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Hospital-Acquired Skin Injuries Associated With End-of-Life in Critically Ill Patients: A Retrospective Cohort Study
Patricia C Pawlow1,2,3,4,5, Lindsay McGrath1,2,3,4,5, Ellen Alvarez1,2,3,4,5
1Patricia C. Pawlow, PhD, ACNP-BC, ChristianaCare, Wilmington, Delaware.
Purpose:
The aim of this study was to describe patient and wound characteristics associated with 30-day mortality in acutely ill persons.
Design:
Retrospective cohort study.
Subjects And Setting:
The sample comprised 270 critically ill patients who developed pressure injuries during hospitalization at a large Delaware healthcare system. The majority were cared for in the Intensive Care Unit (75.1%, n = 203), managed via a ventilator (54.4%, n = 147), and had renal (62.6%, n = 169) or respiratory (63.3%, n = 171) failure.
Methods:
Medical records were collected from an internal database maintained by the Wound, Ostomy, and Continence (WOC) nurse, which was used to track hospital-acquired pressure injuries. Data extracted from the electronic medical record included demographic characteristics, pertinent medical history such as admission diagnoses, comorbidities, and the outcome variable of interest, 30-day mortality.
Results:
Ninety-eight (36.3%) patients experienced mortality within 30 days of the identification of their skin injury. Bivariate analysis revealed race, age, renal failure, sepsis, shock, vasopressor use, ICU stay, and stage of injury as significant risk factors associated with the 30-day mortality.
Conclusion:
This study underscores the clinical significance of skin injuries during acute hospitalization and the risks associated with 30-day mortality. The data support the need for recognition of skin injuries related to clinical deterioration, early goals of care conversations, and palliative care consults to best provide patient-centered care.
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