Pressure Injury in a Community Population: A Descriptive Study

The purpose of this study was to describe present-on-admission pressure injuries (POA-PIs) in community-dwelling adults admitted to acute care. The specific aims of the study were to (1) measure the prevalence of POA-PIs during a 1-year period; (2) determine prehospital location of patients with POA-PIs; and (3) describe demographics, pressure injury (PI) characteristics, risk factors, and posthospital outcome of community-dwelling adults with PIs admitted to hospital.

Retrospective descriptive study.

The study sample was identified from a PI registry, a database maintained for quality improvement, at an 860-bed urban academic medical center in New England. The majority (n = 1022, 76.1%) were admitted to hospital from the community; and the remaining (23.9%) were admitted from long-term care facilities.

All subjects were assessed by certified wound nurses. Data were extracted electronically from selected standardized electronic health record (EHR) fields, representing variables of interest. Descriptive statistics were analyzed using percentages, means, and medians.

The prevalence of patients admitted to acute care with a POA-PI was 7.4%. Community-dwelling subjects with POA-PIs had a mean age of 72.7 ± 15.4 years; 52.4% were male, 80.3% white, 30.9% lived alone, 99.2% were insured, and 30.6% were college educated. They presented with a mean of 1.46 PIs; 37.5% were full thickness. Admission Braden Scale for Pressure Sore Risk scores indicated that 77% were at risk for PI; subscores indicated mobility limitations in 90.8% and inadequate/poor nutrition in 41.3%. Subjects had multiple comorbid conditions (mean 18.4 ± 5.3 admission diagnoses). Only 21.4% were receiving home care services prior to admission. More than half (51.5%) were discharged to a healthcare facility, 33% to home, and 14% died or received hospice care. The 30-day readmission rate was 15.5%.

The overall prevalence of POA-PIs on hospital admission in this study was higher than previous published reports. The majority arrived from community-dwelling locations. The severity of community-dwelling POA-PIs was higher than known benchmarked hospital-acquired PI severity. This real-world profile of community-dwelling patients with PI suggests that these individuals are considerably vulnerable and underserved by home care services. Opportunities exist for community PI screening, prevention, and intervention.