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Acute Skin Failure in the Critical Care Patient
Barbara Delmore1, Jill Cox, Daniel Smith
1Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC-NYU, is Senior Nurse Scientist, Center for Innovations in the Advancement of Care, and Clinical Assistant Professor, Hansjörg Wyss, Department of Plastic Surgery, NYU Langone Health; Jill Cox, PhD, RN, APN-C, CWOCN, is Clinical Associate Professor, Rutgers University; At NYU Langone Health in New York, New York, Daniel J. Smith, MA, is Data Analyst and Research Coordinator, Center for Innovations in the Advancement of Care; and Andy S. Chu, MS, RD, CDN, CNSC, FAND, is a registered dietitian, Food and Nutrition Services. Linda Rolnitzky, MS, is a biostatistician, New York, New York. Acknowledgments: This study was funded in whole by a grant from the American Nurses Credentialing Center Clinical Research Grants, American Nurses Foundation. The authors have disclosed no other financial relationships related to this article. Submitted April 11, 2019; accepted May 14, 2019; published ahead of print November 27, 2019.
Objective:
The purpose of this research was to build on previous work regarding predictive factors of acute skin failure (ASF) in the critically ill population.
Methods:
Researchers conducted a retrospective case-control study with a main and validation analysis. Data were extracted from the New York Statewide Planning and Research Cooperative System. For the main analysis, there were 415 cases with a hospital-acquired pressure injury (HAPI) and 194,872 controls without. Researchers then randomly selected 100 cases with a HAPIs and 300 controls without for the validation analysis. A step-up logistic regression model was used. Researchers generated receiver operating characteristic curves for both the main and validation analyses, assessing the overall utility of the regression model.
Results:
Eleven variables were significantly and independently related to ASF: renal failure (odds ratio [OR], 1.4, P = .003), respiratory failure (OR, 2.2; P = < .001), arterial disease (OR, 2.4; P = .001), impaired nutrition (OR, 2.3; P = < .001), sepsis (OR, 2.2; P = < .001), septic shock (OR, 2.3; P = < .001), mechanical ventilation (OR, 2.5; P = < .001), vascular surgery (OR, 2.2; P = .02), orthopedic surgery (OR, 3.4; P = < .001), peripheral necrosis (OR, 2.5; P = .003), and general surgery (OR, 3.8; P = < .001). The areas under the curve for the main and validation analyses were 0.864 and 0.861, respectively.
Conclusions:
The final model supports previous work and is consistent with the current definition of ASF in the setting of critical illness.
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