Pressure injury severity and trajectory: A 5-year cohort study in an Australian health district

To investigate outcomes of severe hospital-acquired pressure injuries including Stage 3, Stage 4, Unstageable and Suspected Deep Tissue Injuries and examine wound trajectories, patient characteristics and patterns of wound progression over time.

We performed a retrospective analysis of prospectively collected data from a 5-year cohort of hospitalised patients with severe hospital-acquired pressure injuries reported across four Australian hospitals (December 2019-November 2024). Data from a purpose-built database were entered in by Skin Integrity Leads (senior wound nurses), with wounds assessed at initial reporting, specialist review, monitoring and discharge. Associations between clinical variables and injury severity were examined using chi-square tests.

Among 388 patients (mean age 72.2 years; 63.7% male), heels were the most common injury site (53.4%). The majority of wounds were confirmed as severe at initial review. Suspected Deep Tissue Injuries were more likely to receive timely review (83.5%). By discharge, a number of Suspected Deep Tissue Injuries had resolved or were reclassified as non-severe. Factors significantly associated with severe pressure injuries included orthopaedic fractures (p = 0.034), age-related factors (p = 0.019), musculoskeletal diagnoses (p = 0.010), renal/urological comorbidities (p = 0.006), and aged/complex care specialties (p = 0.004). Mean hospital stay was 55.9 days.

Older age, comorbidities, reduced mobility, and specialised care highlight high-risk groups for pressure injury risk. A number of Suspected Deep Tissue Injuries stabilised or resolved with timely assessment. These findings challenge assumptions that Suspected Deep Tissue Injury routinely indicate inevitable deep tissue damage, and reinforce that many severe pressure injuries are preventable. Early recognition can improve outcomes and inform prevention strategies, clinical practice, and resource allocation.