Prevalence of Pressure Injuries Nationwide from 2009 to 2015: Results from the National Inpatient Sample Database in Korea

Socio-economic and environmental factors associated with community-acquired pressure injuries: A mixed method study

AIMS

To: (1) report on the prevalence of community-acquired pressure injuries (CAPIs) in patients admitted into the acute care setting; (2) examine the socio-economic and home environment associated with CAPIs; and (3) understand the challenges of caring for patients with CAPIs at home.

METHODS

This mixed-method study recruited patients admitted with CAPIs in the acute care hospital between March 2021 to June 2022. The hospital's pressure injury (PI) database was used to screen patients admitted with CAPIs. A purposive sample of CAPI patients and their caregivers participated in this study. A cross-sectional survey study was first performed to examine the prevalence of CAPIs and the socio-economic and home environment factors. Semi-structured interviews were conducted to understand the caregivers' challenges in caring for patients with CAPIs at home.

RESULTS

The CAPI prevalence was reported at 1.1 % during the study period (1039 had CAPIs out of 97 912 patients admitted to the hospital). A total of 70 caregivers and patients consented to participate in the study. The mean age of patients was 84.2 (SD = 10.4) years old; 68.6 % (n = 48) were females. Majority presented with a deep tissue injury (DTI) (37.1 %; n = 26) or unstageable PI (31.4 %; n = 22). More than half of the patients had alternating air mattresses at home (54.3 %; n = 38), and only 10 % (n = 7) had positioning wedges and used a sliding sheet for turning. The mean age of the caregivers was 43.4 years old (SD = 13.1), and 84.3 % (n = 59) were female. Continuous data were summarised using means and standard deviations, and categorical data were summarised using frequencies and percentages. Logistic regression found no significant socio-demographic and clinical predictors of patients having PI stages 2, 3, and 4 compared to patients with DTI and unstageable PI. Challenges to caring for PI at home included high financial burden, physical limitations, and personal challenges in CAPIs management.

CONCLUSION

CAPIs are prevalent among older patients admitted to the acute care setting. Understanding the influence of socio-economic factors is crucial for developing comprehensive strategies to mitigate the occurrence and impact of PIs. Ongoing support and education to the caregivers in the community is essential to address the reported challenges in PI care.

The Usefulness of Present-on-Admission Data as an Indicator of Healthcare Quality Evaluation Using the Korean National Hospital Discharge in-Depth Injury Survey Data from 2006 to 2019

Purpose

Comorbidities of a principal diagnosis have varying impacts on disease and require different management depending on the onset timing. This study investigated the usefulness of present-on-admission (POA), specifically focusing on decubitus ulcers, delirium, and hypokalemia, as an indicator of healthcare quality.

Patients and Methods

We analyzed patient discharge data for 14 years from 2006 to 2019 using Korean National Hospital Discharge In-Depth Injury Survey (KNHDIS).

Results

Out of 3,231,731 discharged patients, 19,871 had secondary diagnosis codes for decubitus ulcers (n=10,390, 52.3%), delirium (n=6103, 30.7%), or hypokalemia (n=3378, 17.0%). Analysis of patients with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia revealed notable differences in demographics, including gender distribution, mean age, admission route, insurance type, surgical intervention rates, mortality rates, and length of stay (LOS). Among patients with one of the top 20 principal diagnoses, those with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia exhibited higher odds of surgery, increased mortality risks, and longer LOS compared to those without these secondary diagnoses.

Conclusion

All three of these diseases commonly occur postoperatively or during treatment and thus should be designated as potentially preventable complications that require special attention, and should also be considered as quality-of-care indicators.

Effect of a Team Approach to Pressure Injury Management over 5 Years in a Tertiary Hospital

OBJECTIVE

The authors' facility established a novel integrated wound care team (IWCT), which included the implementation of a strict treatment algorithm by the patients' attending providers and a specialized wound care team led by a plastic surgeon. Investigators then retrospectively analyzed clinical outcomes of pressure injury (PI) management by the IWCT over 5 years.

METHODS

The authors performed a retrospective chart review and periodic statistical analysis of the data for all patients with PI referred to the IWCT in the authors' center from May 2015 to April 2019. Data including patients' demographic information, first and last consultation dates, referring department, PI stage, site of PI, and Braden Scale scores were collected and analyzed.

RESULTS

Patients (N = 15,556) did not differ significantly in age, sex, or Braden Scale score. A preimplementation/postimplementation analysis of PI data before and after establishing the IWCT showed that the incidence of stage 3 or 4 PIs had significantly decreased during the study period (19.1% vs 15.2%, P < .05). Conversely, the incidence of stage 1 PIs significantly increased in the same period (38.0% vs 57.4%, P < .05). The proportion of completely healed PIs also increased, and the median treatment period was significantly shortened (P < .05).

CONCLUSIONS

Implementation of the IWCT in a tertiary hospital setting led to a significant increase in early-stage PI detection and a decrease in severe PIs.

Nationwide time-series surveys of pressure ulcer prevalence in Japan

OBJECTIVE

The Japanese Society of Pressure Ulcers (JSPU) has two purposes: first, to improve knowledge and skills among health professionals related to preventing and managing pressure ulcers (PUs); and second, to represent those in the field managing PUs, including with government and health authorities. Since 2006, JSPU has conducted fact-finding surveys about every four years to identify PU prevalence in Japan (2006, 2010, 2013 and 2016). Based on the prevalence identified by these surveys, an attempt was made to validate the achievements of JSPU's activities.

METHOD

Information from one-day surveys of hospitals, long-term care health facilities, long-term care welfare facilities, and home visit nursing care stations was analysed. We used generalised estimating equations to estimate the proportions of PUs and their 95% confidence intervals (CIs) for each survey.

RESULTS

A total of 662,419 patients in 2631 facilities participated in the surveys. The estimated proportions for all facilities (95% CI) in chronological order, from the first to the fourth survey, were: 2.67% (2.52-2.83); 2.61% (2.43-2.80); 1.99% (1.83-2.17); and 1.79% (1.65-1.94), respectively. In all facility types, the proportion of PUs was lower in the fourth survey than the first survey.

CONCLUSION

The proportion of PUs showed a decreasing trend and was low according to global standards, demonstrating the efficacy of JSPU's activities.

A ten-year follow-up of the prevalence of pressure injuries in the Czech Republic: Analysis of the National Registry

The study aims to follow up on the analysis of Pressure injuries (PIs) prevalence conducted between 2007 and 2014 and after the new methodological requirements for PIs surveillance establishment at the national level. A retrospective, nationwide cross-sectional analysis of data regarding the STROBE checklist was collected by the National Health Information System (NHIS). The International Classification of Diseases (ICD-10) diagnoses L89.0-L89.9 for PIs were used in the period 2010-2019. A total of 264 442 records of patients with diagnoses of L89.0-L89.9 were identified from 2010 to 2019 (26 444 patients per year on average). The numbers are increasing every year, and there is a 40% increase between 2010 and 2019. When comparing recorded PIs, the percentage of PIs occurrence in category I decreased, and the number of PIs in category IV increased in the second analysed period. Still, in absolute numbers, there is an increase across all categories. The age of patients with recorded PIs also rose slightly in the second analysed period. We have proven the PIs prevalence increase in an ageing population.

Frequency of and risk factors for intensive care unit-acquired sacrum pressure injuries in critically ill patients: A multicenter cross-sectional study in China

RATIONALE AIMS AND OBJECTIVES

Hospital-acquired pressure injuries (HAPI) prolong hospital stays and are an important health problem worldwide. The aim of this study was to assess the frequency of and risk factors for intensive care unit (ICU)-acquired pressure injuries (IAPI) on the sacrum in critically ill patients in China.

METHODS

We performed a multicenter, cross-sectional survey of IAPI on the sacrum in 23 adult ICUs in 19 hospitals in China. Data for 421 critically ill patients were collected on December 13, 2019, and January 13, 2020, including patient characteristics, physiological, and clinical information. Logistic regression was used to analyze the risk factors for IAPI on the sacrum in the ICU.

RESULTS

Forty-one patients presented sacrum pressure injuries in the ICU, with a frequency of 9.74%. Risk factors that significantly increased the risk of IAPI on the sacrum were lower body mass index (BMI, odds ratio [OR] = 1.115, confidence interval [CI]: 1.011-1.229, P = .029), chronic obstructive pulmonary disease (COPD, OR = 3.183, CI: 1.261-8.037, P = .014), multiple organ dysfunction syndrome (MODS, OR = 2.670, CI: 1.031-6.903, P = .043), and a lower Braden risk score (OR = 1.409, CI: 1.197-1.659, P < .001).

CONCLUSION

Lower BMI, COPD, MODS, and lower Braden risk score are independent risk factors for sacrum IAPI in China.

Influencing factors of pressure injury healing in an acute care setting: A retrospective cohort study

AIM

This study aimed to investigate the factors that influence healing during acute care hospitalization by examining the differences in pressure injury (PI) status between admission and discharge.

MATERIAL AND METHODS

A total of 371 patients who met the study's inclusion criteria were divided into two groups (aggravated or improved) based on the PI status observed at admission and discharge. We used bivariate analyses to compare demographics and clinical factors associated with wound severity and aggravation/improvement of wound condition. Using multiple logistic regression, we identified and examined independent predictors for significant association with aggravation/improvement of the wound status.

RESULTS

The prevalence rate of PI at acute hospital admission was 12.5%. By the time of discharge, only 5.4% of PI patients had improved PI, whereas 12.6% had aggravated PI. The significant aggravating factors of PI during acute care hospitalization were the patient's consciousness level, use of foley catheter, creatinine level, and Braden Scale scores (p < .05). Residential place prior to admission were found to be associated with the healing.

CONCLUSIONS

Nurses providing prophylactic management require close attention to patients who are admitted from long-term facilities to prevent aggravation of PI during acute care hospitalization.

Comparing the Interface pressure distribution of the full body chest-lumbar cushion made of memory cotton with the traditional chest cushion

BACKGROUND

Pressure injuries are common complications occurred duration hospitalization, whether the interface pressure distribution in full body memory cotton chest-lumbar cushion was superior than traditional chest cushion remains unclear.

PURPOSE

This study aimed to compare the effects that the full body memory cotton chest-lumbar cushion versus traditional chest cushion on interface pressure.

METHODS

A total of 66 healthy individuals were recruited. The volunteers were placed in the left lateral position and left armpit and iliac spine pressure and level of comfort were measured. Group differences were assessed using the paired t-test or Wilcoxon test according to data distribution. Additionally, multivariate regression analysis was applied to determine the potential role of sex, age, and body mass index on left armpit and iliac spine pressure and overall comfort.

RESULTS

Compared with the traditional chest cushion, we noted that the full body chest-lumbar cushion made of memory cotton was associated with less pressure on the left armpit (38.17 ± 10.39 mmHg vs. 67.93 ± 14.67 mmHg, respectively; P < 0.0001) and iliac spine (43.32 ± 13.70 mmHg vs. 50.77 ± 20.94 mmHg, respectively; P = 0.0004). Moreover, we noted that the overall comfort with the memory cotton chest-lumbar cushion was higher than that with the traditional chest cushion (8.48 ± 1.08 vs. 6.36 ± 1.45, respectively; P < 0.0001). Finally, the multivariate regression analyses found iliac spine pressure could affect by sex (P = 0.0377) and body mass index (P = 0.0380).

CONCLUSIONS

The full body chest-lumbar cushion made of memory cotton had beneficial effects on left armpit and iliac spine pressure and on comfort. These findings should be applied to future clinical practice.

Association between socioeconomic position and diabetic foot ulcer outcomes: a population-based cohort study in South Korea

Background

Low socioeconomic position (SEP) is associated with a high incidence of diabetic foot ulcers (DFUs). However, reports on the association between SEP and DFU outcomes are limited. Therefore, in this study, we investigated this association and determined the prognostic factors of DFU outcomes.

Methods

The total cohort comprised 976,252 individuals. Using probability sampling, we randomly selected a sample of patients by reviewing the data from the Health Insurance Review and Assessment Service database of South Korea during 2011–2015. Residence, household income, and insurance type represented SEP. The primary outcome was amputation, and the secondary outcome was mortality. A multivariate model was applied to identify the predictive factors. Amputation-free survival and overall survival were calculated using the Kaplan-Meier method.

Results

Among 976,252 individuals in the cohort, 1362 had DFUs (mean age 62.9 ± 12.2 years; 42.9% were women). Overall amputation and mortality rates were 4.7 and 12.3%, respectively. Male sex (hazard ratio [HR], 2.41; p < 0.01), low SEP (HR 5.13, 5.13; p = 0.018), ophthalmopathy (HR, 1.89; p = 0.028), circulatory complications (HR, 2.14; p = 0.020), and institutional type (HR, 1.78; p = 0.044) were prognostic factors for amputation. Old age (HR, 1.06; p < 0.01), low SEP (HR, 2.65; p < 0.01), ophthalmopathy (HR, 1.74; p < 0.01), circulatory complications (HR, 1.71; p < 0.01), and institution type (HR 1.84; p < 0.01) were predictors of mortality.

Conclusions

DFU patients with a low SEP are strongly associated with increased amputation and mortality rates. Along with age and comorbidities, SEP could provide the basis for risk assessment of adverse outcomes in DFU. Providing targeted care for this population considering SEP may improve the prognosis.

Socioeconomic effects of pressure ulcer

A pressure ulcer is defined as localized ischemic skin or soft tissue damage resulting from disruption of the blood supply by pressure over the bony prominence. However, it is not just a wound that causes pain to individuals, but also a complex disease that causes socioeconomic losses. In 2019, total 30,983 patients with pressure ulcers were treated at medical institutions in Korea, and 76 billion Korean won (KRW) was spent on this treatment. Inpatient care cost amounted to 65.5 billion KRW, whereas outpatient care cost amounted to 9.8 billion KRW. The average hospitalization cost per patient was 6,696,605 KRW, and the average hospitalization period was 57.4 days, averaging 116,707 KRW per patient per day. The average outpatient care cost per patient was 421,134 KRW, and the average period in the clinic was 8.9 days, calculated at 47,428 KRW per day. The development of pressure ulcers inevitably causes socioeconomic losses and puts strain on limited medical resources; therefore, the best socioeconomic solution is prevention. Prevention has been shown to be much more efficient in cost-effective studies on treatment and prevention. Therefore, investment of more resources to prevent the development of pressure ulcers is the best solution to reduce the related socioeconomic burden.

Appraisal and recommendation synthesis of guidelines and consensuses for interventions of pressure ulcers: A protocol for systematic review

BACKGROUND

Pressure ulcers (PU) bring a considerable physical and mental burden on patients and their families, and have put families and government under tremendous pressure to cover the cost for treatment. Therefore, this protocol proposes to evaluate the quality of existing PU clinical practice guidelines (CPGs) and compare the similarities and differences between its recommendations in order to improve the treatment efficacy and reduce the PU treatment cost.

METHODS

Electronic databases and specific databases of CPGs will be searched. Study selection and data collection will be performed independently by two reviewers. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument and Reporting Items for Practice Guidelines in Healthcare (RIGHT) will be used to assess the methodological quality and reporting quality of included CPGs. Bubble plot will be used to describe the difference of the quality, and mind mapping will be plotted to illustrate the comparison of recommendations of a guideline when needed. R software, MindMaster and Excel will be used.

RESULTS

The results of this study will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This systematic review will provide comprehensive evidence of CPGs of PU.

PROSPERO REGISTRATION NUMBER

CRD42020149176.