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Pressure Injuries at Intensive Care Unit Admission as a Prognostic Indicator of Patient Outcomes

William T McGee1, Brian H Nathanson2, Elizabeth Lederman1

  • 1William T. McGee is an intensivist in the Division of Critical Care, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Brian H. Nathanson is Chief Executive Officer of OptiStatim, LLC, Longmeadow, Massachusetts; Elizabeth Lederman is APACHE data coordinator, Baystate Medical Center, Springfield, Massachusetts; Thomas L. Higgins is Chief Medical Officer at The Center for Case Management, Natick, Massachusetts, and Professor of Medicine at the University of Massachusetts School of Medicine-Baystate, Springfield, Massachusetts.

Critical Care Nurse
|June 3, 2019
PubMed

Insights

Patients admitted to the intensive care unit with pressure injuries experienced longer hospital stays. These injuries may indicate a higher risk of mortality, especially when other health scores are unavailable.

Area of Science:

  • Critical care medicine
  • Patient outcomes research
  • Wound care

Background:

  • Pressure injuries (pressure ulcers) are a significant complication for immobile patients.
  • Early identification of pressure injuries upon intensive care unit (ICU) admission is crucial for effective treatment.
  • The correlation between community-acquired pressure injuries and adverse outcomes in critically ill patients requires further investigation.

Purpose of the Study:

  • To investigate if pressure injuries present at ICU admission predict longer hospital stays and increased mortality.
  • To establish pressure injuries as a potential predictive marker for critical care outcomes.

Main Methods:

  • Retrospective analysis of adult ICU admissions from 2010-2012 at a level I trauma center.
  • Multivariable logistic regression and generalized linear models were used to assess the association between pressure injuries and outcomes.
  • Analyses were adjusted for patient characteristics including age, comorbidities, and the Acute Physiology and Chronic Health Evaluation III score.

Main Results:

  • Of 2723 patients, 180 (6.6%) had an admission pressure injury.
  • Patients with pressure injuries had significantly longer unadjusted hospital stays (15.6 vs 10.5 days) and higher mortality (32.2% vs 18.3%).
  • Multivariable analysis revealed pressure injuries were associated with a 3.1-day increase in length of stay; however, the association with mortality was not significant after adjusting for the APACHE III score.

Conclusions:

  • Admission pressure injuries are an objective, easily identifiable factor linked to extended ICU stays.
  • Pressure injuries may serve as a modest indicator of increased mortality risk, particularly when comprehensive scoring data is absent.
Abstract

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