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Prevalence of pressure injuries and bruising in patients with acute ischemic stroke: A prospective observational
Yi-Sin Wong1, Sheng-Feng Sung2, Chi-Shun Wu2
1Department of Family Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia-Yi, Taiwan.
Background:
Skin lesions are associated with higher mortality rates, more extended hospital stays, and poor quality of life. Patients with stroke are at increased risk of developing skin lesions. While significant research exists on skin lesions in critically ill patients, nursing home populations, and the general population, limited studies focus on the prevalence of pressure injury and bruises in patients with stroke.
Aim:
To evaluate the prevalence and risk factors for pressure injuries, and bruises in ischemic stroke patients.
Patients And Methods:
This prospective study adopted a comprehensive approach. All patients with ischemic stroke admitted to a stroke unit were invited to participate. A nurse and study researcher assessed the dermatological conditions of 503 patients admitted between Jan 1, 2023, and Jun 30, 2024, from admission until discharge. We recorded the time of skin lesion onset pre- (community-acquired) and post-admission (hospital onset) and categorized bruises with unknown causes as unexplained bruises.
Results:
Skin lesions were identified in 56.7 % (285/503) of patients with ischemic stroke. Factors associated with an increased risk of skin lesions included older age [72.2 ± 10.9 vs. 67.0 ± 10.9 (p < 0.01)], hypertension [75.7 % vs. 61.9 % (p < 0.01)], cardiovascular disease [20 % vs. 12.8 % (p = 0.04)], atrial fibrillation [12.6 % vs. 6.4 % (p = 0.02)], and stroke severity (p < 0.01). Skin lesions were also linked to more extended hospital stays [12.9 ± 9.3 vs. 8.0 ± 7.1 (p < 0.01)] and poorer functional outcomes at discharge (p < 0.01). Pressure injuries (PIs) were found in 25 % (126/503) of patients. Bruises were present in 25.8 % (130/503), with 55.4 % (72/130) community-acquired and 44.6 % (58/130) hospital onset. In 17.7 % (23/130) of cases, the causes of bruises were unknown and defined as unexplained bruises. Binary logistic regression analysis indicated that stroke severity increases the risk of bruises.
Conclusion:
Pressure injuries and bruises are common in ischemic stroke patients. Preadmission PIs are common, and bruises may develop both before and during hospitalization. Pressure injuries can be prevented by implementing prevention strategies. Further research is urgently needed to develop strategies to prevent bruising in stroke patients.
