay; and treatment factors such as spinal surgery, mean arterial pressure (MAP) targets, and vasopressor treatment. Multivariable logistic regression evaluated associations with PI. RESULTS Eighty-two out of 103 eligible patients had complete data, and 30 (37%) developed PIs. Patient and injury characteristics, including age (Mean: 50.6; SD:21.3), location of SCI (48 cervical, 59%) and ISS (Mean 33.1; SD:11.8), did not differ between PI and non-PI groups. Logistic regression analysis revealed that male gender (OR:34.1; CI95:2.3-506.5, p = 0.010) and increased LOS (log-transformed; OR:20.5, CI95:2.8-149.9, p = 0.003) were associated with increased risk of PI. Having an order for a MAP > 80mmg (OR:0.05; CI95:0.01-0.30, p = 0.001) was associated with a reduced risk of PI. There were no significant associations between PI and duration of norepinephrine treatment. CONCLUSIONS Norepinephrine treatment parameters were not associated with development of PI, suggesting that MAP targets should be a focus for future investigations for SCI management. Increasing LOS should highlight the need for high-risk PI prevention and vigilance.
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Affiliation(s)
| | - Abeer Wasim
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mopina Shrikumar
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tan Chen
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tracey Anthony
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrea Phillips
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Avery Nathens
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Martin Chapman
- Critical Care Medicine and Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Eric Crawford
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Carolyn E Schwartz
- DeltaQuest Foundation, 31 Mitchell Road, Concord, MA, 01742, USA.
- Departments of Medicine and Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA.
| | - Joel Finkelstein
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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