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Published on: March 25, 2020
COVID-19-Related Wounds in Acutely Ill Inpatients Over the First Two Years of the SARS-CoV-2 Pandemic (CRAFT Study)
Jennifer Bart1,2,3,4,5,6,7,8,9, Cristina Phillips1,2,3,4,5,6,7,8,9, Caitlin Tripp1,2,3,4,5,6,7,8,9
1Jennifer Bart, MSN, RN CWOCN , UF Health Shands, Gainesville, Florida.
Purpose:
The purpose of this study was to examine the factors associated with the development of wounds in the acutely ill patient population with COVID-19 and to classify the types of wounds seen in these patients.
Design:
Retrospective single-center descriptive study.
Subjects And Setting:
The target population was acutely ill patients diagnosed with COVID-19 infection who developed wounds during their hospital course. Data collection occurred between March 1, 2020, and March 1, 2022. The sample comprised data from 505 hospitalized patients; most were male (n = 292 patients, 58%) and White (n = 341, 67.5%). Their mean age was mean age was 59.1 years. Common comorbid conditions were renal failure (n = 251, 72.3%), sepsis (n = 245, 70.6%), and malnutrition (n = 116, 33.4%). The study setting was the Shands Teaching Hospital (Gainesville FL), which is located in the Southeastern United States.
Methods:
Researchers collaborated with the UF Health Integrated Data Repository (IDR) to identify eligible patients, develop a data abstraction manual, and standardize tools to ensure consistency and reliability in data collection. Approximately 4,000 COVID-19-positive patients were hospitalized during this period, and wound diagnoses were identified through cross-referencing the IDR COVID-19 limited data set, i2b2, and detailed chart reviews, including nursing flowsheets and wound consults. Independent team members performed annotation and quality assurance throughout the process.
Results:
The average oxygen saturation (SpO2) of the sample was 96.2%, with some patients reaching critically low levels of 77.9%, and a mean fibrinogen level of 452 mg/dl. Their average ICU stay was 22.3 days, and the mortality rate was 15.1%. A weak negative correlation was found between SPO2 and fibrinogen levels (Kendall τ = -0.13, P = .00), and between fibrinogen levels and vasopressor use (Kendall τ = -0.18, P = .01).
Conclusion:
Lower oxygen saturation, elevated fibrinogen levels, and increased vasopressor use may increase the risk of coagulopathy and wound development in patients with COVID-19, particularly in the presence of sepsis and renal failure, which increases the risk of acute skin failure (ASF). Many wounds may have been misdiagnosed as HAPI rather than ASF. Future research should focus on establishing standardized ASF diagnostic criteria to improve diagnosis and treatment.
